Patient Advocate Services

Why is an Amazon delivery tracked better than a newly diagnosed cancer patient’s medical records request?

Current patient medical records requests workflows at health systems, hospitals, cancer centers, and physician practices pose significant barriers to patient continuity of care, patient safety, patient outcomes, and, most importantly, trust.

Our health care ecosystem loves to boast about “innovation”, “placing the patient at the center of their care”, “empowering patients”, and “enabling consumerism”. The problem is that many healthcare delivery organizations (HDOs) do a remarkably poor job with the most visible of patient services: initiating, tracking, and resolving medical records requests.

Today it’s easier to track the purchase of a $3 box of cereal in a complicated supply chain than it is for a cancer patient to figure out where a request of their own medical records is at a typical cancer institution. It’s easy for us to find out where we bought our cereal, which truck or plane it’s on, and when it will arrive on our doorsteps.

Every day, patients across the United States make a seemingly straightforward request of their care providers: “may I have my medical records so that I can get a second opinion for my terminal cancer diagnosis?” This deceptively simple patient request kicks off lots of behind the scenes activity at HDOs because it’s more complicated than it seems.

But before we talk about the necessary (or sometimes unnecessary) complications at HDOs, let’s look at another request we make regularly – of our financial institutions. Every day, patients across the country make a similar straightforward request of their banks: “may I have the money you’re holding for me so I can use it buy something another institution?” Think about these two requests – medical records might be a little more complicated, but the reason for the request and the outcomes should be the same, namely that each institution is holding something on behalf of a patient and the patient needs access to it. But, why is it easier to ask our banks for money they’re holding for us versus HDOs that are holding our medical records?

The answer is simple: processes, procedures, workflows, and staff training. The bank knows that they can use our money while they’re holding on to it (e.g. lending it to others) but also know that we can ask for it whenever we want so their entire business is built around that fact.

At many healthcare delivery organizations (HDOs), the medical records request process is stuck in the phone and fax age because HDOs frequently treat patient medical records as internal business documents and not assets they’re holding on behalf of patients. HDOs often believe they’re doing a patient a favor by handling their medical records requests – in reality, and with the newest patient data access regulations clearly stating it, HDOs are supposed to hold records for patients like banks hold money.

Because the requests for medical records is treated like a favor, after making a request, most patients never receive a single confirmation of receipt from their care provider or health system or hear a single update in the form of a call, email, or text. Patients often will fax requests multiple times out of concern that the request may have never been received causing duplicate requests to be potentially put into workflow queues. Patients may fax the same request to different departments and different fax numbers in hopes of expediting the request. Patients may repeatedly call and leave messages regarding their records requests as well as physically stop by the office for updates. This is a waste of everyone’s time and resources – but even more importantly impacts patient outcomes by delaying care or increasing the likelihood of medical errors.

Imagine having to fax a request to your bank to get access to your cash instead of just stopping by an ATM. Now imagine that you needed to pay for an emergency bill for your child and the bank not only doesn’t give you the money it is holding for you, but makes you send multiple faxes and make phone calls to ask why you cannot access your own money. Banks that treated their customers this way would close quickly but HDOs treat their patients this way regularly with no consequences.

Until now. Not having a streamlined process for patients to access their medical records may become a finable offense under the proposed information blocking rules.

Case in point: HHS recently charged Bayfront Health St. Petersburg hospital with information blocking, fining them $85,000 for failing to give a mother HIPAA compliant access to prenatal records about her child. When the proposed information blocking rules are finalized and implemented, entities that are charged with information blocking could face fines as high as $1 million per instance of information blocking.

A second case of information blocking was charged against Korunda Medical, a comprehensive primary care and interventional pain management company in Florida. The company was found to have failed to send a patient’s medical records in electronic format to a 3rd party in a timely manner as well as charging more than reasonably permitted under HIPAA.

Hospitals and care providers should respond as soon as possible to confirm receiving a medical records request. Here’s how:

  • Requests should be submitted through an online system – sort of like a “help desk” for medical records. There are many free, open source, and commercial customer support ticketing systems that can easily handle requests directly from patients – even through patient portals.
  • Requests should be triaged for urgency. All ticketing systems allow sorting and filtering and can highlight the most important cases.
  • Patient questions or concerns should be addresses digitally in the ticketing system. Care partners and patients should have their issues addressed immediately, ideally the same business day for urgent requests that could impact a patient’s health outcomes.
  • Notifications should go out when the state of a request changes. All modern ticketing systems can easily notify, by email or SMS, when information is lacking.

By having no lines of communication with patients or the care partners that may be helping with coordination of a patient’s care, hospitals and care providers risk being flooded with redundant faxed and mailed requests as well as endless phones call inquiries and messages regarding records requests. The redundancy and poor workflows unnecessarily tie up what may already be overextended or limited staff, further jeopardizing fulfilling records requests in a timely, HIPAA compliant manner.

What can you learn from the Bayfront Health St. Petersburg Hospital and Korunda Medical cases? That’s a digital request tracking is no longer a luxury, it’s a necessity.

While you can build your own, a turnkey solution to your patient requests tracking problems is now available. In less than an hour you can have a new system up and running within your institution.

Our company, Unblock Health, has studied common healthcare delivery organization patient request handling workflows and understands the difficulty that patients routinely encounter in attempting to gather their medical records. Unblock Health has designed a standardized, digitized workflow to seamlessly communicate with patients and their loved ones, providing a way to send confirmation of receipt of medical records requests, providing a tracked way of asking questions, status updates, or notifying patients of anticipate delays or request denials.

The turnkey platform strategically collects and composes all necessary information and details pertaining to a medical records request, including flagging for urgency of request. Unblock Health is designed to alert health systems and physicians of unfulfilled medical records requests, drawing attention to poor workflows and inefficiencies, to help prevent requests from falling between the cracks, leading to potential information blocking charges. Not only is Unblock Health meeting patients and carepartners where they are and truly fostering autonomy and empowerment, Unblock Health can strategically assist health systems and care providers in significantly stream-lining and improving their workflows so as to be HIPAA complaint and reduce or even eliminate the risk of being fined for information blocking.

Unblock Health is FHIR native, fully integratable, and ready to partner with hospitals, health systems, and care providers. While fines may be paid and corrective action plans may be put in place, having your reputation publicly marred as being an information blocker as well as endangering patient continuity of care are your most expensive and damaging losses. Reach out to Unblock Health today to discuss how to proactively best prepare yourself for the implementation of the proposed information blocking rules. We’ve solved the Rubik’s cube for you.

Yours in Unblocking Health,

Shahid Shah & Grace Cordovano

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