Release of Information: The Digitization of ROI
By Angela Rose, MHA, RHIA, CHPS, FAHIMA, and Anthony Murray, CISSP
For The Record
Vol. 35 No. 3 P. 5
Digital Release of Information: How to Shift Your HIM Teams
The health care industry has undergone a significant transformation with the widespread adoption of EHRs and the electronic exchange of patient information. In the wake of digitization, the release of information (ROI) process has also changed and will continue to advance for the foreseeable future.
The ROI process was forced to rapidly adapt during COVID-19. HIM departments closed and patient information requests were digitized via patient portals. Fast forward to 2023, and the ROI process continues to adapt. Today’s improvements are focused on digitization to address burgeoning payer requests and advancements in electronic clinical data exchange. Alongside these rapid advancements toward digitization, our obligation as HIM professionals remains sacrosanct: ensure high-quality data and protect patient privacy.
This article explores recent trends in the ROI process, the importance of digitization to support value-based care, and how the expansion of health information interoperability propels change in ROI workflows. It also provides suggestions on how to prepare your HIM department for the digitized ROI process ahead.
Five Insights from the Rearview Mirror
Following are five new trends in the ROI process:
1. There are tremendous increases in the volume of payer requests. Internal tracking at MRO, which is dedicated to accelerating clinical data exchange and is expert in release of information and health information disclosure, shows an estimated 36% increase in payer requests for information between 2021 and 2022.
2. The seasonality of payer requests to coincide with risk adjustment and Healthcare Effectiveness Data and Information Set (HEDIS) reviews is subsiding. Payer requests are becoming less seasonal and more constant. Consistent staffing and smarter technology to support these volumes are urgently needed.
3. New networks and relationships are being developed to automate the transfer of information. Health systems are expanding their corporate networks and tapping into health information exchanges instead of using traditional copy services and third-party chart chasers to do this work.
4. Digital patient information is becoming a commodity. As this occurs, the industry is seeking new ways to reduce the costs associated with record acquisition. This is especially true for payers and health plans.
5. Data quality, usability, and privacy have always been top priorities. But more is now demanded from our data amid rapidly expanding digital exchange. Quality and completeness of information must be maintained to ensure data usability and support each intended purpose or use case.
With these trends as the backdrop, consider why the digitization of ROI is an important and pressing issue for HIM leaders to address.
Digitized ROI Supports Value-Based Care
During the past two years, health care organizations have experienced an explosion in payer and health plan requests for medical records—primarily to support new value-based care models and reporting requirements. From HEDIS to risk adjustments, payers need greater access to specific and timely patient data from health care provider organizations.
And while many payer requests are submitted to authorize coverage or process claims, payers now need timely health information to proactively engage members and achieve value-based care goals. For example, health plans need provider data to identify rising risk members and quickly offer preventive interventions in collaboration with provider partners.
ROI teams bear the weight of this nascent explosion in payer requests. What was formerly HEDIS or other audit seasons is now an all-year-long surge in requests. Keeping up with these demands in manual, analog ways is untenable. However, providing ubiquitous payer or health plan access to your EHR compromises patient privacy and can inadvertently increase risk of additional payer denials. Digitization of the ROI process provides prompt relief for these concerns while ensuring payer requests are met within contractual response times and support value-based care.
The following are four essential benefits to consider:
• Electronic exchange of medical records between health care providers and payers or health plans reduces administrative burdens while protecting privacy.
• A digitized ROI process helps providers get reimbursed more quickly, improving cash flow and reducing the risk of financial strain.
• Value-based care models require both payer and provider to improve patient outcomes while reducing costs. Expedited information sharing supports both of these requirements.
• In a digital model, teams are shifted to higher value work, thereby improving careers and skills for the future.
Interoperability Requires Digitized ROI
Different EHR systems use different formats and protocols. This has made it difficult to exchange patient data effectively. However, remarkable progress is being made nationwide toward better health information interoperability.
Propelled forward by new standards and regulatory initiatives such as the 21st Century Cures Act, Information Blocking Rules, FHIR, the Trusted Exchange Framework and Common Agreement, and Qualified Health Information Networks, interoperability is no longer a distant dream. It’s here now—happening faster and with greater volumes of clinical data than ever before. What does this mean for ROI?
Immediate Impacts on ROI Staff
Just as transcription moved typists to speech editors, ROI staff are experiencing a shift from manual to automated processes. One example is the logging of requests. Instead of manually logging requests, ROI staff in digitized environments monitor the output of electronic request logs created by automated systems.
In this scenario, the ROI staff serve as human oversight of electronic systems. They apply trained and experienced human intelligence to review and compare what was captured by the technology to the actual document. If all is correct, requests move to the next phase—fulfillment. During ROI fulfillment, smart technology pulls the correct documents electronically based on the verified request. ROI staff again provide oversight to ensure the right information is pulled from EHRs and other systems and properly collated for each specific request.
Greater staff efficiency is achieved through the automation of ROI processes. Staff are upskilled to provide the human intelligence required for optimal quality and accuracy. Yet amid all the various forms of ROI automation, quality and privacy remain paramount.
Quality and Privacy Must Be Maintained
Data errors are nothing new in health care. We had our share of them in the paper world. But the rate at which errors can now be copied, pasted, exchanged, and duplicated is a tremendous challenge. This emphasizes the important role of trained ROI specialists and other HIM professionals to accurately check, validate, and manage information sharing.
For example, when fewer human experts are reviewing the requested information going out, how do you track, count, and measure all the requests? Systems must be capable of tracking ROI activity, including volumes, purpose of the requests, and which requesters are receiving the information.
Business engine rules should also understand the complexities of ROI and address varying regulatory requirements by state, requester, and service type. Data must be cataloged, tagged, and stored so that health care organizations know the location and specific definition of each data element. One example is reproductive health records and the need to keep them private and secure.
In the past, reproductive records weren’t a consideration for additional rules or processes. However, this newly protected information is spread out amongst the entire medical record. It is comingled across a person’s medical history. Reproductive information isn’t siloed in one report or document but rather mentioned in nearly every medical note. This information should be segmented and protected, but it takes health information know-how to get the job done.
Data quality and privacy requirements continue to emphasize the need for expanded technical knowledge requirements within the health information profession.
Health Information Expertise Alongside ROI Innovation
Health information professionals have innate knowledge of data complexities, including tagging, logging, and categorizing. They must be involved as IT partners. This includes EHR implementations, preparing and updating documentation templates, and making decisions regarding interoperability and clinical data exchange.
With the five goals of innovation in mind, health information leaders must consider whether ROI positions can be adjusted. Can teams be upskilled to move from manual to digital tasks? And finally, what new certifications may be available as career ladders for health information teams?
Health information roles are shifting left. Our expertise is becoming more valuable on the front end of data capture and clinical data exchange to ensure quality throughout the process and to support back-end workflows. Health care data aren’t perfect yet, but they’re dramatically improved from the era of manual, analog workflows. The ROI process is just one beneficiary of these advancements.
— Angela Rose, MHA, RHIA, CHPS, FAHIMA, vice president of client success at MRO, and Anthony Murray, CISSP, chief interoperability officer at MRO, are both tenured industry experts at MRO (www.MROcorp.com), accelerating clinical data exchange. MRO is leading the movement to digitize release of information, with the most recent release of its Payer Exchange offering, a fully automated end-to-end solution utilizing FHIR and proprietary technologies to streamline the movement of high-volume, high-fidelity record requests between providers and commercial requesters.
The Five Pillars of Innovation in Health Information
1. Drive down cost of health care by improving efficiency through new technology.
2. Create repeatable, accurate processes. Computers are vital here.
3. Free staff for greater productivity. Focus on the most important goals for our organizations to accomplish, including improved patient care and patient experience.
4. Ensure scalability of innovation to accommodate peaks and valleys in volume and ability to flex staffing.
5. Improve performance by reducing the time it takes from instigation to delivery. For the release of information process, this is time from request intake to secure information delivery.