Back in April, I wrote about my adventures with the Health Insurance Portability and Accountability Act (HIPAA). I had run into a specious HIPAA barrier when the on­col­ogy practice I treat at initially refused to email me my laboratory results, saying HIPAA did not allow emails. Several readers shared comments about their own ex­peri­ences and a few expressed interest in the memo I presented to my oncologist addressing my HIPAA right.

Before I write and before you read another sentence about HIPAA, let me make this disclaimer: The in­­for­ma­tion con­tained in this article is provided for in­­for­ma­tional pur­poses only, and should not be construed as legal advice on any matter.

Okay, now I’m ready to con­tinue.

I confronted the HIPAA barrier by writing my oncologist a memo, which I set out below. I have made some redactions of names, but the meat of my memo is intact.

To: Dr. XXX
From: April Nelson
Re: HIPAA Release to Email My Lab Reports
Date: March 26, 2018

When I saw you on February 27 for my four-week checkup, I raised my con­cern that I could not access any lab results through the patient portal other than my CBC. You were sur­prised as well. I said I would try again, that maybe I was missing some­thing, and I would report back.

Post appoint­ment, new labs appeared in the portal. Once again, I could only see my CBC results. I sent a message through the patient portal; YYY responded and worked on the problem with me. She indicated that the de­ci­sion to limit access was one made by the doctors at [Name of Institution]. We discussed emailing me the results and that was a dead end; she was not allowed to email the results because of HIPAA. She volunteered to fax them; a fax is not secure for me. She offered to mail them, but by this time I was so close to coming back, it seemed ridiculous to waste time, paper, and postage. YYY has been in­valuable in trying to solve this problem.

HIPAA is for patient access, not for doctor security. Emailing medical results is not a vio­la­tion of HIPPA if the patient requests the records be sent that way and specifies the email address. There is no HIPAA barrier to emailing lab results and the medical institution may not refuse the patient.

As you know, I treat with both you and Dr. ZZZ at [Name of Other Institution]. ZZZ charged me (and by extension, you) with watching my M-spike and my alkaline phosphatase be­tween our quarterly appoint­ments, the thought being that if either starts going the wrong way, he would bring me back to Rochester sooner. With no access, and my seeing labs four weeks after the fact, I am unable to monitor any­thing.

This memo serves as my authori­za­tion to [Name of Institution] to release my lab reports to me by email. The email to which they are to be sent to is: [email address]. The triggering event will be my sending a message, subject matter “Test Results,” via the Patient Portal, requesting that all current labs be sent to me by email. This release remains in effect in­defi­nitely; any revocation must be in writing and must be made by me.

My memo has two distinct parts. Much of it is a recap as to the efforts I made to obtain my lab results. My oncologist and I both knew what had hap­pened, and I could have related that story orally at my appoint­ment. But the lawyer in me wanted it summarized on paper.

In contrast, the heart of the memo is the last paragraph. That paragraph is the release language I drafted for my specific situation. I came up with this language as a result of my interpretation that HIPAA put the obli­ga­tion on me to specify the email address and be in writing.

As I noted in my last column, it took me most of a week and several rewrites to pare down the above memo from two pages (flavored strongly with sarcasm and ranting) to what I finally presented my oncologist. He and I have a long rela­tion­ship of many years and there is little I say or do that sur­prises him. After my appoint­ment, he made sure my memo went into my patient file, and it has been smooth sailing since then.

That was my ex­peri­ence. While those of us who live in the United States are covered by HIPAA, I’m not guar­an­teeing that someone else in this country with a dif­fer­en­t oncologist or medical institution will get the same prompt and pos­i­tive response. A number of you related stories of a closely related issue, that of a medical institution or doctor not releasing medical records (such as lab results) to you until your doctor has reviewed them. My feeling is HIPAA doesn’t allow that, but I did not delve into that side issue. (See second paragraph above, Disclaimer!)

And my favorite anti-medical profession law joke that got deleted from my final version?

Catch me when I’ve had a frustrating run-in with a doctor.