The Chester County Hospital and Health System (TCCHHS) has served patients in the Philadelphia region for 119 years, offering a wide range of specialties and services spread throughout the county. Challenged to provide the highest levels of patient care and service while complying with rapidly evolving federal regulations, TCCHHS recently evaluated how it handled the disclosure of protected health information (PHI).

TCCHHS turned to MRO Corporation, based in King of Prussia, Pennsylvania, to coordinate all disclosures of PHI within their organization, and additionally meet the challenges brought on by the meaningful use incentive program. Using a variety of meaningful use solutions that are fully integrated into MRO’s proprietary ROI Online® disclosure management platform, TCCHHS was able to attest for stage 1 meaningful use in an efficient way that provided ease of use to its patients.

The Meaningful Use Challenge

During the evaluation of its disclosure management processes, TCCHHS discovered that although its
health information management (HIM) department owned the formal release-of-information (ROI) function, each department within the health system handled disclosure of PHI slightly differently. Unearthing this triggered an urgency to implement policies and procedures that would ensure consistency and compliance across the organization.

Additionally, in light of the announcement of stage 1 meaningful use criteria, TCCHHS concurrently reviewed how it would handle patient requests for electronic copies of medical documentation containing PHI. The Centers for Medicare and Medicaid Services (CMS) meaningful use stage 1 criteria regarding release of information (ROI) requires that hospitals do the following: one, “provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies, discharge summary, procedures), upon request”; and two, “provide patients with an electronic copy of their discharge instructions at the time of discharge, upon request.” Moreover, CMS requires that more than 50 percent of all patients (population defined by the provider) of the eligible hospital who request an electronic copy of their health information are provided it within three business days, and more than 50 percent of all patients who are discharged from an eligible hospital and who request an electronic copy of their discharge instructions are provided it.
An immediate challenge for TCCHHS, as a mid-sized facility, was that it did not have 24/7 staffing of its HIM department. Leadership within the organization recognized that the health system needed to implement a centralized solution that could consistently and automatically meet disclosure standards regardless of the day or time a request might come in.

Solving for Meaningful Use

To improve their overall disclosure management process and meet the challenges of meaningful use, TCCHHS chose to implement MRO’s ROI Online solution, a meaningful use certified system. The ROI solution enables the hospital to log, process and account for all disclosures—across the entire health system— in one, centralized system, under the guidance of the HIM department. TCCHHS leverages the meaningful use modular add-on to ROI Online, through which meaningful use requests are uniquely tracked by designated fields in the disclosure management application.

Furthermore, to ensure timely delivery of patient requests for electronic copies of their health information and discharge information, TCCHHS partnered with MRO to create a patient portal through which patients can easily activate, log into and use a patient portal website to access their health information online. Through the web portal technology, electronic copies of medical records are provided to the patient within three days and can be downloaded. Additionally, electronic patient discharge information is available on-demand when a request is made by the patient. In this way, TCCHHS meets the requirements laid out in stage 1 meaningful use.

To solve the challenge of having to staff the HIM department 24/7 and to avoid burdening current hospital staff and resources, an automated process for making discharge information available via the patient portal was developed. MRO customized TCCHHS’ disclosure management process to entail routing requests for discharge information to the patient portal 100 percent of the time for the entire population. Through this approach, patient requests for copies of discharge instructions at discharge are logged and processed automatically without any intervention by the HIM staff.

The request process begins by the patient asking a nurse for a copy of their instructions; the nurse then enters an order for the instructions into the clinical system. Based on the order entered, the seamless process begins. Access to the portal is granted by using a secure sign-on received through an email to the patient. Log-on information is emailed to the patient immediately after the request is placed; as soon as the patient logs into their email account, they can follow the instruction to access the portal and get copies of their discharge instructions.

TCCHHS’ patient portal is custom-designed to reflect the organization’s unique brand, including its logo and color schemes, further engendering patient trust and satisfaction.


Today, TCCHHS has increased confidence in the disclosure management processes throughout the organization. As a direct result of both centralizing and standardizing its disclosure processes, the healthcare system has centralized policy enforcement, better accounting of disclosures documentation, and a comprehensive workflow across the healthcare enterprise. With all of the hospital’s departments and units handling disclosure processes uniformly, TCCHHS’ patients are receiving an invariably positive experience when requesting PHI for themselves, and this supports TCCHHS’s good reputation in the community.

With the implementation of MRO’s disclosure management solutions, TCCHHS has decreased liability and financial risk, while also vastly streamlining processes. The healthcare system has improved its turnaround time for delivery of record requests from 10-14 days on average to between one and two days. Through its patient portal, TCCHHS is now able to provide electronic copies of patient health information and discharge information upon request, within the deadlines outlined by the CMS meaningful use program.

Through using MRO’s meaningful use solutions, TCCHHS was able to attest for stage 1 in an efficient way that provided ease of use to patients. The hospital is also preparing for proposed stage 2 criteria that lays the groundwork for greater patient engagement, increases privacy and security measures, and requires patient portal access to health information. While TCCHHS has not yet selected its approach for stage 2 attestation, leaders within the organization have reviewed solutions from MRO, including a more robust patient portal solution and health information service provider (HISP) services that include direct secure messaging (DSM) capabilities.