Hospital Information Systems
Optimizing release-of-information processes
By Bonnie Zahn, RHIA, CHP, October 2010
While Underwood-Memorial Hospital was already working with a provider that was meeting most of its medical records needs, a key element was missing.
For almost a hundred years, Underwood-Memorial has been keeping track of patient records, and while the basic intent of this record keeping has remained consistent, the volume of records, the speed with which records need to be accessed and the legislation governing the handling of these records have all changed dramatically. In particular, we have implemented the Cerner Millennium system to help us improve the quality and efficiency of our delivery of care. This new electronic health record (EHR) system has given us the ability to combine operational and clinical information, while accessing relevant patient information.
We chose to partner with MRO as a staffed service so that the vendor could assist us in hiring new staff — providing full training, salaries and benefits for that staff member.
Underwood-Memorial Hospital has been delivering patient care since the early days of the 1900s. As a 305-licensed-bed, acute-care non-profit community hospital, Underwood-Memorial serves Gloucester County and parts of Salem and Camden counties in New Jersey, with more than 1,800 full- and part-time employees and a medical/dental staff of almost 400. Our hospital provides a comprehensive array of diagnostic, therapeutic and rehabilitative services to the surrounding community and has more than 14,000 admissions annually, as well as 53,000 total patient visits to the emergency department.
Implementing relevant technology
One of the major lessons we've learned in the past is that having a bigger release-of-information software provider isn't always better for our hospital, our patients or our staff. For much of the past 10 years, our release-of-information (ROI) needs were met by one of the largest ROI companies in the country. As this provider grew through a series of acquisitions, the company's business lines, focus and personalized service became more and more diversified.
By late 2008, we made the decision that we needed something more: an ROI software and service vendor that would maintain better contact with the hospital, and that would be able to dedicate time and effort to meeting our needs through service calls and follow-ups. Beyond service issues, legislative and regulatory changes also played a role in our decision to transition to a new ROI software provider. As a small community hospital, at the time, we were quite comfortable with the manual records process, but as technology expanded, our health information management (HIM) department needed to look at alternatives that would allow the hospital to respond to changing government mandates and to the CMS Recovery Audit Contractor (RAC) program. Because of this, we needed to ensure that the ROI service we chose would integrate seamlessly with the EHR and audit-tracking solutions we were already using. In June 2009, Underwood-Memorial Hospital contracted and went live with MRO, an ROI, audit-tracking and document management software and service vendor.
Along with more personalized client service, our HIM department realized several other tangible benefits right from the start. Perhaps the biggest benefit was that this vendor's ROI software cut out a major step in our conversion from our electronic records system into the ROI application. Prior to our transition, if we needed to transmit a medical record, it was an incredibly wasteful process. Even a 50- to 75- page online document would need to be first printed out in the Cerner EHR layout, which might turn out to be more than 200 actual pages per record. Those pages then needed to be scanned in to recreate the electronic record format for the vendor's ROI processing. Instead, MRO's ROI Online comes with a feature called WebPrint Distribution Server built specifically to work in conjunction with our Cerner system, which lets us capture images of medical records into a PDF format, eliminating our need to print huge volumes of paper and waste quantities of toner. Ultimately, this feature reduces our workload exponentially, streamlines our process and saves printing costs.
The ROI Online system also gives us increased access over time. With our previous ROI provider, Underwood-Memorial was limited to the amount of time over which we could access a record, since they would purge records from their system after a year. With MRO, the scanned records are retained permanently, which significantly reduces rework in instances where we need to access or rescan our patient records.
Staff and software results
While some hospitals opt to use standalone software, at Underwood-Memorial we chose to partner with MRO as a staffed service so that the vendor could assist us in hiring new staff — providing full training, salaries and benefits for that staff member. This means that in addition to using the company's software, the vendor also provides in-house, release-of-information processing. Ultimately, for Underwood-Memorial, this adds up to greater control over employee work flow and of the ROI process. With our past provider, the ROI process was configured as a stand-alone system that could only be accessed by the vendor's representative and was not available for shared use by our staff. Through our transition to the ROI Online process, authorized Underwood-Memorial users have improved oversight and accessibility, and they can also access the system as needed to direct accountability, control policies and procedures, and develop usage and work-flow status reports.
The transition to using a staffed model of ROI service and support has been crucial to the continued growth of Underwood-Memorial Hospital and has meant that we can serve our patients and community more efficiently and even more professionally. Turnaround times for request processing have been cut in half, which means the HIM department is no longer bombarded with incoming calls from requesters checking on release status. In addition, with the major changes in medical record management and legislation, having an ROI software partner who helps us stay on top of our release-of-information needs means that our HIM department can focus on the broader concerns of managing our hospital's medical records and ensuring compliance with all the relevant laws and standards.
As a result of this transition, Underwood-Memorial Hospital now spends less time on medical record request processing and is able to maintain its commitment to serving the community through superior patient care. This commitment extends from the very first encounter with a patient all the way through to ensuring that a patient's medical records are secure and accessible by the medical providers who care for
Bonnie Zahn is director of health information management and privacy at Underwood-Memorial Hospital in Woodbury, N.J.