Like many healthcare facilities, Rapid City Regional Hospital has struggled to manage the increasing number of release of information (ROI) requests it receives. The 400-bed inpatient facility in Rapid City, S.D., receives approximately 60 requests per day, and its backlog was growing.

In June 2007, Rapid City began partially outsourcing ROI operations to King of Prussia, Pa.-based MRO Corp. The hospital's health information management (HIM) staff still receives and evaluates requests, pulls the charts and scans documents, but MRO handles distribution, billing and troubleshooting. Rapid City also implemented a software driver that allows staff to import images from the hospital's Meditech clinical information system directly into MRO's ROI Online system.

“Other vendors we talked to wanted to take over the whole function, but we wanted to maintain some control,” says Jennifer Gholson, RHIT, assistant director, operations - HIM operations, at Rapid City. “We still feel like we control the process.”

Most large hospitals, and a number of smaller facilities, are turning to ROI outsourcing services to help handle the growing volume of requests and to stay in compliance with increasingly complex privacy regulations. As more facilities convert to EMRs, their ROI options have increased, with solutions vendors offering a combination of software and outsourcing services.

“These systems automate the record keeping (of) the requests, and can provide detailed reporting functionality,” says Kathy LePar, senior manager at Beacon Partners, a Weymouth, Mass.-based healthcare management consulting firm. “You can easily find out, for example, how long it's taking to fulfill the requests. A lot of organizations are still very paper-driven, so even though they might have an EMR, they're going through a labor-intensive process to generate these documents.”

Requests for patient information come from a wide variety of sources (physicians, attorneys, insurance companies), and usually require HIM staff to gather a mix of paper and electronic records which then have to be vetted for compliance with state privacy regulations and the Health Insurance Portability and Accountability Act (HIPAA). Once the records are delivered, the provider can collect an ROI fee, which can vary depending on who asked for the records and where they reside.

“Many of these organizations just don't have the headcount to handle the requests and the billing,” says Brian Cahill, CEO of ChartOne Inc., a medical records management software and services provider based in Burlington, Mass.

The University of Toledo Medical Center (UTMC) a 319-bed facility in Toledo, Ohio, turned to ChartOne to take over its ROI operations in 2000 precisely for that reason. A five-member ChartOne team working at the hospital manages all ROI requests for UTMC, from receipt through delivery and billing. The company scans documents at the UTMC clinics using mobile equipment, and also has access to records housed in the hospital's new McKesson document imaging system.

“ChartOne brought in their own workflow processes for ROI requests, and took the burden off of the HIM department,” says Jill Buathier, MA, RHIA, associate vice president, revenue cycle, at UTMC.

The migration to electronic records should make ROI fulfillment easier, but the operational challenges can still be daunting, even for organizations with a robust EMR.

“We've considered bringing the function back in-house,” says Melissa Jarriel, RHIA, CTR, CHP, director of HIM services at the Medical College of Georgia (MCG) Health System in Augusta. “But we receive about 150 requests and send out approximately 6,000 pages of records per day. We're not set up here to collect money and follow up with requesters that haven't paid.”

MCG is using an on-site service from Smart Document Solutions (SDS), Alpharetta, Ga. MCG's medical record is now entirely electronic (approximately 65 percent of that being scanned documents) across the 478-bed adult hospital, a 154-bed Children's Medical Center, and MCG's Ambulatory Care Center, which includes more than 80 outpatient clinics. The SDS team has access to MCG's Cerner Millenium clinical information system on its own hardware, and Jarriel can access the SDS reporting tools via a Web browser.

No-cost outsourcing

In most cases, hospitals don't pay for outsourcing services. The provider gives up all or part of any potential ROI revenue in exchange for offloading the operational costs to its outsourcing partner. This might seem counterintuitive, but because ROI fees are regulated in most states, revenues often don't cover the HIM department's operational costs.

“The only way to make this profitable is through cost management,” says Chart- One's Cahill.

The payback to the healthcare provider is through customer satisfaction, robust reporting tools, and the vendor's regulatory compliance expertise.

“I can find out how long it took to scan the documents, measure individual productivity, and look at the turnaround times for different parts of the process,” says Rapid City's Gholson. “There's a gold mine of information for me as a manager.”

Many outsourcing companies provide software solutions as well. ChartOne and SDS both offer in-house solutions for their customers, and St. Louis-based First Class Solutions Inc.'s Cortrak software can be deployed as part of a document management solution.

The decision to implement a software solution or to outsource ROI will depend on the size of the facility, the volume of requests, and the ability of the IT department to support an ROI application. For facilities with a high volume of requests, outsourcing will remain the most attractive option because it can free up HIM staff, and doesn't require a significant amount of IT integration.

“If we did everything internally, it would be cost prohibitive,” says UTMC's Buathier. “From a budget perspective, outsourcing paid for itself.”