Fall 2025 Issue

Release of Information: Improving Release of Information Workflow
By Jordan S. Maliavsky, MPA, RHIA
For The Record
Vol. 37 No. 4 P. 33

Is it possible to improve the release of information (ROI) workflow? This is a question that our HIM leadership team has grappled with for many years. While other areas within HIM operations have seen significant advancements over the past two decades, ROI seemed stuck in place, with few technical improvements available. At times, we felt that enhancing this vital area was simply not possible. However, it was time to rethink this workflow and make meaningful progress in this critical HIM function. I will share the changes our department implemented and the benefits we’ve realized since.

Let’s begin by reviewing some key operational improvements over the last 15 years. Paper records are now nearly obsolete. Gone are the days of rounding hospital units with squeaky carts, collecting stacks of paper charts (anyone remember those NICU charts?), and crosschecking discharge lists to ensure we had all records. HIM staff no longer contend with employees on units holding or hiding charts. The tedious process of pulling folders based on the last two digits of a medical record number, assembling the record, and hole-punching it is a thing of the past.

In chart completion, we’ve eliminated the need to flag records for doctors’ signatures or scramble to pull dozens of charts at a moment’s notice—only to be told the doctor was called away for an emergency surgery. We no longer spend time removing flags or updating deficiency tracking systems after physician reviews. These improvements have greatly streamlined workflows. But what about ROI?

We all know how crucial the ROI area is. As custodians of the legal medical record, HIM professionals must ensure records remain secure, accurate, and released promptly. While the shift from paper to electronic records has prompted some changes in ROI, the internal workflow itself had remained largely unchanged—unlike in scanning and chart completion. ROI staff found themselves overwhelmed by phone calls and emails, unable to fully focus on processing and releasing records. Much of their day was consumed answering inquiries about status updates or redirecting misrouted requests.

Following a merger with another hospital and successful implementation of an EMR system a few years ago, we were well-positioned with resources in chart completion and scanning. The new EMR created efficiencies that allowed us to optimize workflows in these areas. After extensive discussions, a realization dawned on us: ROI staff needed to focus on releasing records, free from constant external distractions.

A New Approach
Our plan was to leverage extra resources by creating a centralized “call center” to handle all inquiries. Previously, there was no central phone number or email for ROI; each hospital within our health system maintained separate contact information. The new coordinators would triage all incoming calls and emails routed to HIM. These coordinators would not be ROI staff but would be fully trained to assist callers, handle a wide range of questions, check request statuses, and provide real-time updates. They would also be trained to guide patients through accessing and requesting records via MyChart, including basic functions such as password resets. This new workflow would relieve ROI staff from daily calls and emails, allowing them to focus exclusively on processing and releasing medical records. Though promising, this was an entirely new approach and team. We had never implemented such a change in ROI before.

In January 2022, we began building this team. Our project leadership included the senior director of HIM, the director of HIM, the assistant director of system ROI, and the assistant director of HIM. Our goal was to hire a supervisor and six coordinators. We posted vacancies internally and received numerous applications. After many interviews focusing on organizational and communication skills, we selected our top candidates. The supervisor started in February, quickly developing a training manual covering policies, workflows, and frequently asked questions. He also collaborated with IT and telecommunications to create new email addresses, phone numbers, and a phone tree for proper call routing.

By early April 2022, staff were onboarded and began training. Clear communication would be critical to success—the coordinators would serve as liaisons with patients and ROI staff alike. By late April, the coordinator team was live. Phone lines and email systems had been thoroughly tested. As with any launch, we encountered unanticipated challenges—some requiring immediate adjustments, others needing IT fixes. Despite hurdles, we remained agile and learned along the way.

Since implementation, the coordinator team has been highly productive. Overall, our turnaround time has decreased significantly. ROI staff now report a major improvement, as they can fully focus on their core function: entering, processing, and releasing medical record requests. After years of distractions and inefficiencies, the workflow methods in ROI have finally been overhauled.

It is essential to regularly evaluate your internal workflows for improvement opportunities. Challenges and frustrations are inevitable, but persistence pays off. For example, one employee resigned just before go-live—yet, two years later, the team is thriving and continues to evolve.

After years of transformative changes in scanning and chart completion, we can finally add ROI to that list.

— Jordan S. Maliavsky, MPA, RHIA, is a health care administrator with over 20 years of leadership experience in HIM and hospital operations. As director of HIM at NYU Langone Health and an adjunct professor at NYU School of Professional Studies and CUNY School of Professional Studies, Maliavsky is passionate about advancing data integrity, process improvement, and the next generation of health care leaders.