Spartanburg Straightens Out Document Fulfillment Process

MargaretAnn Cross, Contributing Editor
Health Data Management Magazine, July 2007

For hospitals and clinics alike, responding to requests from patients, attorneys and insurance companies for copies of treatment documents and other information contained in medical records can be a time-consuming, cumbersome and costly process. One hospital discovered that by outsourcing some, but not all, of the necessary tasks, it could greatly streamline the process and minimize the cost.

When 559-bed Spartanburg (S.C.) Regional Medical Center rolled out a comprehensive electronic medical records system, it became much easier to fulfill requests for copies of medical records. Locating a record on a computer system and printing it out took much less time than pulling a paper file and making a copy or printing a record from archived microfiche. Turnaround time went from 30 days to three days.

Yet the requestors and an outsourcing company that handled the fulfillment process for Spartanburg were the only ones benefiting from the change. The medical center was still operating under the same contract it had with the outsourcer before the inpatient electronic record system was put in place, with the hospital receiving about $4 for each medical record the outsourcing company sent out.

"As things evolved, we realized that the outsourcing agreement no longer made a lot of sense," says Lynne Henderson, corporate director of health informatics at Spartanburg Regional Healthcare System. "We had purchased a computer system that made it very easy to release information, but we were still only getting the minimal payment that we always received."

Spartanburg worked with the outsourcer, Alpharetta, Ga.-based Smart Document Solutions, to use the electronic record to redesign the release-of-information process and earn more money for the hospital. Spartanburg now receives a percentage of the revenue collected from individuals and companies paying for copies of medical records. That revenue is higher than the $4 per record Spartanburg used to earn and is a significant benefit to the delivery system, Henderson says, though she declined to give specific figures.

The effort is a good example of how hospitals are looking for ways to get additional value from computer-based patient information, says Erica Drazen, vice president at First Consulting Group, a Long Beach, Calif.-based health care information technology consulting firm.

"Obviously, hospitals are implementing these applications to deliver the safest, highest quality care possible, so a lot of effort has to go into making sure you realize those clinical benefits. But providers that have been at this for a while, like Spartanburg, have the luxury of looking at other opportunities. This is part of a general trend for hospitals to really make sure that they extract value from the investment they are making."

ROI Redesign

Before the redesign of the release-of-information process, Smart Document Solutions had staff members on-site in the hospital's medical records department to fulfill requests. Before the electronic record was implemented, the outsourcer's employees located the paper chart, made a copy, and mailed it to the requestor. Smart Document Solutions also handled all billing and collections for providing these documents.

Once Spartanburg implemented an electronic document imaging and management system and other electronic record components from San Francisco-based McKesson Corp., on-site SDS employees were given access to the computer system so they could print copies of the records.

When Spartanburg approached Smart Document Solutions about making a change, a whole new process emerged. The vendor took its employees out of Spartanburg's medical records department and worked with the hospital to deploy its SmartPartner software. The software is designed to enable hospitals to scan paper files into the system or transfer files directly from an electronic record. Spartanburg was the first hospital to use the software with an electronic record application.

Today, two of Spartanburg's medical records employees, both release-of-information specialists, handle the requests. They ensure that each request that comes in has all of the elements required by the Health Insurance Portability & Accountability.

How It Works

They scan the request and the authorization form that is signed by the patient, locate the medical record, and transfer the patient chart and the scanned request into the SDS system, which is on their computers. SDS then downloads the information using a secure Internet connection, prints and mails the patient records, bills the requestors, and processes payments.

When a request comes in for a medical record that predates the electronic record-about five per week-Spartanburg employees locate the chart on microfiche, print a copy, and mail it to SDS. The hospital considered using technology that would enable employees to scan and transfer the microfiche records electronically, but decided that it took less time to print the records.

Because Spartanburg was the first to work with SDS to transmit records electronically into the SDS system, it had to work closely with the vendor-and be patient-to make it happen, Henderson says.

"Our biggest obstacle was getting the software to connect the way it was supposed to," Henderson says. "We kept our information technology department involved, and they worked with SDS to make sure that everything was secure."

In the new process, Spartanburg has taken on a larger role in completing release-of-information requests. But scanning the request, locating a record online and uploading it to the SDS software takes less than 15 minutes, depending on the file size of the medical record, and the revenue makes that worthwhile, Henderson says.

She decided to continue outsourcing mailing, billing and collections to SDS, however, because she did not want to hire additional employees. Spartanburg was able to take on the part of the job that the electronic record made easier, leaving the rest for SDS.

"If we brought the whole process in-house, we would have had to add at least two or three FTEs," Henderson says. "I didn't want to contribute to the number of FTEs per patient discharge, so we figured out a way to efficiently get the work done in a timely manner without adding staff."

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