In Days Of Data Galore, Patients Have Trouble Getting Own Medical Records

Federal law guarantees that people have a right to see and obtain a copy of their medical records, so why are they so hard for patients to access?

Judith Graham, Kaiser Health News

Medical records can be hard for patients to get, even in this digital information age. But they shouldn’t be: Federal law guarantees that people have a right to see and obtain a copy of their medical records.

New evidence of barriers to exercising this right comes from a study of 83 leading hospitals by researchers at Yale University. Late last year, researchers collected forms that patients use to request records from each hospital. Then, researchers called the hospitals and asked how to get records, the cost of doing so, how long it would take, the format in which information would be sent and whether the entire record would be available.

Researchers didn’t disclose they were conducting an academic study; instead, they posed as a relative asking questions on behalf of a grandmother who needed her records before seeking a second opinion. Family members make such requests on behalf of older relatives every day.

Hospitals’ answers were inconsistent: In many cases, the information on forms didn’t match what researchers were told on the phone. Sometimes their answers violated federal or state legal requirements.

Notably, only 53 percent of hospitals’ forms indicated patients could get their complete records. This right was acknowledged in all the phone calls. Forty-three percent of hospital forms didn’t disclose the estimated cost of obtaining records, as required. In phone calls, all but one hospital disclosed costs, but 59 percent cited a higher-than-government-recommended fee for electronic records.

“The unfortunate truth is that the system doesn’t give patients reliable or consistent responses. And some people who work in medical records departments appear to be ignorant of the law and the rights that patients have,” said Dr. Harlan Krumholz, co-author of the study and professor of medicine, epidemiology and public health at the Yale University School of Medicine.

Under a groundbreaking law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), patients have a right to get some or all of their medical records upon request. (Psychotherapy notes can be excluded.) Hospitals, medical clinics, physician practices, pharmacies and health insurers are required to make this information available within 30 days (sometimes a 30-day extension can be granted), at a reasonable cost and in the format that patients request (for instance, paper copy, fax, electronic copy or CD), if possible.

Research suggests that reviewing medical records can be beneficial. People are more likely to follow treatment recommendations, remember what happened at medical visits and feel engaged in their care when they have access to this information, studies indicate.
But HIPAA requirements are often misunderstood. Jacqueline O’Doherty, a geriatric care manager with Health Care Connect LLC of Califon, N.J., encountered this last month when she tried to see records for an 80-year-old client who was being transferred from a hospital to a nearby rehabilitation facility after suffering acute respiratory distress.

Although the older woman had signed a form appointing O’Doherty as a “designated representative” — a status that should have allowed O’Doherty access to her clients’ records — a hospital nurse refused to let O’Doherty check the client’s lab results, medication list and discharge summary. It was only when an infectious-disease doctor intervened, citing the need for continuity of care, that O’Doherty was able to review her client’s records.

“It really depends on the institution, what they will and won’t let you do,” O’Doherty said.

After receiving a large volume of complaints about records’ cost and accessibility, the Office for Civil Rights of the U.S. Department of Health and Human Services, issued new guidelines in January 2016. For electronic records, the guidelines prohibit per-page charges and recommend a maximum cost of $6.50 for consumers. They also clarify patients’ right to have records sent to third parties, including family members or professionals advocating on their behalf.

Despite these protections, the forms used to request records aren’t standardized and can be confusing. Often it’s not clear what is being offered. “As a person who works in the health care system, even I had trouble understanding the forms and what I could request based on the options listed,” said Carolyn Lye, a medical and law student at Yale who did much of the legwork for the new study.

Problems may be even more common at physician practices, which often don’t have medical records departments. When GetMyHealthData, a campaign to expand access to digital health information, asked consumers about their experience, people described poorly informed or unhelpful staff, high fees, long waits and frustrating bureaucratic processes, among other barriers.

“People are being told ‘No I can’t give this to you’” because office staff, nurses and doctors “don’t know what they can or cannot do,” said Pamela Lane, vice president of policy and government relations for the American Health Information Management Association.

Electronic patient portals don’t solve the problem yet: Most contain limited information and don’t currently include a way for patients to request records such as the notes physicians take during patient visits. “We’re slowly moving in that direction, but we’re not there yet,” said Catherine DesRoches, executive director of OpenNotes, an organization devoted to making doctors’ and nurses’ notes more readily available to patients.

The government is making improved electronic access to medical records a priority through its new MyHealthEData Initiative, announced earlier this year. Full details of the initiative are not yet available. But Seema Verma, administrator of the Centers for Medicare & Medicaid Services, has repeatedly called for people with Medicare coverage to have better access to their records. In an unusual move, she spoke out on Twitter about the Yale study, calling its findings “not acceptable.”

What can people do if they encounter problems like those documented by the Yale researchers?

If your hospital or doctor’s office declines to make your records available, print out materials about your rights and use them to advocate on your behalf. “Tell staff, ‘I’m entitled to a copy of my records: This is my legal right, as explained here,’” Lane said.

A good resource is a model medical records release form created by the American Health Information Management Association last year, which people can copy and bring with them to help make their case, Lane said. A summary of your right to share medical information with family, friends or other authorized third parties can be found here.

To familiarize yourself with your overall rights, see this “Guide to Getting & Using Your Health Records” published by the government’s Office of the National Coordinator for Health Information Technology. And take a look at the “Get Your Data” section of the GetMyHealthData website, which includes a clear summary of your rights, how to request your medical records, and troubleshooting suggestions if you encounter obstacles. A helpful two-page summary is available here.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Where Healthcare Costs the Most

In Anchorage, AK healthcare prices are nearly 2.5 times higher than in Baltimore, MD. How do other cities costs stack up?

Healthcare costs have rapidly increased across the nation, but focusing on an average amount for the country doesn’t necessarily capture just how high they’ve skyrocketed in some areas.

To give Americans a better picture of price levels and growth rates across the nation, the Health Care Cost Institute analyzed over 1.78 billion commercial healthcare claims and compared the average prices paid for the same services across 112 metro areas.

Here are the top ten cities with the highest healthcare costs and how they compare to the national average, according to HCCI’s Healthy Market Index:

  1. Anchorage, AK — 65% above the national average
  2. San Jose, CA — 65% above the national average
  3. San Francisco, CA — 49% above the national average
  4. Milwaukee, WI — 17% above the national average
  5. Green Bay, WI — 14% above the national average
  6. San Diego, CA — 12% above the national average
  7. Los Angeles, CA — 11% above the national average
  8. Trenton, NJ — 10% above the national average
  9. New York City, NY — 10% above the national average
  10. Portland, OR — 7% above the national average

The city with the lowest comparative cost in the country was Baltimore, MD, which is 33% below the national average.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

How Alternatives Such as CBD Oil Make an Impact on the Opioid Epidemic

As the opioid epidemic continues to wreak havoc on the United States, we take a look at the viability of cannabidiol as an alternative.

According to the Center for Disease Control and Prevention (CDC), 40 percent of the opioid-related deaths that occurred in the United States in 2016 involved a prescription opioid. Opioids are a form of medication prescribed by a healthcare professional that are used to treat unrelenting pain, typically caused by an underlying illness or as a result of surgery. With so many patients in the United States abusing their opioid prescriptions, it is hard to comprehend why many doctors nationwide continue to prescribe these highly-addictive pain medications. However, with the easily-accessible nature of these drugs and given the severity of a patient’s pain or suffering, opioids such as Oxycodone and Hydrocodone have become a popular choice for both medicinal and recreational use.

Fortunately, alternative, non-addictive forms of pain relief are becoming more frequently prescribed to patients. While Cannabis Sativa still has a negative stigma revolving around it and receives political backlash, the pain relief it provides for users may be enough to help patients shy away from opioid use.

What is Cannabidiol (CBD)?

Cannabidiol (CBD) is one of the many compounds created by the Cannabis plant, and it is often recognized alongside Tetrahydrocannabinol (THC). The difference between these two compounds is that CBD is non-psychoactive, providing the same benefits as THC without the euphoric feeling that THC produces. This has allowed for the legal sale of products such as CBD oil, as it does not contain THC and cannot be abused or cause a dependency.

CBD oil is still a fairly new product, which has limited the scope of existing research into the health benefits of this substance. However, scientists and doctors are starting to introduce this form of pain relief amongst select patients and new data is being continuously gathered as to exactly what benefits CBD oil can provide to patients.

How Does CBD Oil Relieve Pain?

CBD oil is believed to behave the same way that opioids work within a user’s body. By interacting with pain receptors in the brain and the immune system, CBD provides relief from the pain. However, it should be noted that the CBD is not directly causing a patient pain relief. The human body contains an endocannabinoid system, which allows it to regulate substances such as CBD. According to a study conducted by Neurotherapeutics, CBD actually promotes other compounds within the endocannabinoid system from being absorbed, such as anandamide, a compound known for reducing pain. This creates an abundance of anandamide in the body, which results in pain relief.

Evidence of CBD Success

While CBD is a potential alternative to opioid pain relievers, it is also showing success amongst patients who suffer from serious diseases. In a recent study published by the New England Journal of Medicine, 76 patients with Lennox-Gastaut Syndrome, a rare and severe form of epilepsy resulting in seizures, were given 20-mg of CBD twice a day for 14 weeks. As a result, this group of patients had a 41.9 percent decrease in the number of seizures they experienced.

Epilepsy has shown some of the greatest success for CBD usage out of all diseases that have utilized this treatment method. Many epilepsy patients have to take multiple pills a day to reduce the frequency of their seizures, and some patients even have an implant that sends electrical pulses throughout the body to regulate seizures. For patients with such severe epilepsy, CBD is a breath of fresh air.

While these trial results are very promising, some researchers are still skeptical about its success amongst cancer patients. CBD has not been scientifically proven to reduce the size of cancerous tumors in humans, but studies have shown that it may be effective in treating symptoms and side effects of chemotherapy. For cancers such as mesothelioma, whose treatment options are intensive, this may be a safe and effective way for patients to relieve pain without the health risks of opioids. Aggressively spreading cancers tend to cause a severe amount of pain for the patients, and patients’ overall quality of life will improve if they do not have to worry about becoming dependent on opioids while also receiving treatment for their diseases.

The Future Of CBD

As the stigma associated with Cannabis diminishes and more countries around the world begin to legalize it, more research will be conducted involving CBD as a form of pain relief. Too many people have fallen victim to opioid addiction, and with non-addictive pain management alternatives gaining in popularity, the number of yearly opioid-related deaths is predicted to decrease.


David Haas is a health advocate specializing in mesothelioma. He works to ensure everyone has access to information about the disease and advocates for a complete ban of asbestos in the United States.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Entry Level Positions with Surprisingly High Pay and Demand

Healthcare is a notoriously stable industry, making it a smart career choice. Here are some great positions to consider, if you want to get into healthcare.

Healthcare is known for being a stable and, beyond that, a constantly growing industry, even in times of economic uncertainty, making it a safe bet as a career choice. But which career should you choose? Here are five entry level healthcare jobs that are not only in demand, but also come with a solid annual salary, making them viable options to consider, if you are looking to get into the field.

Medical Secretary
Average Base Salary: $39,527
Education Required: High School Diploma or Certificate
Projected Job Growth from 2016 to 2026: 15%

Medical Billing Clerk
Average Base Salary: $37,529
Education Required: High School Diploma or Certificate
Projected Job Growth from 2016 to 2026: 13%

Medical Assistant
Average Base Salary: $34,594
Education Required: High School Diploma or Certificate
Projected Job Growth from 2016 to 2026: 29%

Pharmacy Technician
Average Base Salary: $33,841
Education Required: High School Diploma or Certificate
Projected Job Growth from 2016 to 2026: 12%

Certified Nursing Assistant
Average Base Salary: $32,048
Education Required: State-Approved Certificate
Projected Job Growth from 2016 to 2026: 11%

Ready to start your search? You can find these positions and thousands of others on HealthJobsNationwide.com.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

$16M: The Record Breaking Cost of a Data Breach

Anthem is being held accountable, to the tune of a record breaking $16,000,000, for cyber attacks that compromised protected health information.

Anthem is being held accountable, to the tune of a record breaking $16,000,000, for cyber attacks that compromised protected health information in the largest health data breach in U.S. history.

The staggering payment, which will be made to the Department of Health and Human Services, Office for Civil Rights, is to settle HIPAA violations that results after a series of cyberattacks led to close to 79 million people having their health data stolen. This is the largest settlement related to a data breach, towering over the previous high of $5.5M.

Indianapolis-based Anthem, an independent licensee of the Blue Cross and Blue Shield Association, is one of the largest healthcare entities and the nation’s second-largest health insurer, providing coverage to one in eight Americans through its health plans, making it a desirable target for hackers the world over.

“Anthem takes the security of its data and the personal information of consumers very seriously,” Anthem said in a statement released on Monday. “We have cooperated with [the government] throughout their review and have now reached a mutually acceptable resolution.”

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Two Healthcare Majors Ranked “Most Valuable”

Two medical and health sciences and services fields of study were ranked in the top 10 most valuable college majors according to a new survey.

Two medical and health sciences and services fields of study were ranked in the top 10 most valuable college majors by Bankrate.com, a personal finance website. Health and Medical Preparatory Programs ranked fourth on the list, while Pharmacy, Pharmaceutical Sciences, and Administration was ranked sixth.

To determine the rankings, Bankrate.com examined the most recent data from the U.S. Census Bureau American Community Survey. The data was used to rank 162 majors based on a variety of factors, including the degree holder’s average annual income, the unemployment rate for college graduates with that degree, and whether a degree holder’s career path required a higher degree, such as a master’s degree or doctoral degree.

According to Bankrate.com, Health and Medical Preparatory Programs degree holders earn an average annual salary of $130,308, and their unemployment rate is only 2.3%, while Pharmacy, Pharmaceutical Sciences, and Administration graduates earn $103,350 on average annually, and have an unemployment rate of 1.8%.

Comparatively, the least valuable major is Miscellaneous Fine Arts, ranking at #162 on the list, with an average annual salary of $40,855 and an unemployment rate of 9.1%.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Congress Bans Pharmacist ‘Gag Orders’ On Drug Prices

Pharmacists will no longer have to keep it a secret when the cash price for a prescription is less than what someone would pay using their insurance plan.

By Susan Jaffe

For years, most pharmacists couldn’t give customers even a clue about an easy way to save money on prescription drugs. But the restraints are coming off.

When the cash price for a prescription is less than what you would pay using your insurance plan, pharmacists will no longer have to keep that a secret.

President Donald Trump was expected to sign two bills Wednesday that ban “gag order” clauses in contracts between pharmacies and insurance companies or pharmacy benefit managers — those firms that negotiate prices for employers and insurers with drugstores and drugmakers. Such provisions prohibit pharmacists from telling customers when they can save money by paying the pharmacy’s lower cash price instead of the price negotiated by their insurance plan.

The bills — one for Medicare and Medicare Advantage beneficiaries and another for commercial employer-based and individual policies— were passed by Congress in nearly unanimous votes last month. A spokesman for Sen. Susan Collins (R-Maine) said her office had been told the president would sign the bills Wednesday. The White House declined to comment.

“Americans deserve to know the lowest drug price at their pharmacy, but ‘gag clauses’ prevent your pharmacist from telling you!” Trump wrote on Twitter three weeks ago, shortly before the Senate voted on the bills. “I support legislation that will remove gag clauses.” The change was one of the proposals included in Trump’s blueprint to cut prescription drug prices issued in May.

Ronna Hauser, vice president of payment policy and regulatory affairs at the National Community Pharmacists Association, said many members of her group “say a pharmacy benefit manager will call them with a warning if they are telling patients it’s less expensive” without insurance. She said pharmacists could be fined for violating their contracts and even dropped from insurance networks.

According to research published in JAMA in March, people with Medicare Part D drug insurance overpaid for prescriptions by $135 million in 2013. Copayments in those plans were higher than the cash price for nearly 1 in 4 drugs purchased in 2013. For 12 of the 20 most commonly prescribed drugs, patients overpaid by more than 33 percent.

Yet some critics say eliminating gag orders doesn’t address the causes of high drug prices. “As a country, we’re spending about $450 billion on prescription drugs annually,” said Steven Knievel, who works on drug price issues for Public Citizen, a consumer advocacy group. The modest savings gained by paying the cash price “is far short of what needs to happen to actually deliver the relief people need.”

After the president signs the legislation affecting commercial insurance contracts, gag order provisions will immediately be prohibited, said a spokesman for Collins, who co-authored the bill. The bill affecting Medicare beneficiaries wouldn’t take effect until Jan. 1, 2020.

But there’s a catch: Under the new legislation, pharmacists will not be required to tell patients about the lower cost option. If they don’t, it’s up to the customer to ask.

The Pharmaceutical Care Management Association, a trade group representing pharmacy benefit managers, said gag orders are increasingly rare. The association supported the legislation. Some insurers have also said their contracts don’t include these provisions. Yet two members of Congress have encountered them at the pharmacy counter.

At a hearing on the gag order ban, Collins said she watched a couple leave a Bangor, Maine, pharmacy without their prescription because they couldn’t afford the $111 copayment and the pharmacist did not advise them about saving money by paying directly for the medicine. When she asked him how often that happens, he said every day.

“Banning gag clauses will make it easier for more Americans to afford their prescription drugs because pharmacists will be able to proactively notify consumers if a less expensive option may be available,” she said last week.

When Rep. Debbie Dingell (D-Mich.) went to a Michigan pharmacy to pick up a prescription recently, she was told it would cost $1,300. “After you peeled me off the ceiling, I called the doctor and screamed and talked to the pharmacist,” she recalled during a hearing last month. “I’m much more aggressive than many in asking questions,” she admitted, and ended up saving $1,260 after she learned she could get an equivalent drug for $40.

While the legislation removes gag orders, it doesn’t address how patients who pay the cash price outside their insurance plan can apply that expense toward meeting their policy’s deductible.

But for Medicare beneficiaries there is a little-known rule — not found in the “Medicare & You” handbook or on its website —that helps people with Medicare Part D or Medicare Advantage coverage. If they pay the lower cash price for a covered drug at a pharmacy that participates in their insurance plan and then submit the proper documentation to their plan, insurers must count it toward patients’ out-of-pocket expenses.

The total of those expenses are important because that amount affects the drug coverage gap commonly called the “doughnut hole.” (This year, the gap begins after the plan and beneficiary spend $3,750 and ends once the beneficiary has spent a total of $5,000.)

And beneficiaries don’t have to wait until the gag order ban takes effect in two years.

The Medicare rule also says that if a senior asks about a lower price for a prescription, the pharmacist can answer.

Rep. Buddy Carter (R-Ga.), a pharmacist who sponsored the Medicare gag order bill, said he wasn’t surprised by the bipartisan support for the legislation. “High prescription drug costs affect everyone,” he said.

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.


Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Healthcare Continues Adding Jobs; Unemployment Hits 49 Year Low

The unemployment rate is at a 49 year low, and healthcare’s steady and consistent job growth is one factor as to why.

Healthcare added 26,000 jobs in September, including 12,000 in hospitals, 10,300 in ambulatory care, and 3,400 in nursing care facilities, according to numbers released by the U.S. Bureau of Labor Statistics on Friday.

The constant and steady growth of jobs in the healthcare sector has contributed to what is now the lowest unemployment rate (3.7%) in 49 years.

Over the year, healthcare has added 302,000 jobs.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

80,000 Flu Deaths Reported in the U.S. in 2017

900,000 Americans were hospitalized and 80,000 Americans, including a record-breaking 180 children, died from the flu during the 2017-2018 season.

900,000 Americans were hospitalized and 80,000 Americans died from the flu during the 2017-2018 season, according to figures released during a news briefing held last week by the Centers for Disease Control and Prevention (CDC) and National Foundation for Infectious Diseases (NFID). This is the highest flu-related death toll in over a decade, according to federal health officials.

Among the 80,000 dead were 180 children under 18, the highest reported death toll of any non-pandemic year since the CDC began tracking pediatric deaths. 90% of the flu-related deaths from last flu season were reported in people over age 65.

The high mortality rate is unusual and alarming, as it was not caused by a new pandemic influenza strain, but by a “normal”, albeit severe, flu season.

As we head into the 2018-2019 U.S. flu season, Americans are urged to prepare by getting vaccinated by the end of October.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Health Data Breaches Are on the Rise

Healthcare data breaches are trending upward, rising from 199 reported incidents in 2010 to 344 reported incidents in 2017.

A research letter, penned by Thomas H. McCoy Jr, MD and Roy H. Perlis, MD, MSc and published this month by the American Medical Association, took an in-depth look at reported healthcare data breaches from 2010 through 2017 and found breaches are on the rise, while postulating that the ongoing transition to EHRs may increase such breaches.

The authors of the letter analyzed all data breaches occurring between January 1, 2010 through December 31, 2017 that were reported to the Office of Civil Rights at the US Department of Health and Human Services, as is mandatory under the 1999 Health Insurance Portability and Accountability Act (HIPAA) and 2009 Health Information Technology for Economic and Clinical Health Act. Trends and types of breaches were observed across three types of reported categories, including those taking place at healthcare providers, at health plans, and at businesses associated with healthcare.

The analysis revealed that 2,149 breaches took place during the seven-year period, involving a total of 176.4 million patient records. From 2010 through 2017, it was found that the total number of breaches increased every year except for 2015, starting at 199 reported breaches in 2010 and ending with 344 reported breaches in 2017.

It was found that the most common type of breach was paper or film, accounting for 24% of total reported breaches, comprising a total of 3.4 million breached health records. However, tech-related breaches are on the rise, with the most popular form of breach shifting from laptop or paper or film to network server and email by 2017.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.