It's a fairly large volume of requests, more than 80,000 annually, says Margaret Verity, administrative director of HIM and medical transcription. "The size of the file released may range from just a few pages to several thousand," she says. "More and more, patients want to see their record. And insurance companies want to be prudent about what they are paying out."
Prior to the spring of 2009, Florida Hospital outsourced the entire ROI workflow to HealthPort, an Alpharetta, Ga.-based software and services firm. HealthPort (and its various corporate precursors) had played the role since the mid-90s. But the advent of the EHR, from Cerner, in 2007, set the stage for change.
Replacing a paper chart which was housed at each campus, the Cerner system enabled enterprisewide chart access. In addition, Florida Hospital centralized its HIM department, putting many of the department's 210 employees under one roof. "By 2009, we were used to change," Verity says. "The new arrangement gave the department the opportunity to grow and learn something new."
It also enabled Florida Hospital-part of Adventist Health Systems-to keep a large chunk of the change it once turned over to HealthPort. The vendor's not entirely out of the picture, however. Under the current arrangement, Verity's crew fields the ROI requests, then identifies the portions of the record to release, and calculates the cost to the requestor.
Through a secure file transfer, it ships a PDF of the portions of the EHR needed to fulfill the request to HealthPort (the vendor lacks direct access to the EHR, although it set up the file transfer infrastructure). HealthPort, in turn, prints the files, mails them out, bills and collects for the services.
Florida Hospital staff-which include a handful Verity hired from HealthPort during the transition-can track the status of ROI requests and expected delivery dates online. "We do not have the expertise to do the billing," says Verity, who declines to disclose any of the financial terms of the revised outsourcing arrangement. "It's not a ton of money, but it establishes HIM as a revenue center. I've always said we had the volume to make it worthwhile."
In addition to recouping part of the cash flow it once turned over to HealthPort, Florida Hospital now has better control over customer service. "If we did not like the way HealthPort staff was interacting with our patients, we had no control over it," she says. "So we do the front-end, and they do the back-end. For us, it was a win-win."
The Cerner system functions as the central repository for all records. About 60 percent of the chart comprises scanned documents, with the rest of the information originating as electronic data, native to Cerner. "The ER visit is mostly electronic," Verity adds.
To handle the large volume of ROI requests, Verity assigns one staff person at each of the eight campuses to field requests directly from patients. The health system's Orlando campus, for example, has some 20 to 30 patients walk in every day with a request for part of their chart.
"Most people requesting a chart know the main buckets," Verity notes. "They will ask for the discharge summary, the nurses' notes, or the physicians' notes."
In certain cases, the local staff might fulfill the release of information request on the spot, but most are sent on to Verity's centralized HIM department in Altamont Springs. The hospital charges $1 per page, except for requests related to continuing care at another hospital, which are free per state law, Verity adds. "If it looks like a large fee, we will call the requestor and let them know," she says.
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