Are Health Record Guidelines the Same in Every State?

By Kayla Matthews, HealthIT writer and technology enthusiast, Tech Blog
Twitter: @ProductiBytes

Health professionals typically know many federal guidelines instruct how to handle patient health records. However, they may not understand whether such guidelines differ from state to state.

Getting clarification on that matter is essential, particularly when people move to other places after practicing in one for extended periods of time, or if they work as traveling providers on short-term assignments.

Medical Retention Time Frames Vary by Location
One of the specifics health providers must comply with during their patient care duties relates to the length of time they keep medical records. The details change based on the state.

Furthermore, there are differences in retention time for hospitals versus physicians. Some states don’t have guidelines for single-party providers but institute them for hospitals or vice versa, which makes things increasingly complex.

Differences also exist for adult patients versus minors. For example, in North Carolina, hospitals must retain the records of adult patients for 11 years after discharge. However, they keep the records of minor patients until their 30th birthdays, which could be significantly longer than 11 years.

Statewide Health Tracking Indicators May Use Federal Data Standards
More than half of U.S. states receive funding from the Centers for Disease Control and Prevention (CDC) to use for creating a state-based tracking of health characteristics of residents and how environmental factors affect them.

Vermont is one of the participating states, and it offers a privacy disclosure within the publicly accessible tool. The details state that personally identifying health information is not disclosed and that the people who engineered the tracker abided by Health Insurance Portability and Accountability Act (HIPAA) federal laws.

Regardless of the location, states using these tools should provide plain-language privacy statements to the public.

Specifics Related to Mentally Ill Patients and Substance Abusers
State laws about health records are not straightforward enough to apply to all people receiving medical treatment in a given place. Many states have stipulations for providing disclosures about mentally ill patients who may be a danger to themselves or others.

A 2013 change in New York made it so mental health practitioners had to let others know about potentially dangerous patients, thereby replacing legislation that merely permitted them to give such warnings.

Massachusetts and Missouri are two states that uphold the absolute confidentiality of mental health records and do not permit sharing under any circumstances. But, it’s important to point out that in Missouri, only people holding particular professions — social workers, psychologists and professional counselors — are bound by such confidentiality rules.

Moreover, 31 states let minors consent to receive specific mental health treatments. As previously discussed, though, the record retention requirements for minors are different from those related to adults in many states. That means health providers must take care to remain abreast of the record keeping details and the mental health consent differences in particular regions.

Specifics also exist for the records of people receiving treatment for substance abuse. In New Jersey, practitioners can only disclose information related to such individuals if required by a court order.

Looking back at Missouri for a moment, pregnant people in that state who are getting substance abuse treatment receive absolute confidentiality, barring sharing of records between providers at various organizations.

A law in New Hampshire affords patient confidentiality in substances abuse cases sometimes, but it does not require patient consent for information sharing in instances related to rehabilitation or medical purposes.

Guidelines for Medical Records Copying Costs
Federal guidelines mention that states can charge fees when people request copies of their medical records. The rates imposed cover the labor costs of making the copies, as well as the expenses of sending those documents through the mail if applicable.

The federal recommendations for the fees suggest a maximum price of $6.50 for electronic copies of the records, but some doctors say the costs amount to much more than that and pose financial barriers to people who want information.

That’s often because the search and retrieval process encompasses so many tasks that each has an associated fee. The substantial amount of variation can be confusing to everyone and especially limiting to those on tight budgets.

In places including Washington D.C., Hawaii and Iowa, records-copying specifics only discuss charging a “reasonable rate,” and say that such a fee may only be imposed, which is ambiguous and seems to give too much power to individual holders of health records.

Kentucky residents get their first copy of health records at no charge, then receive charges of a dollar per page for additional copies of the same content. Louisiana and Massachusetts both enforce search feels that are more than $20.

On a positive note, Maine has maximum per-request fees for paper-based and electronic medical records, which are $250 and $150 respectively. Such caps could aid people in planning their finances, especially when they require substantial amounts of documents.

Health Professionals Must Stay Informed
This brief overview illustrates the significant variation between states regarding the treatment of health records. With those examples in mind, health workers should prioritize getting the relevant information and checking back regularly to see if it changes.