Lancaster, Pennsylvania

The Challenge

As a mid-sized specialty practice with one location, Orthopedic Associates of Lancaster found it challenging to handle the several dozen release-of-information (ROI) requests that came in each week. The practice has 10 orthopedic surgeons and five physician’s assistants, who typically see 200 patients per day. Staff members did not have time to fulfill ROI requests in a timely manner.

“We simply could not get the job done in-house,” says Carolyn Vack, R.N., who serves as the practice’s medical records supervisor. “Despite our best efforts, the ROI requests were piling up because we had no dedicated medical records manager on staff.”

The Solution

ROI requests at Orthopedic Associates are primarily related to subpoenas, disability, and worker’s compensation. Practices that fail to respond promptly to such requests can face legal consequences. But the primary motivation for improving the ROI request process at Orthopedic Associates was even more fundamental.

“We felt that fixing the ROI process was a part of our larger mission to serve our patients well,” says Vack. “It’s simply not good practice to neglect ROI requests.”

Orthopedic Associates’ first attempt at solving the ROI problem, full outsourcing to a vendor, proved unsatisfactory. The vendor assigned a person to scan the requested records, process them, and manage billing and collections. As its compensation, the vendor took 100 percent of the collected fees.

“We realized that we were, in essence, paying a premium to relieve our headache,” says Vack. “But if it eliminated our backlog and restored our confidence, it would be money well spent.”

The vendor was unable to live up expectation, however. Staff members at Orthopedic Associates noticed errors in the vendor’s work that made them uncomfortable. “We felt a general lack of control and confidence,” says Vack.

After experiencing the worst of both worlds – that is, both in-house processing and complete outsourcing – Orthopedic Associates was ready to switch to the “shared services” approach offered by MRO and its ROI Online solution. Under this business model, front-end tasks such as logging ROI requests are performed by Orthopedic Associates while MRO handles back-office processes such as invoicing, fulfillment and customer service. The practice keeps half of the revenues.


Orthopedic Associates implemented ROI Online in September 2004 over the course of about one month. The start-up cost equaled $1,200, including a dedicated scanner. MRO deducted that amount from fee revenues, so the practice avoided any cash outlay. Ongoing costs consist of a small monthly maintenance fee and half of the ROI fees collected.

Implementation was simple. Orthopedic Associates gave its outsourced services vendor a 30-day notice, met with MRO representatives to review the mechanics of its ROI process, and set up a dedicated personal computer with a scanner.

“Training was not a hurdle, as ROI Online was easy to learn,” says Vack.

Shortly after implementing ROI Online, Orthopedic Associates implemented an electronic medical record (EMR) system, which accommodated the practice’s transition from paper to electronic records.


ROI Online has cleared up the backlog of ROI requests at Orthopedic Associates and even allowed the practice to pocket a share of the fees. As such, the solution represents a win for both Orthopedic Associates and MRO. But there’s a third benefit as well: confidence.

“We maintain responsibility and control for the aspects of the process we’re interested in: fielding requests and locating records,” says Vack. “That has restored our confidence in the ROI process.”

Another confidence booster is ROI Online’s ability to “double check” the work of Orthopedic Associates, ensuring that the records requested are in fact the records being transmitted.

“The shared services model has been a huge positive for us,” says Vack. “Based on creative use of technology and our productive personal relationships with MRO, we’ve finally been able to meet all of our goals for ROI processing.”