Do you charge for medical records?

You probably do, and so do I, at times.

Generally, I’m willing to give a patient one copy of their records or transfer them to another doctor for continuation of care, at no charge. People move away. They change insurance or doctors. They have urgent hospital admissions. To me, charging to forward records in these cases is like withholding care.

That’s not to say I don’t lose money on them. It takes a few minutes (or more) of staff time to print them up and fax them. If they need to be mailed, postage costs money. And then there’s paper, printer ink, and so on. I’m sure it adds up to something over the course of the year, although I have no idea how much.

I charge for records that are requested for nonmedical reasons, such as an attorney requesting them for a legal case or a life insurance company wanting to decide if someone is worth covering. Those sorts of things I generally charge based on how big the chart is, if they insist on having it mailed (instead of faxed), and if they want me to take the time to get the copy notarized.

How much you can charge is a more complex issue, with each state setting its own rules. A recent article published in JAMA Internal Medicine noted that a patient in Georgia could pay up to $111.68 for a 100-page record. Hitting someone up for that amount, who’s already having health problems and may be relocating or trying to find a new doctor, seems like making an already difficult situation worse.

But we’re in the digital age now. So how much does it cost to send records? Most files (.doc, .pdf, .jpg, and so on) are interchangeable between Mac and Windows.

Things get iffy here. I mean, it’s easy to send a .pdf file by email, but that’s not particularly secure. And I hate having to sign up and create passwords for the many allegedly safer file-sharing services out there.

Burning records on a CD or DVD certainly saves postage, though takes about the same amount of computer time as printing them up. Not only that, but this seems to be a format that’s on its way out. The last three computers I’ve bought didn’t even have optical drives. CD/DVD’s are starting to resemble VHS tapes in the late 1990s.

Flash drives are the present and immediate future of transferred records. Small, lightweight, and capable of holding a lot. But they still need to be mailed, and are more expensive than paper. They also have security risks that concern me. When a patient hands me one and asks me to plug it in, I never do. There could be a virus or spyware that can compromise the security and privacy of my office, and cost a fortune to reverse the damage.

And so, at the end of that chain of thought, paper still appears to be king. It’s not going to carry ransomware into my office. It can be mailed or faxed, and is easily adaptable to any system (like mine) with a scanner. The paper world may hypothetically no longer exist, but for many things in medicine it still does, and is critical.

Some ultimate solutions, such as a universal database of health care data on all patients or a complete interchangeability between systems, sound great. No one would need to transfer records between doctors and all would have access to their own charts. But at this point in time, while technologically achievable, the privacy concerns and high-stakes security risks make such a thing impossible.

It’s easy to hope that the age of electronic medical records will lead to, as the article states, “easy, inexpensive” reproduction of medical records. But things never seem to be that simple, for some of the reasons I’ve mentioned above.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

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