Winter 2025 Issue

Automatic for the People
By Angela Rose, MHA, RHIA, CHPS, FAHIMA
For The Record
Vol. 37 No. 1 P. 18

Three hospitals share real-world advice.

With rising request volumes and a shrinking health information (HI) workforce, the demand for efficiency in the release of information (ROI) process has reached a tipping point. For example, within MRO’s efforts we see a 25% increase in medical record requests year over year.

Whether outsourced or managed in-house, health systems juggle hundreds of thousands of requests annually, while navigating alongside tighter deadlines and evolving regulations. For example, a single payer may request the same patient’s information three to five times a year, often for audits or care management purposes.

Automation offers relief, but implementation isn’t as simple as flipping a switch. From complex EHR integrations to workflow overhauls, HI leaders must navigate significant change. Properly implemented, automated ROI can drastically reduce turnaround times and administrative burdens.

This was the case during a panel I hosted with three HI leaders at the 2024 AHIMA Annual Conference. Each panelist automated their ROI processes to enable tasks such as electronic request validation, record retrieval, and delivery, leading to measurable benefits for their organizations and HIM teams.

Implementing Automation
One of the panelists serves as HI director for a large nonprofit health system covering six western states. The organization averages 1,500 to 2,000 medical record requests per day and 400,000 requests annually. Leadership sought new ways to achieve greater efficiency for their 400+ HIM operations team.

A large component of the organization’s request volume was from patients. Patients requested information through the EHR patient portal with additional support through a call center and electronic delivery options. Therefore, an essential requirement was to integrate ROI workflow with the patient portal while also providing data insights on patient adoption and satisfaction.

To achieve their goals, the organization integrated their EHR portal with an ROI platform to automate logging of medical record requests. Auto-assisted logging included all requests from patients and other third parties. The following are four benefits of the new workflow:

• Staff works from a single screen throughout the process to achieve greater efficiency and improve compliance.

• ROI specialists edit inbound requests vs creating and logging request information into systems.

• Technology extends beyond the logging process to get requests out faster and with a higher level of compliance.

• Customer feedback reports assess requestor experience with patient satisfaction scores ranking four out of five.

Record retrieval was the next area for ROI automation. New technological capabilities such as application program interfaces, the current HL7 standard of FHIR, artificial intelligence, natural language processing, and optical character recognition now combine to automate 30,000 to 40,000 transactions per month for risk adjustment requests across the health system.

The organization has experienced a 96% to 97% success rate for automatic information retrieval in collaboration with their outsourced ROI services partner and a new technology-driven workflow. Instead of a slow analog process, the outsourced team processes up to 80 requests per hour with a dramatic uptick in the related revenue share for third-party requests. Perhaps the greatest advantage of electronic record retrieval for health system staff is the elimination of duplicate work when payers request the same record multiple times.

Automating Information Delivery
Another panelist focused on automating back-end ROI processes: outbound shipping and requestor billing. Faced with workforce shortages, the use of experienced and credentialed HI staff to ship and bill information wasn’t practical or sustainable. Instead, the organization outsourced the entire back-end process.

A shared model was established whereby the ROI work was completed by in-house teams, and backend processes were completed by the outsourced partner. Depending on the format needed, information is transmitted via email, secure File Transfer Protocol, mail, fax, in-person delivery, or portals. Relief from having to ship and bill removed a huge burden from the HI staff.

Back-end data is shared and reviewed to identify requestor trends and adjust processes. The collaboration builds trust and heightens engagement between the organization and their outsourced partner. The organization also uses data from this partnership as part of due diligence to convince superiors of the need for new HI investments when productivity gains can’t be achieved through existing systems.

Four Tips
Across six hospitals and two states, Northeast Health System emphasized the need to engage staff during ROI automation initiatives. Successful implementation should focus on upskilling people and reengineering processes. It also includes strong project management, comprehensive planning, user involvement, and constant training to ensure staff fully uses the new ROI applications.

Here are four tips to build the right automation workflow for your organization and implement change effectively:

• Adopt a project manager mindset. The shift from manual processes to technology-enabled workflows requires upfront goals, timelines, and milestones. Effective planning is the foundation of success.

• Prioritize end-user input. Staff should view technology as an asset, rather than a burden, with tools that are user-friendly, intuitive, and well-integrated into ROI workflows.

• Educate staff and teams accordingly. Ongoing training with proactive updates is essential as technology evolves.

• Use the data. Data talks. Use data from automated ROI processes to make staffing decisions, negotiate with payers, prepare for request spikes, and justify new investments.

Training is imperative whether the ROI process is conducted in-house or by an outsourced ROI company. Training should focus on familiarizing staff with the technology, workflows, compliance requirements, and practical benefits of automation. System-specific sessions are essential, including tasks such as how to navigate the platform, process requests, and retrieve data.

Finally, patient privacy and HIPAA compliance remain foundational to ROI automation and compliance. New rules have emerged, especially regarding reproductive HI, interoperability, and information blocking. With these changes in mind, ROI training should always remain up to date with current national and state laws, address organization-specific needs, and incorporate new regulations and privacy rules.

Time to Automate
ROI automation isn’t just a trend. It’s the future of HIM. By adopting the right technology, organizations can streamline workflows, improve compliance, and free staff to focus on high-value tasks. Whether managed in-house or outsourced, the time to embrace automation is now—because falling behind is not an option.

— Angela Rose, MHA, RHIA, CHPS, FAHIMA, serves as vice president of client success at MRO where she is responsible for activities related to successfully onboarding new clients, account management, and corporate policy.

 

RELEASE OF INFORMATION CHALLENGES ABOUND IN 2025
• Greater demand for clinical information amid constant change: what format, what purpose, and by when

• Complex and varying regulations including national and state laws

• Differing payer requests such as risk adjustment, the Healthcare Effectiveness Data and Information Set, payment integrity, prior authorization, and care management

• Evolving stakeholders including public health, other providers, insurers, patients and families, governmental agencies, etc

• Various data standards, formats, and disparate systems

• Multiple care locations with differing processes and procedures

— AR

 

FOUR BEST-PRACTICE STEPS FOR AUTOMATED RETRIEVAL
Identify the records. Automated systems electronically locate personal health information records located within the EHR or other databases. This can include patient demographics, dates of treatment, test results, discharge summaries, and more.

Access the information. Once the information is identified, the system retrieves the information from databases, ensuring compatibility across various formats. Some health care systems have the records as scanned, physical documents, and others are digitally entered in the EHR.

Filter and sort. Retrieval of patient information requires an advanced filtering process. By implementing filters, health systems ensure they are excluding irrelevant or unauthorized information. Filtering and sorting information ensures only the required information is further processed.

Prepare the data. To fit requestor specifications, the retrieved data may require formatting or consolidation before electronic delivery.

— AR

 

FIVE IMPORTANT QUESTIONS TO ASK POTENTIAL RELEASE OF INFORMATION AUTOMATION PARTNERS
• Does the solution have end-user input?
• What efficiency gains and financial improvements are possible?
• How is technology used to measure quality?
• How is patient privacy protected, and what is considered minimally necessary?
• Is the vendor on current regulatory standards and flexible from state to state according to changing rules?

— AR