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The Disconnect Between Patient Experience and Records Requests – HIM Scene

Posted on April 19, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the HIM Series of blog posts. If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

This week I met with one of the digital marketing team at a children’s hospital. We had a great conversation about the hospital website and the way the hospital’s website represented the organization to the patient. Plus, we talked about how patients choose to interact with the hospital through their website. There are a wide variety of patient requests through the website, but one of those requests was a request for their patient record.

It wasn’t really a surprise that this digital marketer didn’t really know the details of what’s required for a patient to make an appropriate medical record request from his hospital. In his defense, he didn’t usually answer the questions, but just created the website that collected the questions. However, it was quite clear that the workflow for any medical records request was to send it to their HIM department and let them figure it out.

Most organization then have their HIM staff play phone tag with the patient to explain how to make a proper records request which will allow them to release the information to the patient. The progressive organizations might send the patient an email. However, many of them will then ask the patient to mail, drop off or fax in the official records request. If this sounds painful, I can assure you that it’s as painful as it sounds.

This illustrates the massive disconnect between creating a great patient experience and most organization’s current records request process. Please note that I’m not blaming the digital team at hospitals for the issue and I’m not blaming the HIM people for this problem. I’m blaming the disconnect between the two organizations because the only way to solve this problem is to have both organizations involved.

The best patient experience would actually be for the patient to go to their patient portal and download their whole record. Maybe we’ll get their one day, but there are hundreds of systems in a hospital where a patient’s data is stored. So, it’s going to take a while for us to reach the point where a patient can self-service their data requests.

Since I’m not holding my breath on this amount of data sharing happening between disparate systems, I’m more interested in making the current processes so it’s a seamless experience for the patient. If you can model a medical records request on paper, then you can do it digitally. To their credit, I’ve seen a few organizations working on this. In fact, their system is part education about records requests and part getting the information that’s needed to fulfill a records request.

It’s time that HIM and a hospital’s digital and tech teams come together to make the process for requesting records a seamless patient experience. And if you think using a fax machine is a seamless experience for patients, then you’re part of the problem.

If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

The Cost of Encouraging Patient Engagement

Posted on June 15, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

We all know that healthcare providers want to encourage patient engagement to ensure patients have the information they need to manage conditions and share information with other providers. There has been a longstanding push for the adoption and maintenance of personal health records for many years to give patients the power to share and disseminate information wherever it is needed. We have seen a remarkable new interest in this with Meaningful Use and population health initiatives. Since HIM professionals are charged with maintaining and producing legal copies of records, we are aware that the tasks surrounding these processes can be very expensive. This is especially true if any of the tasks are not handled properly and breaches of protected information occur.

My concern is that lately I have heard many discussions that are pushing for more access yet with fewer costs to patients to encourage patient engagement. Some are even pushing for patients to have “free” access to records- paper or electronic. Don’t get me wrong, I am a huge proponent for patients having copies of their records and I personally keep copies of my own records. The Office of Civil Rights (OCR) recently published further guidance on charging for records. In a nutshell, the OCR says: “copying fees should be reasonable. They may include the cost of labor for creating and delivering electronic or paper copies; the cost of supplies, including paper and portable media such as CDs or USB drives; and the cost of postage when copies of records are mailed to patients at their request.” The OCR actually has the authority to audit the costs of producing records if they feel your organization is violating this patient right and overcharging for release of information.

Living in a state such as Florida where the state law has allowed facilities to charge up to $1 per page means most facilities have charged $1 per page without blinking an eye. The latest OCR guidance has led to questioning if that amount is actually “reasonable” or true to cost. Afterall, HIM professionals must use expensive systems, supplies, and labor costs to produce these records. Many organizations have outsourced release of information functions (another cost) but it is still the responsibility of the custodian of records to oversee the processes for compliance.

That being said, it is beneficial for HIM departments to evaluate the expenses and methods used to produce records as technologies and laws change. Dr. Karen Desalvo of the Office of the National Coordinator (ONC) strives to lead the EMR interoperability movement. At the top of the ONC’s list of commitments is consumer access to records. HIM professionals should continue to assist in the quest for interoperability and electronic data sharing at the notion of patient engagement. We must lead patients to use EMR patient portals and facilitate the efficient electronic data sharing among healthcare providers. We must be creative in lowering overhead costs to produce and maintain the records in order to ensure costs are affordable for healthcare consumers. There will always be costs associated with this important task, whether on the provider’s end or the patient’s end, just as costs are incurred with most services or products in every industry.

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

HIM Professionals and the Patient Portal

Posted on October 21, 2015 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

One of the hot topics in healthcare that has been consistently developing and growing over the past few years is the patient portal. Since many different EMRs and portal platforms are used across hospitals and physician offices, each facility is left to develop policies and procedures for what will be released through the portals and how they will be used. There are no specific standards for patient portals, aside from those needed to meet Meaningful Use requirements, which results in different experiences and functionality for end users.

HIM involvement with patient portal implementations has been a little spotty over the years from what I gather from my peers. I heard someone say we “missed the boat” on patient portals. I don’t necessarily agree but I do see inconsistencies in the level of HIM involvement. When it comes to developing policies governing the content that will be released through the portal, HIM professionals are the experts on this initiative. HIM professionals have always been the stewards of the medical record and keeping release of information processes secure and appropriate. There has been a focus on encouraging patients to keep a personal health record long before EMRs and patient portals came to exist. So how could some HIM professionals get left out of the patient portal process?

My first assumption is that patient portals came to exist mostly, although not solely, as a result of Meaningful Use initiatives. If you have had similar experiences to mine, you have witnessed Meaningful Use initiatives typically being handled by IT professionals. As a result, patient portals have fallen under that umbrella from a technology standpoint but I see great opportunities for HIM professionals to be involved to optimize the content shared for the end users. Since the main intent of patient portals is to encourage patients to be engaged in their own care, these portal initiatives have much more benefit beyond attesting to Meaningful Use and should be incorporated into organizational strategic plans for patient engagement.

There has been a lot of discussion around the struggle of increasing patient portal participation. A common factor in patient portal adoption is the lack of patient competencies in using the technology involved. Some patient populations do not frequently use computers, email, or mobile applications which are all a part of the patient portal functionality. To address this at my facility, we created a position within the HIM department to coordinate all patient portal functions including enhancing the user experience by creating frequently asked questions and answers, troubleshooting issues that patients may have when attempting to login, and resetting portal passwords as needed among many other initiatives. Policies were developed to address who can have access to the portal information, how the patients confirm their identity to log in, what is released, and the duration of the availability of the information. We have an interdisciplinary team that contributes to the patient portal process but having the point person reside in the HIM department makes the most sense for governing the entire concept.

One thing to remember is that patient portals do not eliminate the need for traditional release of information processes because we release information to many different requestors for different purposes. The portal does not include every patient document due to the sensitive nature of some results therefore requests for entire charts and abstracts are still necessary in some cases. Patients should participate in the portal for the personal benefit of being proactive in their own healthcare but they should not expect it to replace release of information. I encourage HIM professionals to be involved in the patient portal process in an administrative capacity. The strides made with patient portal optimization are key in optimizing the transition to health information exchange (HIE) concepts which also require heavy HIM involvement.

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

Why Can’t Release of Records Be Automated Through A Patient Portal?

Posted on March 31, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was in a recent discussion with one of the leading providers of release of information services, HealthPort about EHR’s impact on the release of health records. In our discussion, I asked why the release of health records can’t be completely automated through a patient portal. In my mind, meaningful use is requiring that healthcare organizations put a patient’s record up on a patient portal, so shouldn’t that mean that the release and disclosure of patient records would become obsolete?

Of course, I was applying a limited view to what’s required when a disclosure happens and who is making the records request. In most cases, it’s not the patient requesting the record and these third parties don’t have access to the patient’s portal. Plus, the release and disclosure of patient records often requires accessing multiple systems along with assessing which information is appropriately included in the disclosure. The former is a challenge that can be solved, but the later is a complex beast that’s full of nuance.

In order to clarify some of these challenges and explain why a patient portal won’t replace all records requests, here’s a short interview with Jan McDavid, Esq., General Counsel at HealthPort.

Q: What are HIPAA requirements around “charging” for copies of records, and what are considered “reasonable” costs?

A: HIPAA is very clear that its pricing applies only to copies provided to “individuals,, which HIPAA defines as the person who receives treatment—the patient. HIPAA guidance pertains only to patient requests for medical records, approximately seven percent of all requests received by healthcare providers.

The majority of records are requested by physicians for continuing care, governments for entitlement benefits, insurers, and inquiries from attorneys, according to internal data from HealthPort’s 2014 record release activity nationwide.

Within the realm of patient requests, providers can charge patients no more than their labor costs to produce the record, plus supplies and shipping. No upfront fee to search or retrieve records may be charged to patients.

Q: Why shouldn’t records just be free now that they are electronic?

While many believe the cost to produce records should be negated once information is digital, there are misperceptions and logistics that must be understood. The process of disclosure management (release of information) involves many steps that still require human intelligence and intervention—especially on the front end of the process (receiving, validating and approving the request). Here are three examples:

  • The authorization must be adhered to strictly, which often requires contacting the requester and explaining that some of the records they requested may not be available, or may require very specific patient authorization.
  • Information is commonly pulled together from multiple sources and systems (paper and electronic) to fulfill a request. While providers are working toward completely electronic environments, almost all still have a combination of paper and electronic. Depending on who makes the request, every single page of a record may require review.
  • Staff releasing records must be trained on HIPAA, HITECH, the Omnibus Rule, state and federal subpoena requirements, and specific state and federal laws for drug, alcohol, HIV/AIDS, mental health, cancer, genetics, minors, pregnancy, etc.

Q: If the EHR is in the portal, what other records aren’t in the EHR that HIM staff has been aggregating in a records request?

A: Not all patient information is automatically included within the patient portal view, nor should it be. Each provider organization determines what EHR information is posted to the portal and what patients can do within the portal (e.g. requesting refills, scheduling appointments, viewing lab results, etc.). HIM experts are key in these decisions.