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Health Information Technology and Quality
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How can I provide patients with electronic access to and copies of their health information?

When patients and families are well informed of their medical condition and recommended care plans, they are more likely to comply with their provider’s recommended regimens and are less likely to experience negative health effects due to non-compliance.  Unfortunately, many patients do not remember or understand the instructions of their health care provider.  This lack of understanding may be due to instructions that are not clearly written or language that that is too difficult for those with limited health literacy.  Additionally, more basic communication problems may contribute to non-compliance, such as a patient’s difficulty reading or speaking English, or because the medical instructions are not culturally relevant.  Thus, it is important that patients have access to their health information and that this information is up to date.  

Three objectives address the topic of providing patients with electronic access to and copies of their health information:

  • Provide patients with an electronic copy of their health information (core objective)
  • Provide patients with an electronic copy of their discharge instructions (core objective)
  • Provide timely electronic access to health information (menu set objective)

You may provide this health information to patients using various electronic means such as a patient portal, Personal Health Records (PHR), or electronic media such as CDs or USB.  Providers are expected to make reasonable accommodations for patient preference.  Some patients (possibly those without Internet access) may prefer their information on CD or USB.  The disadvantages of the CD and USB are that they cannot be readily updated and they are relatively expensive to provide.  Thus, patient portals and PHRs appear to be more up-to-date and efficient for both providers and patients.   

Patient portals and PHRs are a repository of the information that can be viewed and controlled by patients.  They enable patients to collect, view, manage, or share copies of their health information or transactions electronically.  Such systems may include a wide variety of applications and may use personal health information to target specific patients, educate them, and help them with specific tasks.  For example, they can help sedentary adults to become more physically active.  Through a patient portal or PHR, patients can input personalized information on their activity level and lifestyle and then receive a customized plan of activities (e.g., taking stairs rather than the elevator).  There are two related but distinct types of PHRs currently available: a stand-alone PHR, such as the Internet-based tools for patients developed by Google, Microsoft, health insurance plans, and others; and an “integrated PHR” that is an extension of physicians’ EHRs.  

For all three of these objectives, you must comply with the applicable requirements under Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule, access of individuals to protected health information.  HIPAA, however, allows that certain information may be withheld from the electronic copy of patient’s health information if the access to the information is deemed to cause substantial harm to patient or individual.  Thus, it will be up to you to decide whether to let a patient access a test result or to withhold the result until meeting with the patient.

Note that while this health policy priority promotes providing patients with their medical information, access to this information may not be sufficient for them to take charge of their heath.  Thus, how this medical information is interpreted and then used by the patient is important.  Patients will need tools (such as the tools for sedentary adults above) that interpret their data and patient-specific educational resources that guide their heath actions and health decisions.  

Below are explanations of the EHR Incentive Program’s three related objectives and the requirements for meeting and reporting on these objectives:  

1. Health information

Core Objective for Eligible Professionals and Hospitals:  

  • Provide patients with an electronic copy of their health Information, upon request.

Measure:

  • More than 50 percent of all patients of the eligible professional or the inpatient or emergency departments of the eligible hospital who request an electronic copy of their health information are provided it within three business days.

Exclusion:

  • Any eligible professional or hospital that has no requests from patient or their agents during the EHR reporting period.

If you are an eligible professional, upon a patient’s request, you must provide the patient with all of the health information you have available electronically in or accessible from the certified EHR technology.  At minimum this would include diagnostic test results, problem list, medication lists, and medication allergies.  Eligible hospitals are required to provide this same information (diagnostic test results, problem list, medication lists, and medication allergies), along with discharge summary and procedures (see the next objective).  You must achieve this objective using certified EHR technology.  

Providers must give patients this copy of their information electronically within 3 business days, which are defined as Monday through Friday excluding federal or state holidays on which you are unavailable.  Health information can be provided to patients using various electronic means such as Personal Health Records (PHR), patient portal, or electronic media such as CDs or USB.  You are expected to make reasonable accommodations for patient preference.  The health information must be must be in easily readable format and efforts should be made to make it easily understandable to the patient.

Assuming that patients’ requests for their health information are recorded, the EHR technology will have the ability to calculate both the numerator and denominator.  Requests from a family member or patient’s authorized representative consistent with federal and state law may substitute for the patient and count in the numerator and denominator. All patient requests for information should be recorded in the EHR, and if the requests are recorded by means of other than the EHR, the provider would be responsible for determining the denominator.  Only those patients whose records are maintained using certified EHR technology are included in this calculation.  The denominator is the number of patients who request an electronic copy of their electronic health information four business days prior to the end of the EHR reporting period.  The numerator is the number of patients in the denominator who receive an electronic copy of their electronic health information within three business days.  If you have no requests for patients or family members for an electronic copy of the patient’s health information during the EHR reporting period, you are excluded from this requirement.  To claim this exclusion, you must attest that you have a zero denominator (no requests by patients or family members for an electronic copy of the patient’s health information).  

2. Discharge instructions

Core Objective for Eligible Hospitals:

  • Provide patients with an electronic copy of their discharge instructions at time of discharge, upon request

Measure:

  • More than 50 percent of all patients who are discharged from the inpatient department or emergency department of an eligible hospital and who request an electronic copy of their discharge instructions are provided it.  

Exclusion:

  • Any eligible hospital that has no requests from the patient or their agents during the EHR reporting period.

“Discharge instructions” are defined as any directions that the patient must follow after discharge to attend to any remaining conditions that need to be addressed personally by the patient, home care attendants, and other clinicians on an outpatient basis.

Examples of how you can give these instructions to the patient include providing the patient with access to an Internet website with the discharge instructions, sending the instructions to their email, or handing them an electronic media (e.g., CD, USB).  These electronic means should be used instead of or in addition to a paper copy.

Note that you are not required to give every patient an electronic copy of their health information or discharge instructions—this is stipulated only for those who request it.  It is anticipated that many patients will prefer a paper copy during the first years of Stage 1, so the measurement threshold is set at 50 percent.

The ability to calculate this measure is included in certified EHR technology.  The denominator is the number of patients discharged from an eligible hospital who requested an electronic copy of their discharge instructions during the EHR reporting period.  The numerator is the number of patients in the denominator who are provided an electronic copy of discharge instructions.  If you have no requests from patients for an electronic copy during the EHR reporting period, you are excluded from this requirement.  

3. Timely electronic access to health information

Menu Set Objective for Eligible Professionals:  

  • Provide patients with timely electronic access to their health information (including diagnostic test results, problem list, medication lists, and medication allergies) within four business days of being updated in the EHR.   

Measure:

  • More than 10 percent of all unique patients seen by the eligible professional are provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to their health information subject to the eligible professional’s discretion to withhold certain information.    

Exclusion:

  • Any eligible professional that neither orders nor creates this information.

Note that this menu set objective does not apply to eligible hospitals.  

The intent of this objective is that a patient can access the heath information on demand, such as through a patient portal or PHR (but not from a CD or USB).  If you have many patients who do not have Internet access or who are not able or interested in using a patient portal, it may be difficult for you to attain the 10 percent threshold.  Note that you are not responsible for ensuring that 10 percent request access or have the means to access.  You are encouraged though to make the availability of electronic access known to your patients.  

Your certified EHR technology has the ability to calculate this measure.  The denominator is the number of unique patients seen by the eligible professional during the EHR reporting period.  The numerator is the number of patients in the denominator who have timely access to their heath information online.  

Related Resources:

Electronic Medical Instruments For Patient-Centered Care go to exit disclaimer– Medical Informatics Review article that defines the effectiveness of interactive health communications in achieving patient-centered care outcomes.  
Connecting for Health: Connecting Americans to their Healthcare go to exit disclaimer– Report on the public perception, benefits and barriers of adopting EHRs, and guidelines for information sharing between patients and providers.
Personal Health Records – HRSA Health IT Adoption Toolkit module on Personal Health Records.  Module provides an introduction to PHRs and addresses questions related to PHR standards, PHRs and EHRs, current industry initiatives, health center use of PHRs, and PHR evaluation and sustenance.

Developed by the Health Resources and Services Administration as a resource for health centers and other safety net and ambulatory care providers who are seeking to implement health IT.
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