Medical Record Accessibility
Reasons to Advocate It
Taiwan Healthcare Reform Foundation (THRF) has considered medical records accessibility the key reform for the improvement of patient's rights in Taiwan. The issue has been a controversial subject in Taiwan's healthcare culture. By 2004, many healthcare institutions still refuse to provide full medical records to patients, and the authenticity of the record is often doubted.
In 2004 we conducted our first medical records accessibility survey (by phone and field survey) but the results were discouraging. According to the field survey on the 15 major medical centers and hospitals, one third (1/3) of them failed to provide the medical records upon the patient's request, whereas two of them turned down the request directly. The phone survey showed similar result. All 103 healthcare facilities surveyed required patient's to bring doctors' approval during the request, and patients would usually have to go through cumbersome registration procedures and long waiting hours.
Both the Department of Health (DOH, 2004) and the Legislative Yuan (2005) has put some emphasize on patients' rights to their complete personal medical records in the recent years. However, our surveys indicate that the public still experiences numerous obstacles on this issue.
During the investigation, we notice that many healthcare personnel were wary of the intentions behind medical records requests. Some viewed the request as a gesture of distrust, while others fear the request as the sign of possible medical litigation. In the flip side of the coin, the surveys also show that majority of patients were reluctant to ask for medical records for the fear of damaging patient-doctor relationship.
In conclusion, requesting full medical record is an uncommon practice in Taiwan's culture. Though most of healthcare professionals are willing to provide medical information, they tend to view the request of full medical record as unnecessary or having negative agendas. Such cultural norms have generated pervasive information disparity and miscommunication between Taiwan's patient and healthcare providers. Furthermore, the difficulty of accessing full medical record often severely undermined patient's position during the medical disputes. Thus, we believe the medical record accessibility reform would be crucial for the success of our other advocacies to bring healthcare environment to Taiwan.
Our first press conference on the medical records accessibility reform was hosted on 2004 after conducting the survey mentioned previously. The conference was to push the Department of Health (DOH) to set up standards allowing public to access their medical records easily and under reasonable prices. We believed that a standardized requesting process would increase patients' utilization rates.
The following is our ideal model of medical records requesting process:
1. Fill in the application form;
2. Patient’s ID check
3. Print out the medical record;
4. Make the Payment;
5. The patient can decide how to collect the copy, either by person or by post.
Medical record authenticity is another concern during our advocacy. Several respondents in our surveys complained about their records had been spoiled or incomplete. As of today, the majority of the medical records are still written in English. And the patients often found them difficult to understand.
We proposed the government to cooperate with the hospital to form a stronger supervision mechanism to monitor the quality of the medical records. It is also preferable that the record be preserved in electronic form in the future. The electronic form would likely to improve record's preservation and the accessibility.
The goal of this press conference is to make government, hospitals and the public aware of individual's right to their health information. And eventually, the request of the medical records would not be viewed as a symbol of distrust toward the healthcare personnel.
THRF believed the medical record reform is an important step toward a more transparent healthcare system. It would also help reduce repeated medication, smoothen the transfer process, empower the patients, and eventually promote the trust between the public and the medical professionals.
The Department of Health responded to our advocacy by hosting several joint conferences aimed to establish standards for the medical records request. The final result was announced at 9/17/2004. The new regulation regularized the fee charged for each medical record copy. And the doctor's approval could no longer be required when request the medical records.
Second Press Conference
Between July and November 2006, Taiwan Healthcare Reform Foundation launched another survey on the medical records accessibility. The goal of this survey was to review the impact of our first press conference on 2004, and how well did the government reinforce its new regulation on the medical records.
The 2006 survey investigated 437 healthcare institutions around Taiwan, included 19 medical centers, 79 hospitals, and 339 local hospitals. The main objective was to see how many obstacles patient still face for accessing his/her medical records.
The result of the survey showed that many difficulties remained, albeit some improvements compared to 2004. The followings are practices we have observed which clearly violated to the government regulations:
1. Registration Fee:
The new 2004 regulation stated that there should be no registration fee charged for the medical records, yet 74% of medical centers, 57% of hospitals, and 67% of local hospitals still required registration fees for records requested.
2. Unnecessary requirements or direct refusal:
In the new regulation, the doctor’s approval is not required for requesting medical records. The survey showed, however, 68% of medical centers, 71% of hospitals, and 67% of local hospitals still demanded the patient to ask for the doctor’s permission. 36 out of 437 local hospitals refused the requests directly, whereas 11 of them required the approval from the Dean of the institution.
Although the new regulation standardized the price for copy of medical record, the result of the survey still showed wide disparity of fee charged. According to the survey, the prices for medical record went from twice to as much as forty times more expansive than the official regulation.
Based on the observations of our second medical records accessibility survey, we suggested the following changes:
1. For a reform to be successful, the government should reinforce and supervise the changes. From our observation, the lack of actions from the government was one of the key reasons the new regulation could not be effectively implanted. We believed the Legislative Yuan should urge the Department of Health and the Bureau of the National Health Insurance take actions against the substandard practices.
2. The public still lacks of awareness about their rights to the medical record. We encourage the public to take actions and report to the authorities when their rights were violated.
The Department of Health stated in a press release at November 2006 that it would reinforce the regulations on the medical record more vigorously, and punish the infractions reported.