Reducing the Copy Fee for Electronic Records

In Illinois healthcare organizations and trial lawyers are disagreeing over how much facilities may charge when fulfilling requests for health records that are stored electronically. Also at issue is whether facilities must provide their digital records in a digital format.

A state law lowering the copy fees for electronic documents went into effect January 1, 2008. The law, the result of negotiations that tempered reductions in earlier proposed legislation, is already being countered with a bill to create a higher flat rate for all copying, regardless of record format.

In part, the tug-of-war highlights the gap between expectations over health IT’s potential and the current reality on the ground.

How Low Could It Go?

The flurry of bills begins in 2007, when the Illinois Trial Lawyers Association (ITLA) advocated for a bill that would change the Illinois Code of Civil Procedure and lower the copy fees for electronically available health records. Supporters argued that health information stored electronically is easier to access and can be produced by mouse clicks.

The bill would have lowered the rate that facilities can charge from 86 cents per page for printed-off electronic documents to a combined single charge of the facility’s normal processing fee plus 75 cents. The 75-cent charge was intended to cover the cost of the CD or DVD used to transfer the information to the requester.

That rate structure didn’t make sense to those close to records systems, who argued that producing electronic records is more labor-intensive than the legislation’s supporters portrayed. The Illinois Health Information Management Association (ILHIMA), the Association of Health Information Outsourcing Services (AHIOS), and Illinois Hospital Association all opposed the bill. Just because information is stored electronically, they argued, doesn’t mean it is easier or less expensive to produce in a request of records.

“Regardless if [a record] was one page or if it was 1,000 pages, [ITLA] thought that all you do is push a button and it downloads—this is all they want to pay,” says Colleen Goethals, MS, RHIA, an HIM consultant with Midwest Medical Records Associates and past-president of ILHIMA.

The bill also proposed that information stored electronically must be produced electronically—saved onto a CD, DVD, or other electronic storage device—for release of information requests. ILHIMA officials argued that the EHR systems in use in many hospitals today are not capable of copying records onto an electronic disc. Instead the facilities must print out those records to share them.

A New Law and an Alternate Bill

After negotiations, a new bill was drafted proposing that healthcare and release of information organizations could charge 50 percent of the paper copy rate for all documents stored electronically. If a facility could not produce their electronic documents in an electronic format as requested, a formal letter must be sent to the requestor explaining why the facility cannot fulfill the request.

The bill was passed into law and has been in effect since January 1, 2008. Still, HIM professionals have reacted negatively to the changes, Goethals says, which have created confusion and financial loss in some healthcare organizations.

ILHIMA and AHIOS immediately helped propose SB 2458, introduced in February 2008. The bill would set the standard copy rate for all documents at $1 per page regardless of the record’s medium. The new bill also proposes that it is the facilities discretion whether or not to release documents in an electronic format.

The bill has sat in the Senate Rules Committee since March as sponsors and opponents await the scheduling of a negotiation meeting to discuss it. Goethals said ILHIMA is still hopeful the meeting will take place this year, but SB2458 will likely not be voted on until the 2009 session.

The bill’s progress may be tracked at the Illinois General Assembly Web site.

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