Just as the COVID-19 pandemic has accelerated patients’ options to access medical care, it has also accelerated the need for more flexibility in how patients can access their medical records.
Health information management (HIM) departments mobilized rapidly early in the pandemic to institute changes that would allow continuous medical records access. As we become accustomed to the “new normal,” and as patients experience the benefits of increased medical record access options, HIM departments will need to decide what changes to retain and perhaps which to further develop. HIM leaders have an exciting opportunity to shape patient experience and embrace digital transformation.
What are we learning about patient preferences?
Ciox has been partnering with our clients to continuously enhance the process of releasing medical records to patients and other requestors. Recently, we launched an online, self-service patient request that provides patients with a contactless way to request their medical records anytime, from anywhere. Analyzing user data has yielded some interesting insights:
- One sizeable academic health system saw an increase in digital patient requests — from 1% to over 75% of total patient requests received by the HIM department — in just three months
- Digital adoption is spread evenly across age groups from 20- to 50-year-olds, with the largest user group being 51- to 60-year-old, and ~20% of users are age 61 and over
- ~ 20% of requests occur outside of hours that the HIM team would normally operate
- ~ 40% of requests are completed exclusively on mobile devices, with an additional 12% of requests being started on a computer but finished on a mobile device
While the percentage of total patients requesting medical records digitally is still lower than traditional request methods, it is clear that patients are using the digital option and the greater flexibility digital provides. A survey recently commissioned by the Pew Charitable Trusts (Pew) documents this shift in usage. “Patient Priorities on Health Data Access, Sharing, and Patient Matching” surveyed over 1,000 adults in June and July this year.
The Pew study found that almost 80% of survey respondents said they would personally want to access and view their electronic health records through a website, an online portal, an app on their phone, or electronically in some other way. This desire was only lessened when it came to behavioral or mental health history, substance use history and data related to social determinants of health.
Another interesting finding is that patients don’t seem to tie their desire for electronic access to the COVID-19 pandemic. This disconnect suggests that while the pandemic is accelerating provider changes in behavior, patients’ desire for more options is independent of the pandemic.
While the examples we’ve shared have focused on digital options for access to medical records, it’s important to remember patients are asking for more flexibility in general. That may mean having options for dropping off requests or picking up medical records curbside, instead of the need to park and traverse expansive and confusing hospital campuses. Maybe it’s a combination of digital and on-site solutions, such as request kiosks in various locations throughout a facility. It’s important to consider ways that medical records access can enhance the overall patient experience.
What themes can forward-thinking HIM departments keep in mind?
HIM leaders who embrace the opportunity to innovate the release of information (ROI) experience can consider a few themes.
It’s not just about virtual
Many of the rapid changes HIM has implemented in response to COVID-19 have focused on virtual solutions. While digital is a critical option to access medical records, there are other ways to offer patients the flexibility they seek.
Looking at patient interaction with physicians may provide a useful analogy. Data shows that patients are returning to in-person doctor visits. Commonwealth Fund has been tracking the COVID-19 pandemic impact on outpatient visits over the last few months. The most recent analysis in October shows that the use of telemedicine is dropping and many patients are returning for in-person visits.
Patients will similarly desire multi-faceted support when they need to access their medical records. While digital options will work in many situations, HIM departments and ROI vendors must make innovations in both services and technology a priority to better address patient needs. These needs include making their health data rights understandable and apparent and ensuring they can simply and securely access their medical records.
Requestor authentication may need to be more flexible
Providers have been implementing easier ways for patients to complete their necessary documentation to accommodate safety measures and social distancing. This means that HIM departments have made many changes during this pandemic to accommodate requests, including acceptance of verbal and electronic signatures.
Verbal Requests: Per OCR’s February 2016 FAQs, HIM departments may take verbal requests over the phone that are authorized by health information staff who witness and document the request in the patient’s record. Providers should ensure a clear policy and procedure, including defining the appropriate identification method.
Electronic Signatures: The pandemic expanded the validity of electronic signatures for a variety of legal reasons and many providers have updated their policies to define a valid electronic signature. Providers may consider allowing electronic signatures as part of standard policy going forward and the policy should clearly indicate what type of electronic signature is permitted, e.g., DocuSign with the authenticator code present.
To adopt what was initially intended to be temporary, permanent policies will provide more flexibility in the ROI process. However, it will require careful consideration — including consideration of state regulations — and staff training to ensure policies are appropriately developed, implemented, and applied.
Patient engagement is crucial
As ROI evolves, one critical need is for patients to be better informed of their health data privacy rights and the limitations of HIPAA. The Pew survey results indicated most individuals are concerned about privacy when it comes to making health data more digitally accessible. In addition, many of the respondents were unaware that HIPAA protections do not apply to most health apps.
- About 80% of respondents were somewhat, very or extremely concerned about the privacy of their health data when downloaded to health apps.
- That percentage increased to 90% once patients were informed that medical information downloaded to some health apps may not be protected by federal laws relating to privacy such as HIPAA and may instead be subject to the health app’s privacy policy or terms of service.
Healthcare leaders will need to walk hand-in-hand with patients as ROI evolves. Consider convening patient advisory groups to gather feedback. Develop marketing campaigns to highlight the expanded options for accessing medical records. And offer educational resources to help patients understand health data privacy.
ROI is ready for evolution. By taking a patient-focused approach, we can make medical records more accessible and usable and improve the delivery of healthcare.
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