Thousands of times a day, at health systems throughout the US, workers manually search for patient medical charts, print them out on paper, or save them to a file—and then fax, mail, or email them to a payer or third party who has requested it. The productivity for this often manual approach is about five charts an hour per worker, and the average cost to retrieve a medical record varies by state, health system, and the number of pages. The cost per medical record ranges from about $25 to upwards of $100. Not only is this expensive, it’s also not exactly accurate or efficient. On average, it takes about three weeks for a requested chart to be delivered.
Even with advances in interoperability, retrieval of records is still moving, too often, at the speed of paper. This means that payments from payers to providers may also be moving slower than necessary. And at the same time, much of the metadata contained in those records, including data crucial for risk adjustment, HEDIS, denials, prior authorizations, and other important priorities, remain trapped—on paper or in a format that does not readily work for payers. How can we unlock these records?
Increasingly, providers and payers are automating the release of information (ROI) process. The best digital ROI solutions can improve the average backlog of requests from more than 21 days to less than seven. They offer improved accuracy, with average patient-member match rates of more than 90%. This means that payers get the data they need quickly, eliminating time-consuming follow-ups. They’re fast, processing thousands of charts in a matter of minutes, directly from the EHR. These solutions enable an increased patient focus by eliminating HEDIS and risk adjustment backlogs, so the staff can respond to patient and continuation of care requests in a timelier manner. Finally, they enable optimized staffing; without the need to pull in clinical staff or temporary staff during seasonal spikes, workloads are balanced, and resources are focused on more high-value patient-centric initiatives.
Why are providers still pulling charts manually? Part of it is inertia, because “that’s the way it’s always been done.” But the big challenge is that electronic health record systems were not designed to electronically share data in a form that is automatically useable by payers and other authorized parties. Despite much progress in interoperability between EHRs, providers have special needs that are not always met by existing technology. For example, providers may need to share part of a patient’s clinical record but not wish to share all of it. So special controls are needed to set what is shared with each player, and what is not. Moreover, highly evolved APIs are required for automating this process. Chart retrieval APIs need to ingest release of information (ROI) requests and search EHRs to uncover rich, contextual clinical data that support payment and operations use cases, comply with unique release restrictions, and then securely deliver that data in the preferred format.
What are the critical qualities providers should look for in digital ROI solutions? For starters, it needs to comply with a provider’s current policies and procedures as well as state and national regulations—and be flexible as these evolve. It also needs to be scalable and neutral, working with as many requestors as possible. Providers should have full visibility
into the requests, from who is requesting and for what purpose as well as the status. It should also report on the requests that are fulfilled and completed. This transparency allows the providers to remain in control and better manage their payer commitments.
Privacy and security concerns are paramount. Strictly defined access controls are required to reflect unique provider preferences and release restrictions to support minimum necessary data exchange. The solution must be HIPAA-compliant, SOC 2 Type II audited, and fully auditable.
A digital solution should seamlessly integrate with a provider’s EHR. For example, does the vendor use APIs approved by the provider’s EHR? If the EHR has a program for third-party connectors, like Cerner’s code Developer Platform or Epic’s App Orchard, the vendor should be participating in those programs. A digital solution vendor should be transparent and willing to connect to as many payers as possible. Does the vendor partner have direct connections with the payers? How often does the vendor update the payer on status of chart requests?
A good digital vendor should have a great track record in customer support. Providers should seek a vendor committed to their success—beginning with implementation and after they go live, by providing them with a seasoned team that can troubleshoot and advises them every step of the way. Finally, work with a vendor who can share the results of an external audit. External audits demonstrate that a vendor can be trusted to facilitate the exchange of clinical data. If a vendor hasn’t been audited, find out why.
Digital ROI solutions offer a faster, more accurate, and cost-effective approach than inefficient manual methods. These solutions also facilitate the rapid exchange of the information needed for risk adjustment, HEDIS, payment integrity, and other priorities. The result is an easier collaboration between payers and providers, enhanced capacity to support large volumes of requests, and a long overdue reduction in administrative costs.
About Beth Zuehlke
Beth Zuehlke is the Chief Customer Officer at Moxe Health, a company that leverages technology to improve and simplify the sharing of clinical information and critical insights between payer and provider organizations. Beth works closely with our customers to ensure we deliver solutions that support their strategic objectives and drive better healthcare outcomes. She brings more than 20 years of experience in healthcare technology, consulting, project management, and sales. Beth got her start in healthcare IT at Epic and has held leadership roles at Evergreen Healthcare Partners and healthfinch. She can be reached at firstname.lastname@example.org.