Do you remember the days when release of information (ROI) was an area within your department stacked high with paper charts, rubber thumbs and industrial-strength photocopy machines? Or perhaps when the first desk-top scanners were introduced in the early 2000s? Since it was first outsourced in the 1970s, ROI processes and partnerships have experienced dramatic change. Paper and postage seem like ancient history as we welcome in automation, secure messaging and efficiency.

It is truly time for a fresh approach and new options for the ROI process. HIM departments from coast to coast are re-evaluating their ROI process in light of electronic medical records (EMRs), electronic delivery and environmental concerns. From new service and revenue sharing options with vendors, to RAC production databases and e-discovery mandates, this article explores the latest trends and possibilities for a least-favorite, but critically important HIM function--ROI.

New ROI Options in EMR Environments
As more hospitals are moving to EMRs, they are evaluating ROI options:

Bring ROI back in-house (re-insource)

Develop a "shared" approach: services, responsibilities and revenue

While bringing the ROI function back in-house is neither good nor bad, many EMR vendors are including recouped requestor fees in their return-on-investment calculations. Buyer beware--many requests are non-billable and the average payment received from the record requester is only between $20-$30 per transaction. Re-insourcing ROI usually means adding staff, adding processes and adding complications. As a result, it rarely delivers any real cash benefit to the organization's bottom line. Therefore, if re-insourcing ROI with an EMR is the preferred choice for an organization, it is important to carefully weigh all the costs and risks (Table 1).

The second new option available once an EMR is installed, is a flexible (shared) approach whereby some of the tasks are performed by hospital personnel and some of the tasks are outsourced. Many HIM directors are finding this shared-service approach is the best fit for their organizations.

Sharing the Load
According to Lynne Henderson, RHIA, corporate director of health information at Spartanburg Regional Health Care System in South Carolina, "when I looked at how many full time employees I would need to handle printing, envelope stuffing and mailing, plus the cost of toner, stamps and other materials, I realized that the cost/benefit rationale just wasn't there." With the shared-service approach Henderson's internal staff receives and validates requests and electronically pulls documents from McKesson Horizon Patient Folder (HPF) for upload to HealthPort. "We rely on HealthPort to handle all the back-office burdens and processing--including electronic delivery to requestors. We've taken huge amounts of paper out of the process and are supporting our hospital's going-green initiative," mentioned Henderson.

Saint Agnes Medical Center in Fresno, CA, also opted for a shared-service approach. Another HPF customer, Saint Agnes had in-sourced ROI for many years and believed the new system would provide significant efficiencies. However, the new technology only solved a piece of the problem. HIM staff was still responsible for collection calls, cash flow and a lot of paper production. Today the organization uses a combination of technology and outsourced services to complete the ROI process and deliver records to requestors electronically. "Our electronic medical record capabilities fit well with HealthPort's vision for a paperless ROI process, and complemented their centralized processing technology," mentioned Stacey Hansen, RHIT, CPC-H, HIM manager, systems and services.

Finally Halifax Regional Health System in Virginia found that the shared-services approach provides another important benefit--shared revenue! Once the organization's new document management system was installed, Cecelia Owen, RHIA, manager of health information services, and privacy officer, decided to out-task electronic delivery, invoicing and collecting to HealthPort. The revenue generated is shared between Halifax Regional and HealthPort. "In the past, we spent money every month to support the ROI function. Today we actually get revenue back in the form of a check. It is a completely new concept," concludes Owen. Sharing revenue isn't the only change ROI vendors have made; they are also sharing technology and personnel.

Go Ahead--Ask Your ROI Vendor to Do More
It is no surprise that the lack of qualified credentialed HIM professionals is a nationwide problem. In their 2004 report, the American Health Information Management Association (AHIMA) confirmed there are an insufficient number of certified processionals available to fill all the positions and roles requiring HIM competencies.¹ One way to combat work force shortages in HIM while meeting key performance indicators and compliance is to employ a remote work force. These remote workers can be hospital employees who work from home, outsourced professionals or a combination of both.