How Do I Fulfill Continuity of Care Requests?
By Elizabeth McElhiney, MHA, CHPS, CPHIMS, CRIS
Director of Compliance and Government Affairs
Verisma
December 9, 2024
When a patient moves between healthcare providers, their medical information and records often need to follow. Records necessary for care of the patient fall under the treatment provision on the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule and (generally) don’t require an authorization from the patient or their personal representative. But when sharing records with another facility for treatment purposes, what and how much should you disclose?
What’s Transfer of Care?
While a Continuity of Care request is often a patient travelling between providers, the patient remains actively involved with both organizations. Consider a patient moving between a primary care physician and a cardiologist. It’s important for both providers to know what the other facility’s treatment of the patient entailed. So, they may submit a Continuity of Care request to obtain the records from the other provider.
A Transfer of Care request is different. In a Transfer of Care, the patient is transferring who’ll provide his or her care from one provider to another, and there’s no intent for the patient to return to the originating organization. Transfer of Care requests happen most often when the patient has moved and established care with a new provider.
Minimum Necessary Standard
The minimum necessary standard of the HIPAA Privacy Rule requires a provider to disclose the minimum amount of information be disclosed to accomplish the intended purpose. However, the minimum necessary standard isn’t required to apply to provider-to-provider requests for treatment purposes. Providers are permitted to request and disclose the amount of PHI necessary to treat a patient. The releasing provider is permitted to rely on the requesting provider’s judgment about what’s the minimum amount of information needed. Even though minimum necessary may not be required for Continuity of Care or Transfer of Care requests, the framework can serve as a best practice to get the most meaningful information to another provider.
When a provider receives hundreds of pages of medical records, it’s burdensome for them to sort through the information and determine what’s needed. The electronic health record (EHR) can be filled with “note bloat” and templated, duplicative information. For Continuity of Care purposes, most providers only need the most recent records of a patient. Sending all records for Continuity of Care requests can be a waste of time and resources. Applying the minimum necessary standard to Continuity of Care and Transfer of Care requests allows providers to receive the most pertinent information often on the first request. Of course, if the requesting provider needs more records, a second release of information (ROI) can occur with the transfer of the additional records.
Creating a Continuity of Care Policy
It’s important healthcare organizations create policies and procedures remaining consistent when applying standards like the minimum necessary. This can be done through a general ROI policy or within linked procedures and workflows. In either case, when your organization implements the minimum necessary standard for Continuity of Care or Transfer of Care requests, you should outline what factors are considered to limit the number of pages or information initially disclosed.
These factors could include, but aren’t limited to:
- An understanding with the receiving practice on what they want to receive
- Patient age
- Patient condition
- Size of the medical record
- Organization’s EHR solution
- The specialty of the provider
If your organization decides to limit the information initially sent to the requesting provider, it’s critical you make the receiving facility aware not all the information has been sent. This can be incorporated through a cover letter indicating the most recent records have been sent and include instructions on how the provider may request additional records if needed.
Release Record Requests to a Partner
If you find Continuity of Care, Transfer of Care, and all other record requests take too much of your staff’s valuable time, consider releasing this administrative burden to a partner. Verisma processes hundreds of millions of record requests annually and is an industry-leader with the highest accuracy rate. If you need to focus more on patient care, request a demo today to see how we can help.
