© 2021 American Medical Association. All rights reserved.
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Scenario 1:
“My primary care doctor and cardiologist need more information on the chemotherapy regimen that was used to treat
my cancer ten years ago. I called the oncologist’s number, and it was disconnected. I checked online and it seems his
oce closed years ago. Why didn’t anyone let me know? How do I get a copy of my records now?”
Scenario 2:
“I stopped by my doctor’s old oce. It was no longer a doctor’s oce. The receptionist had no information for me.
I desperately searched for the other physicians that also used to be in the practice to no avail. I called the Department
of Health. I searched for my doctor on the internet, Facebook, and LinkedIn hoping I could nd him and ask how I
could get a copy of my medical records. What if I never get in touch with him? I need copies of my medical records to
include in my social security disability application. Without them, I’m afraid my application will be denied.”
Scenario 3:
“My doctor passed away. She was in a solo practice and didn’t use electronic medical records. It was all paper charts.
I didn’t know where to go to get a copy. I was able to nd some contact information for her surviving family members
online hoping they could help me. I felt so guilty bothering someone who is grieving the loss of their loved one so I
could get access to my medical records. It shouldn’t be this complicated.”
Barriers to Access Overview: Obtaining Medical Records from Practices
that are Closed
Physician practices close for several reasons. Physicians may merge with another practice or hospital system.
They may sell or close their practice for nancial reasons, such as in the event of the negative nancial
consequences incurred because of the COVID-19 pandemic. Physicians may retire. They may get sick and pass
away. In short, while there are numerous reasons that a practice may close, patients and their families may
encounter signicant barriers to obtaining medical records if a physician’s practice closes and there isn’t a robust
plan in place to provide patients easy access to their records.
When the Practice is Permanently Closed
The Health Insurance Portability and Accountability Act (HIPAA) gives patients the right to access and get copies
of their medical records. Unfortunately, many patients struggle to exercise this right when their physician’s
practice has closed. This is most concerning in settings that—for whatever reason—do not use electronic
health records (EHRs), such as in behavioral health practices, many independent practices, and some practices
and clinics in rural settings. This is because patients may live far from the location where they received care or
simply have one less method available to them to access information absent access to an online patient portal
or smartphone app facilitating access to an EHR.
Medical record retention requirements, in general, are not specied by HIPAA, but rather state laws. The
American Health Information Management Association (AHIMA) provides a guidance on Protecting Patient
Information after a Facility Closure and a resource on state laws governing medical records retention after the
closure of a practice or facility. Relevant agreements, such as physician employment and services contracts,
Obtaining Medical Records
from Closed Practices
PATIENT ACCESS CHALLENGES
© 2021 American Medical Association. All rights reserved.
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could also govern record availability upon practice closing. State statutes of limitations, and/or hospital policies
and procedures, can also impact record retention and availability.
Physicians should contact the Medical Board of the state in which they practice as part of their practice closure
strategy. If a physician decides to store medical records with a custodian, patients still have a right to request
access to a copy as per HIPAA, so long as the records are available as per state laws and other agency and
organizational regulations for retention. AHIMA also has a resource with more information on Retention and
Destruction of Health Information that may be useful for physicians to review. While HIPAA protects a patient’s
right to privacy and medical information for up to 50 years after the patient’s death, state laws on the duration
of time that clinicians must retain medical records vary from state to state.
One of the most common access challenges patients face is failure to realize that their physician’s practice
is closing or has closed. Physician practices should make every eort to inform patients of a practice closure
or when a physician ceases to practice medicine with ample time for the patient to obtain a copy of their
medical records.
Ensuring Continuity of Care & Medical Records Coordination
Plans for closing, selling, or retiring from practice and what to do with medical records should begin at practice
start-up. The American Academy of Family Physicians (AAFP) has a resource for physicians starting, selling, and
closing a practice. Its Closing Your Practice Checklist highlights the importance of having a proactive plan for
medical records retention. Physicians must plan for safe, HIPAA-compliant storage of both paper and electronic
medical records, as well as imaging and pathology samples, tissue blocks, and slides, if their oce should close.
State Medical Boards must be notied of anticipated closures. Physicians must conrm how long records need
to be stored as per state and other applicable laws and requirements.
Patients should be notied by a letter at least 60 days (or greater when required by applicable law) in advance
of an upcoming oce closure, where possible. The letter should specify the date of the anticipated closure,
the option to transfer records to another physician, the option to obtain a personal copy, and the contact
information of the appointed custodian overseeing medical records storage. The AMA also recommends that
all physicians who plan to close their practice provide their local post oce with a forwarding address in case a
patient needs to contact them in the future.
Closing practices should encourage patients to either transfer their records to another physician’s oce or to
pick up a copy with instructions on best practices for coordinating one’s care from this juncture. This can be
done via written correspondence and a copy of this letter should be placed in each patient’s chart. Patients who
are diagnosed with high-risk conditions, who are actively undergoing aggressive treatments, or who require
routine follow-ups should have their letters sent with a return receipt request to minimize any disruptions
in care or continuity of care. Every attempt should be made to notify the patient about the oce’s closure
or the physician’s departure from medical practice. Physicians should also consider contacting any specied
emergency contacts, patient advocates, personal representatives, legal guardians, or executors of the estate of
the forthcoming oce closure or cease of medical practice in an attempt to coordinate medical records and
continuity of care.
Physicians should include an Authorization for Use and Disclosure of Health Information letter (AMA Patient
Records Electronic Access Playbook, Appendix C, p. 92) with the notication letter for the patient’s convenience.
If the practice is a Part 2 provider under 42 CFR Part 2, it should also include an Authorization for Substance
Use Disorder Records (AMA Patient Records Electronic Access Playbook, Appendix C, p. 94). The patient may
complete these forms to authorize the transfer of records to another physician or to specify if a patient wishes to
pick up a copy of their records.
It is critically important to notify patients and their carepartners of the oce closure and emphasize the
importance of getting a copy of one’s records while the oce is still open. While the oce is still open, someone
will be available to answer any patient questions, concerns, and provide guidance for any uncertainties on the
next steps. Once the practice closes, patients are left with no point person for assistance. This should be avoided
at all costs.
Patient Access Challenges: Obtaining Medical Records from Closed Practices
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When Patients Are the Last to Know
Most individuals do not obtain copies of their medical records as they are generated. Much of the general
public incorrectly assumes that their medical records will be readily available in a longitudinal, comprehensive
fashion when they need them. EHRs are not comprehensive, nor do all physicians and practices have them.
When a physician’s practice closes, it can cause a signicant barrier to access, breakdowns in trust in medicine,
as well as trauma for patients who may need their health information.
The implementation of the 21st Century Cures Act and Information Blocking Regulations, as well as the rise
of the digital app economy in health care, will help reduce barriers that patients face in accessing their health
information. This transformation will be incremental, not a magic x. Physicians can serve as access champions
by proactively structuring their patient access workows to ensure patients have seamless, actionable access
to their health information as is their right under HIPAA. This eort should also take into account privacy and
security considerations to maintain patients’ trust in how their data is being stored and used.
When patients nd out that their doctor’s oce has already closed or that their doctor is no longer in practice,
they have no choice but to resort to what is often an uncoordinated eort in hopes of tracking down their
medical records. Here are some strategies patients use in their quest to nd their medical records, directly and
indirectly, in the event their doctor’s oce has closed:
• Search the physician’s or practice’s website online.
• Contact the local library to search archived newspapers for announcements.
• Contact their insurance company to search for claims and health information that may oer insights about
their care.
• Contact their old doctor’s oce or practice location in hopes a current employee there may have a lead
on where they may get their medical records.
• Call their local chamber of commerce, borough hall, or local Department of Health looking for more
information.
• Search for their old doctor, their practice colleagues, and/or oce sta on social media such as Facebook,
LinkedIn, Instagram, or Twitter.
• Contact their imaging centers and labs to individually request imaging and bloodwork results.
These strategies and tactics can quickly become an immense undertaking and burden for patients hoping
to track down their health information. Many patients may not have the means and ability to take on such
barriers to access. Physicians must recognize how social determinants of health, language barriers, limited
English prociency, low health literacy, and poor digital literacy negatively impact and prevent individuals from
accessing records from closed practices. By better understanding and recognizing these barriers to access
ahead of time as part of one’s practice opening strategy or medical records retention strategy, physicians can
signicantly alleviate unnecessary burdens and barriers to patient access.
All physicians should commit to sharing best practices for preventing patient access barriers from legal,
regulatory, and practical standpoints to Do No Harm and continue to protect all patients’ best interest even
when they may no longer be in practice.
Key Takeaways
• All physicians should have a comprehensive plan for medical records retention at the start of their practice.
Like the rationale for preparing advance directives, it’s never too early to plan until it’s too late.
• Patients should be made aware of the realities of how dicult it may be to get copies of records after a
practice has closed. Physicians should cultivate a doctor-patient relationship that supports an actionable
health information and data-sharing partnership with the patient.
• Physicians should encourage patients to obtain copies of their medical records throughout their care.
Workows at physician practices should be modernized and automated to comply with the Cures Act and
Information Blocking Regulations.
• Physicians should carefully consider all the dierent avenues that patients and their carepartners may
need to explore should they need access to their medical records and the practice has already closed.
Reviewing these steps from the patient perspective may help make your practice closure plan more
Patient Access Challenges: Obtaining Medical Records from Closed Practices
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robust to prevent patients and their carepartners from needing to reverse engineer the wheel in gaining
access to their records.
• All physicians should commit to sharing best practices for preventing patient access barriers to protect the
best interest of all patients even when they may no longer be in practice.
FAQs
1. Why would patients need medical records that are not recent or even from a few years ago?
There are many reasons that patients and their primary carepartners need access to their medical records,
even if they are not recent. First of all, it is the law and patients’ right under HIPAA to have access to their
medical records. Achieving a patient’s health care goals often requires the entire care team, including the
patient and their carepartners, have access to the patient’s medical health history. Some of the reasons
patients may need access to their records include:
• Preparing a personalized, comprehensive, longitudinal timeline for their care coordination
• Preparing to participate in shared decision-making at appointments
• Appealing insurance denials
• Preparing advance directives and discussing end of life care
• Preventing dangerous delays in care
• Checking for medication errors to improve patient safety
• Avoiding redundancy in care, such as unnecessarily repeating tests or imaging
• Preventing billing errors and fraudulent claims
• Researching potential clinical trials for treatment planning
• Contributing data to scientic research
2. When we talk about patients having access to their medical records, are we also talking about
radiology imaging, lms, pathology slides?
Yes, data that has been collected as part of the patient care journey, including imaging and pathology, is part
of the patient’s medical record. These components need to be considered when designing a robust medical
records retention and access plan in the event of an oce closure.
3. Can patients le a complaint if they do not get a copy of their medical records from a closed
practice?
Yes, patients may le a formal complaint with the U.S. Oce for Civil Rights, the agency that enforces HIPAA, if
they cannot get a copy of their medical records.
Additional References
AAFP: Closing Your Practice Checklist
AAP: Managing the Practice: Records Retention
AHIMA: Protecting Patient Information After a Facility Closure
AMA: 4 Must-Dos Before Physicians Retire
ONC: Information Blocking FAQs
Disclaimer
The information provided in this document does not, and is not intended to, constitute legal advice. All information is for general
informational purposes only. Consult appropriately qualied legal counsel regarding applicability of or compliance with federal
and state laws and regulations.
Patient Access Challenges: Obtaining Medical Records from Closed Practices
© 2021 American Medical Association. All rights reserved.
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