The Cost of Encouraging Patient Engagement

We all know that healthcare providers want to encourage patient engagement to ensure patients have the information they need to manage conditions and share information with other providers. There has been a longstanding push for the adoption and maintenance of personal health records for many years to give patients the power to share and disseminate information wherever it is needed. We have seen a remarkable new interest in this with Meaningful Use and population health initiatives. Since HIM professionals are charged with maintaining and producing legal copies of records, we are aware that the tasks surrounding these processes can be very expensive. This is especially true if any of the tasks are not handled properly and breaches of protected information occur.

My concern is that lately I have heard many discussions that are pushing for more access yet with fewer costs to patients to encourage patient engagement. Some are even pushing for patients to have “free” access to records- paper or electronic. Don’t get me wrong, I am a huge proponent for patients having copies of their records and I personally keep copies of my own records. The Office of Civil Rights (OCR) recently published further guidance on charging for records. In a nutshell, the OCR says: “copying fees should be reasonable. They may include the cost of labor for creating and delivering electronic or paper copies; the cost of supplies, including paper and portable media such as CDs or USB drives; and the cost of postage when copies of records are mailed to patients at their request.” The OCR actually has the authority to audit the costs of producing records if they feel your organization is violating this patient right and overcharging for release of information.

Living in a state such as Florida where the state law has allowed facilities to charge up to $1 per page means most facilities have charged $1 per page without blinking an eye. The latest OCR guidance has led to questioning if that amount is actually “reasonable” or true to cost. Afterall, HIM professionals must use expensive systems, supplies, and labor costs to produce these records. Many organizations have outsourced release of information functions (another cost) but it is still the responsibility of the custodian of records to oversee the processes for compliance.

That being said, it is beneficial for HIM departments to evaluate the expenses and methods used to produce records as technologies and laws change. Dr. Karen Desalvo of the Office of the National Coordinator (ONC) strives to lead the EMR interoperability movement. At the top of the ONC’s list of commitments is consumer access to records. HIM professionals should continue to assist in the quest for interoperability and electronic data sharing at the notion of patient engagement. We must lead patients to use EMR patient portals and facilitate the efficient electronic data sharing among healthcare providers. We must be creative in lowering overhead costs to produce and maintain the records in order to ensure costs are affordable for healthcare consumers. There will always be costs associated with this important task, whether on the provider’s end or the patient’s end, just as costs are incurred with most services or products in every industry.

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About the author

Erin Head

Erin Head

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.


  • Great article. I think most of us IT people look at this and wonder why it costs so much to release patient records. In our ideal world it should be one click on a piece of software and your entire record prints out or creates a PDF which is delivered to the patient. Might be interesting to see you outline the reality of doing a release of records.

    The other aspect you don’t mention is that a huge number of records requests don’t come from patients, but come from other third parties. That’s more work that should be compensated.

    Might be interesting for you to outline what really goes into a records request. What are some of the challenges today (ie. why isn’t it just a one click process) and what are the costs.

    I’d also ask you if you think that this will get better as more things become electronic and as interoperability becomes a reality (hopefully).

  • Excellent summary Erin. Any opportunity to increase transparency will help build trust between patients and providers, an important building block to ensure the efficiency of digitized healthcare in the future.

    One other point to mention, and something that you pointed out in your recent podcast with us ( is the critical importance of ensuring that these patients and third party entities are authorized to access medical records in the first place through strong identification technology. This helps reduce medical ID theft and fraud and protect patient privacy.

  • Charging seems a little ludicrous no matter how arduous you claim it is. Yes, you can say that it is not easy because the system is poorly architected. But as consumers we are used to logging into our credit card accounts and looking at detailed summaries of statements and do not expect to be charged for that. With such an expectation $1/page seems like some lawyers came up with that pricing strategy!

  • Ironically, lawyers are the some of the most common people that pay the $1/page to get access to the medical records for their cases.

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