Most hospitals have an electronic health records system and consumers have more access than before to their health information online.

But because most patient electronic health data is still heavily siloed and not able to be universally shared, many consumers still pay stiff fees to have a health system reproduce their paper medical records, says a new study published last week in the Journal of the American Medical Association.

In the study, researchers found that fees by hospitals to copy mostly paper records are expensive and can vary widely from state to state and from one government agency to another.

In Kentucky, for example, state law requires healthcare providers to give requesting patients the first copy of their medical record at no charge. And the Veterans Health Administration allows patients to “view, download, and transmit” their entire medical record with several mouse clicks and no fees, says Dr. Harlan Krumholz, a practicing cardiologist and director of the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital and author of the study.

In comparison the cost of having a hospital copy a person’s medical record can range from $53.60 in Texas for 15 pages to Minnesota where under state health law it can cost a consumer $218.70 for 150 pages and $687.70 for 500 pages. “The availability of electronic medical records should usher in a new age of easy, inexpensive reproduction of medical records for patients,” Krumholz writes.  “Per-page fee formulas are a poor proxy for the costs associated with providing electronic copies of records.” 

Today about 80% of all physician offices now have an electronic medical records system in place, as do four of five hospitals, says Patients can access some basic electronic information for free from a hospital, such as laboratory results and summaries of doctor visits. Many hospital portals also let patients share some medical information with other doctors and clinicians that are part of that hospital’s internal health information network.

But most hospitals still don’t share universal medical records online with the broader market of other healthcare organizations, Krumholz says. When a patient moves or sees a doctor in a new system many hospitals have to manually copy paper records or download disparate electronic records into a PDF. Not all records get transferred in many cases, he says. “Many healthcare providers have made steps forward with electronic health record systems that enable patients to view components of their healthcare history online,” Krumholz writes. “However, patient portals can render less information than a full medical record, often missing clinical notes and images among other aspects of the record.”

For the foreseeable future consumers will be subject to paying hefty fees for replicating their medical records, Krumholz writes. But eventually as the healthcare industry embraces more secure and universal data sharing, fees may come down to about $6.50 per copy of an electronic medical record as outlined in provisions of the Health Insurance Portability and Accountability Act of 1996, or HIPAA, which ensures patient confidentiality in medical records. “The guidance introduces an option of a flat fee not to exceed $6.50—inclusive of labor, supplies, and postage—for copies requested in digital form that are maintained electronically,” Krumholz writes.

To expedite more universal access to electronic patient records, Krumholz and Yale-New Haven Hospital have been developing Hugo, a web-based platform that enables patients to access electronic health records from multiple healthcare systems and synchronize them with a research database. Hugo incorporates application program interfaces, or APIs, that facilitate sharing data stored in disparate systems, along with universal electronic data formats to create an electronic health record portal that patients and doctors can access and update anywhere and at any time.