Managing External Reviewer
Requests in the EHR
Considerations, Requirements, and Associated Expenses
By Lou Ann Wiedemann, MS, RHIA, FAHIMA, CPEHR
MANAGING THIRD-PART Y requests for health information is a routine function for every HIM department. HIM professionals regularly receive record requests from third parties for a variety of reasons, such as revenue integrity audits or admission validation reviews. Historically, fulfilling these requests required labor-intensive processes that included locating the record, copying pieces of paper, and mailing the record to an off-site reviewer. Today, requesters are asking for electronic access to organizations’ electronic health records (EHRs). In today’s HIM department it is impractical to continue the labor-intensive manual processes associated with
paper records. However, electronic access to health records
provides new concerns. Before providing access to their EHRs,
organizations must review the considerations, requirements,
and expenses associated with providing electronic access to
third-party requests.
Note: requests from external reviewers should not be
confused with a patient request for electronic access. Under
the HITECH Act patients may request electronic access to
their health records, and organizations must strive to reassess
current system functionality to meet that request.
The Considerations
HIM professionals first should consider how the record is
comprised. If the organization is operating with a hybrid
record (i.e., the record is comprised of both paper and
electronic components), providing a complete and accurate
record electronically may be difficult.
In these instances, organizations may choose to print
electronic components and copy paper components to produce
a complete and accurate paper record. The alternative is to
provide electronic access for the EHR components and copies
of the hard-copy paper record, which can be time-consuming
and difficult.
In addition, the organization should clearly define its legal
health record. This will establish the basic information that
will be released in response to third-party requests.
Organizations also should consider their system’s ability
to transfer information to electronic media such as a CD or
thumb drive. Organizations with systems that can transfer
information to electronic media can then provide copies of
health records in a format other than paper. These formats
are becoming more common practice as more information is
created and maintained electronically.
Establishing Limited Access
If an organization has an EHR or is utilizing a document
imaging system as a bridge to an EHR, it may choose to
provide limited access to the outside reviewer. This ensures
that reviewers see only the records listed on their request.
Reviewers can then review records electronically either on site
or remotely.
To assist in the review process some HIM departments
choose to develop reviewer queues populated with the
requested records. Depending on system capabilities the
HIM department can populate the work queue manually or
automatically.
For example, if all patients with Medicare Advantage are
reviewed for medical necessity, the system can search for the
insurance type and populate the queue based on the discharge
date. Records remain in the queue for a specific time period,
