Clinical and Economic Impact of Duplicated Radiographic Studies in Trauma Patients Transferred to a Regional Trauma Center.

OBJECTIVES: Many trauma patients are evaluated at community hospitals and rural emergency departments before transfer to regional trauma centers. Radiographic studies are often duplicated, leading to significant additional costs to the healthcare system. Our purpose is to identify the reasons for duplicate studies, the costs associated with this practice, and potential clinical effects to patients. METHODS: The institutional trauma database was queried to identify patients with orthopaedic injuries transferred to our regional trauma center. Patient demographics, mechanism of injury, referring hospital, reason for transfer, payor source, injury severity score, and Glasgow Coma Score (GCS) were recorded. Duplicate imaging studies were identified and confirmed with each outlying hospital radiology department. The radiation exposure was estimated based on average reported values. The cost of duplicated studies was derived from the Medicare fee schedule. RESULTS: In 1 calendar year, a total of 513 patients were accepted in transfer from 36 outlying facilities. Almost half of the patients (47.7%) had at least 1 radiographic study repeated. There was a significant association between repeated study and age (P < 0.0001), Injury Severity Score (P < 0.0001), and GCS (P < 0.0001). No association was identified for size of transferring institution, injury mechanism, or payor status. Reasons listed for duplication included inadequate data transfer, poor quality, inadequate study, and physician preference. The additional cost to the healthcare system is estimated to be $94,000. CONCLUSIONS: The duplication of imaging studies at regional trauma centers is a common problem that represents a significant opportunity for cost savings and reduction of patient exposure to radiation by implementing imaging protocols at outlying facilities and improving the transfer of imaging data through information technology solutions. LEVEL OF EVIDENCE: Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

[Survey to evaluate fees charged and time limits for issuing a medical records's paper copy by hospitals of Lazio Region (Italy)]. / Indagine sui costi e sui tempi di consegna di rilascio agli aventi diritto della copia cartacea della cartella clinica nelle strutture ospedaliere del Lazio.

Aim of the present study was to evaluate the different fees charged for providing paper copies of medical records and time limits for their delivery. The analysis involved all the public and private hospitals in Lazio Region (Italy). The authors administered a short telephone questionnaire to the medical affairs direction of all the hospitals in the survey. In 94.6% of cases (n=106 hospitals) the requested information have been provided. Data analysis showed that average fee charged for issuing copies of medical records was, respectively, 13.90 vs 12.66 euro for inpatient and day hospital. Average time limits for dealing with a request for paper copies of medical records was 24.2 days, less than time established by Italian Law (30 days). The survey showed, however, a huge variability that concerns both the fees and times of issue of medical charts.

Copy fees and patients' rights to obtain a copy of their medical records: from law to reality.

Patients have a legal right under HIPAA to a copy of their medical records. Personal life-long medical records rely on patients' ability to exercise this right inexpensively and in a timely manner. We surveyed 73 hospitals across the US, with a geographic concentration around Boston, to determine their policies about fees for copying medical records and the expected time it takes to fulfill such requests. Fees range very widely, from $2-55 for short records of 15 pages to $15-585 for long ones of 500 pages. Times also range widely, from 1-30 days (or longer for off-site records). A few institutions provide records for free and even fewer make them accessible on-line. We argue that electronic records will help solve the problem of giving patients access to their own records, will do so inexpensively and in a format more likely to be useful than paper.

The prohibitive costs of accessing evidence online.

Delivering continuing education online involves making published materials available to learners. As part of a study that examined the use of the Internet for dissemination of information, permission to provide resources online was sought from 43 publishers, of whom 36 responded. Four (11.1%) denied permission to copy their materials. Seven (19.4%) granted permission to copy articles at no cost. The remaining 25 (69.4%) granted permission for a fee, ranging from dollar 2 to dollar 410 per article. These findings highlight a need for more accessible and cost-effective online resources to meet the challenges of evidence-based programs and practice in public health.

HIPAA copy charges for medical records.

The HIPAA privacy rule allows providers to charge for providing copies of medical records to patients and their representatives. Providers need to know which activities in the retrieval and handling of such information can be included in the medical record copy charges. State-mandated fees for copies vary and may be preempted by HIPAA, requiring careful review by providers. Healthcare organizations that use a copy service may need to determine whether bringing the activity in house would be more cost-effective under HIPAA.