• JUNE 2007 FEATURE ARTICLES •
Document Management
Changing Gears
with eROI
Henry Ford Hospital switches to an electronic process
for managing release-of-information requests without
having to ask their CFO.
By Karen Schmidt
When it comes to managing release-of-information
(ROI) requests, it can sometimes
seem all too easy to stick with the status
quo. Some health systems have relied on
copy services for so long that it often seems there’s no other
way of doing things. Others have built their own internal
process to suit current needs but haven’t planned ahead for
when they might need to scale up in the future.
However, a new business model called eROI is emerging
to leverage the control benefits of handling ROI requests
in-house, combined with the automation benefits of using
a vendor’s software and database.
Comforts of the Status Quo
Henry Ford Hospital and Health Network, (HFHHN)
is one of the nation’s largest healthcare providers. The
auto pioneer himself founded it in 1915 to serve Detroit
autoworkers. The group has since grown into an integrated
health system employing 14,000 full-time workers and
handling 2.1 million patient visits a year, including international
patients seeking innovative treatments such as
robotic technologies to combat prostate cancer.
We receive more than 42,000 ROI requests each year,
which equals about 1.6 million copies. The Medical Record
Services Department assumes responsibility for all of these
requests, no matter where the request is received (whether
from a hospital or one of the 30-plus clinic settings). It’s
always a challenge to get the requests routed appropriately
to the department, and while they’re en route to the right
location, those seeking the information must wait that
much longer for acknowledgement of their request. While
this situation wasn’t ideal, we eventually ramped up employee
education efforts and worked with our copy service
to achieve a 7-day turnaround time on ROI requests. We
were meeting customers’ needs, but not exactly “wowing”
them with our service.
A New Approach
In early 2006, I ran into a business contact at the AHIMA
(American Health Information Management Association)
national meeting in San Diego. This person was familiar
with Health Information Management
(HIM) department
operations at HFHHN and told
me about an eROI process. The
ROI Online system from Medical
Records Online (MRO) integrates workflow for both
paper-based and electronic record systems. The software
enables the provider to maintain control of the ROI process
while outsourcing the time-consuming “back office” functions.
The vendor then remits a percentage of the revenue
back to the facility on a monthly basis.
In addition to being the director of medical record
services, I also serve as Henry Ford Hospital’s privacy
and information security officer, so at the time, I was
convinced that the eROI approach would require an
unacceptable level of access to our electronic records.
Nevertheless, I discussed the idea with the IT department,
and to my surprise, the system would not only
operate well within our firewall, it was also inherently
HIPAA compliant.
We began the process of checking references, and everyone
that I spoke with discussed their positive experience in dealing with MRO. “You’re going to think that I work
for them,” said one HIM director as he raved about the
eROI service. HIM directors can be a close-knit group, and
our reputations are too valuable to say or support things
we don’t mean. So I was impressed by the feedback I
was getting.
We tried to use a traditional selection process by sending
out RFPs to evaluate the service against similar competitors,
but we couldn’t find a company that was comparable to
MRO, and I refused to take proposals from companies that
would continue to deal in the paper realm. Our copy service
requested that they stay on with us as a partner, but they
simply couldn’t match the eROI vendor’s capabilities.
A Seamless Implementation
In November 2006, we ended the contract with our
existing copy service and switched to the eROI process.
It took only a few weeks to make the full transition, and
although the change was immediately obvious to us, it was
seamless to our customers.
Now we no longer need to print out electronic medical
records for a copy service to mail. We just forward the
records electronically to the vendor, who handles request
acknowledgement, validation, logging, tracking, requester relations/communications, and the physical distribution of
requested information, billing and collection. They send
out the records in whatever format the requester wants, which might be CD-ROM, FTP or Web portal. The whole
process is efficient and stays current with today’s continually
evolving laws and regulations, particularly with regard
to fees.
Since Henry Ford has records going back 90 years, we
sometimes have to dig back into our paper archives to fulfill
an ROI request. MRO’s software allows us to fulfill the
electronic component first and catch up a day or two later
with a scan of the paper record obtained from storage.
During implementation, trainers from the vendor
worked alongside our employees to show them, one-by-one,
how to handle new ROI requests. The vendor even
picked up the tab for costs left over from the prior vendor
in an effort to aid us in the transition.
Revenue From ROI Requests
Since implementing the ROI Online solution, we’ve
reduced phone calls from requesters by 50 to 60 percent.
Customers (including patients) no longer have to wonder
if their request has been received. Some of our top clients,
including high-end insurers and records deposition companies,
get a personalized Web page to instantly check on
the status of ROI requests.
The new system also allows me to establish productivity
standards with real-time management reports. What’s
more, I can view the amount of this newly found revenue
at anytime. In the past, my department frequently paid
several thousand dollars each month to the copy service. Today,
we’re actually bringing in a continual stream of income,
even after having to share part of it with the vendor.
The potential for revenue generation is important, no
matter how incremental it may be. The last thing any
director wants to do is ask the CFO for a substantial upfront
investment in a new technology. We implemented
the eROI solution for the initial cost of the software and
a few scanners—expenses so minimal, I didn’t even put it
into the budget. Upfront costs are being paid for directly
out of the new revenues.
We received a return of investment from revenues
earned in the first 90 days of implementation. Of all the
services and vendors I’ve worked with over the last 30
years, this experience ranks right up there at the top.
Karen Schmidt
is director for medical record
services at Henry Ford Hospital and
Health Network, Detroit.
Contact her at kschmid1@hfhs.org.