choice. The facility or an outsourced ROI service company can
deliver the requested information through electronic means,
such as a Web portal for secure download, PDF file, CD, or
thumb drive.
Revisiting ROI Workflow
Meeting the meaningful use measure requires HIM
professionals track the flow of ROI diligently, including
who requested the information, when the information was
requested, who received the information, and when it was
received. Further, they must ensure that the record (including
the discharge summary for hospitals) is completed within
three business days following the patient request.
HIM directors should implement these steps now in
conjunction with internal ROI management and any
outsourced partners.
HIM professionals also must determine which records are
stored in a certified EHR and thus eligible for the meaningful
use program. There may be workflow issues associated
with completing the record within three business days of
the patient’s request, particularly if the patient requests an
electronic copy upon discharge.
For instance, facilities may be challenged to complete all
documentation quickly following discharge to allow sufficient
time for the release of information within three business days,
particularly if multiple departments are involved. Record
completion issues will require clinician involvement and
high-level executive support.
Regardless of the depth and breadth of an organization’s
EHR, some information may always be stored outside the EHR,
such as e-mail, which may be part of the designated record set
but not stored in other systems associated with sophisticated
medical technology like radiology. The goal of implementing
an EHR is to get patient information into the system and use
it to support clinical processes. On the other hand, ROI has a
broader goal of distributing and controlling information. HIM
professionals must automate and verify their organization’s
ROI process.
Optional: Timely Electronic Access
The objective to provide patient access to an electronic health
record is an optional menu objective for eligible providers and
is not required of hospitals at this time.
Timely patient access to health information refers to the
patient’s ability to access his or her electronic record within
four business days of a healthcare encounter. It is probably
best accomplished via patient portal technology that allows
secure viewing by patients.
Eligible professionals should not allow direct patient access
to the EHR due to the privacy and security risks. Further, while
the electronic access objective mentions only a subset of the
EHR (lab results, problem list, medication lists, medication
allergies and brief encounter details), HIPAA requires
ROI Stage 1 Objectives
TWO OBJECTIVES IN the first stage of the meaningful use
program have a major impact on an organization’s release of
information functions.
OBJECTIVE
Electronic Copy:
On request, provide patients
with an electronic copy of their
health information (including
diagnostic test results, problem
list, medication lists, medication
allergies, and for hospitals,
discharge summary and
procedures).
Timely Electronic Access:
Provide patients with timely
electronic access to their health
information (including laboratory
results, problem list, medication
lists, medication allergies).
More than 10% of patients had
access to up-to-date information
within 4 business days.
MEASURE
More than 50% of requests
within 3 business days
organizations grant patient access to medical records except
specific items the provider judges to be potentially harmful to
the patient.
This objective has a very low threshold for incentive payment
in stage 1, requiring that only 10 percent of all EHR patients with
encounters receive access within the four-day time frame. The
final rule indicates the bar was set low because many patients
may not have Internet access or be able or interested in using
a patient portal.
HIM professionals must be involved in establishing,
managing, and monitoring a patient portal. Most physician
systems will need to be upgraded to meet this objective and
establish an effective patient portal.
Meaningful Use as Driver for ROI
The meaningful use requirements related to ROI are intended
to increase the engagement of patients and their families in
their own healthcare, thereby achieving a goal of improved
wellness.
In both current and future ROI environments, there is a need
to balance provider control, privacy, security, and audit trails
with the benefits achieved by providing patients access to
their own health information. The ability to capture incentive
payments in year 1, while difficult, is achievable, particularly
when HIM professionals get engaged and involved. ¢
Steve Emery ( steven.emery@healthport.com) is director of product
management and Jan McDavid ( jan.mcdavid@healthport.com) is a
compliance officer and general counsel at HealthPort.
