AHIMA form aims to streamline, simplify patients’ requests for medical records

A new model patient request for health information form aims to simplify the medical record request process and reduce confusion and errors that lead to compliance problems. AHIMA’s model form is designed to help providers comply with HIPAA’s right to access requirements and the Office for Civil Rights’ (OCR) guidance, the association said in a July 20 statement.

Providing individuals with access to their medical records isn’t just a compliance requirement—patients who have access to their own data are more involved in their care and receive better, more coordinated care, the Office of the National Coordinator of Health IT (ONC) said in a June report, Improving the Health Records Request Process for Patients. However, OCR’s 2016 patient access fee schedule guidance threw a curveball at organizations, creating confusion and potentially opening up loopholes. Patient access requests, release of information (ROI), and OCR’s fee schedule guidance were hot topics at the 2016 AHIMA national convention.

OCR’s guidance may have inadvertently complicated the ROI process, according to HIM Briefings’ 2016 ROI benchmark survey. Some respondents experienced more difficultly handling record requests from attorneys that mistakenly believed they were covered under OCR’s guidance on patient access. In some cases, an attorney may legitimately be acting as a patient’s personal representative for healthcare purposes and such requests must be treated as if they come directly from the patient. However, that won’t always be the case; an attorney may be acting as a third party, and these requests may require the patient to sign an authorization to use or disclose his or her protected health information. Some of the confusion may have stemmed from the practice of using a single, multipurpose form to authorize use or disclosure of an individual’s PHI and for an individual to request access to his or her own medical records.

Additionally, patients are often confused by inconsistencies between patient access forms given to them by their providers, AHMA said in its statement. Patients might not understand that they have the right access their records at all or that they have the right to request access or copies in the format of their choosing such as via email. The ONC’s report recommended that providers adopt a more streamlined and transparent process to reduce the burden on patients. AHIMA also heard from members in need of additional guidance on patients’ right of access.

The model form is intended to be used as a template and modified with an organization’s specific contact information. The modified form can be given to patients or their personal representatives when they request access to their own health records.