Customized services strengthen a true partnership

The shared services model for release-of-information (ROI) processing helps Lehigh Valley leverage its EMR
and capture more benefits

By Zelda Greene, MS, RHIT
Administrator, Health Information Management
Lehigh Valley Hospital and Health Network

With three major campuses and one of the largest teaching facilities in Pennsylvania, Lehigh Valley Hospital and Health Network (LVHN), headquartered in Allentown, Pennsylvania, is very much a community-based institution.

We’re proud of our hospital’s century of innovation and our status as a progressive teaching center, but we also
realize that we need to be a full-service provider. We’ve carefully customized the specialties and healthcare services
we provide to better serve our community in general, so our residents do not have to travel to Philadelphia or other
major cities for care.

When we partner with other organizations, we look for a similar willingness to get involved, adapt to the need, and customize solutions. While upgrading our release-of-information (ROI) processing, we found just such a partner in
MRO Corporation.

Multiple ROI objectives

At Lehigh Valley, we’ve had an electronic medical record (EMR) system in place for about ten years, gradually integrating information systems and moving away from paper. For many years, we wanted to take advantage of the fact that so much data is readily accessible by bringing ROI request processing in-house.

As well as leveraging our investment in the EMR, locating medical records is much simpler than in a paper-based environment– no photocopying or scanning is necessary so it made business sense to move that part of the ROI process in-house. In such a transition, there would be no real cost involved with making better use of the EMR. In addition, LVHN would capture a share of the revenue from billable ROI requests, which had been going to an outsourced ROI vendor that maintained an on-site presence.

Beyond capitalizing on the efficiencies of our EMR, our second objective was to reduce turnaround times for our customers. As with any business function, ROI fulfillment merits professionalism, not delays that our customers measure in weeks.

A third objective arose in response to the increasing volume of ROI requests that are regulatory in nature. It’s becoming more common for providers to contract with other companies to review medical records for appropriate billing. We simply wanted more control over the process. Though we had no reason to suspect our outsourced vendor was not handling requests appropriately, we felt we needed more internal control regarding legal and compliance medical record requests.

Yet another objective we identified was to reduce the number of staff focused on fulfilling ROI requests. We did not want to merely duplicate the existing workflow our traditional outsourced vendor was using. We wanted to apply a new model and expedite the process.

Among all of these positive objectives, we had a negative one. We did not want to manage the billing, fulfillment and customer service components.

Bringing ROI Online

In 2005, we made the decision to go ahead with bringing ROI in-house. Not many companies offered the partnership we sought in handling the collections end of ROI processing, and we realized that we were looking for a unique concept at the time. Releasing an RFP didn’t make sense, so we relied on professional association resources, online research, and our own literature reviews to conduct our search.

We soon came across MRO Corporation and their ROI Online solution. There were not many other companies offering a service like theirs, a “shared services” model that combines software and off-site resources.

We ultimately went live with ROI Online in December 2005. Now, we separate our requests into non-billable, which we handle on site, and billable, which are processed by ROI Online. We log requests in the ROI Online software. Using our EMR, we locate the required information and transmit it, via ROI Online, to the MRO offices via a simple print driver installed on our existing systems.

After we’ve completed these “front-end” tasks, the folks at MRO take it from there. They verify that the information is correct; monitor regulations that determine fees and apply them appropriately; generate invoices; track payments; verify addresses and mail records in the required format or on the requested media; and handle phone calls from requesting parties or their record retrieval agents.

MRO takes care of the tasks we wouldn’t want to do. In addition, they offer some services we couldn’t, such as a Web site requesters can use to track request status.

Customized for success

Early in the transition, it became apparent to us that MRO was a mid-sized company and very approachable. They had high-level staff who became involved with our organization. They got to know us very well, and that was invaluable because it turned out that we would be asking a lot of them in terms of customization.

This has been one of the biggest advantages with MRO. They’ve been willing to customize a solution for us every step of the way. We didn”t have to retrofit our processes to work with theirs.

Neither a canned product nor a traditional service, ROI Online allowed us to do things like find a way for billable customer service inquiries go directly to them rather than requiring us to re-direct calls.

Because security is such a hot button for us, they worked closely with our IT group to ensure data confidentiality
and integrity.

And specifically at our request, they developed a method for us to document all ROI activity in our EMR. After MRO completes a request, the ROI Online system transmits a disposition report back to our EMR. It automatically becomes a permanent part of the record, providing all the details of the transaction.

MROs flexibility extended into other important areas. When our outsourced vendor’s contract ended, we weren’t quite ready for the transition internally. So MRO actually staffed our ROI operation for three or four months. When we were ready, they trained our people and helped us develop policies and procedures.

A successful partnership

We are leveraging our EMR and managing ROI requests in house, and we’re now doing it with an average turnaround time of five days. Whereas our outsourced vendor used five people on-site, we now dedicate just two staff members to ROI and have become a revenue generating department.

We also have transparency. We know everything about our ROI processing operation. While outsourced, we were not involved in the level of our ROI volume. ROI Online has showed us our true volumes, which are higher than we originally projected. In fact, MRO updated our contract accordingly — to our advantage.

The entire project was essentially cost neutral because, outside of a couple of scanners for the occasional paper record, we used existing hardware and staff. On the other hand, it’s revenue positive in that we now enjoy a significant share of the ROI fees.

All of this and we have not received a single service-related complaint since we partnered with MRO. Historically, those kinds of complaints were common.

Measured against every objective we had, we’ve succeeded. We attribute this to MRO’s willingness and ability to offer flexible technologies and services. To us, that’s the positive sign of partnership.