Release of Information (ROI) – At An Operational Capacity Flashpoint?
Providers and healthcare facilities today face myriad growing threats to both their continued ability to deliver best treatment and care to patients as well as sustain their ongoing financial viability. Patient volume continues to rise at the same time nursing and other staff shortages continue to rise. Managing patient flows and optimizing clinical care workflows is growing more complex due to poor line of sight into day-to-day operational processes.
All of these challenges pose an increasing risk to healthcare organizations from a compliance, efficiency and cost control standpoint. The emergence of digitized health data records has resulted in patients and other healthcare players demanding faster access, adding to these challenges. In fact, the Release of Information process has become a potential new flashpoint for provider operational paralysis.
If healthcare ROI processes are slow and the data requested is inaccurate and/or not compliant with HIPAA and other regulations, revenue leakage can potentially result from a number of sources. This leakage, in the form of patient dissatisfaction, payer non-coverage of treatment performed and/or declining patient referrals from other healthcare practitioners, can become a big problem for providers.
The Health Data Inundation Threat
The volume of data in the healthcare industry has been exploding for several years now…and there is no end in sight. Storing, managing and retrieving this data even as more and more of it comes in has been an ongoing struggle. It is rapidly transforming into an insurmountable problem for even the largest providers and facilities. For mid-sized and smaller providers, it threatens to shut down their operations.
Providers need to stay on top of near astronomical health data growth rates. They also need to stay ahead of dramatically rising ROI submission requests from millions of patients (and dozens of payer audits and care providers). The almost overnight availability of newly-accessible digital formats for delivering that data makes this task that much more difficult.
Care Providers Are Not Administrative Services Providers
The number of patients being treated at provider facilities is steadily increasing even as healthcare operations are becoming more and more complex due to changing regulations. As a result, care institutions have had to add numerous processes and departments to deliver administrative services. Patient services, payer relations and health record keeping are just some of the service areas physician groups, hospitals and health systems have had to significantly expand in the last few years. The danger of this trend is when administrative services bottlenecks and inefficiencies begin to encroach upon or impede what providers are expert at delivering – high quality patient care. Additionally, administrative complexity – if not closely monitored by providers – can put their facilities at risk of a range of compliance violations. These violations can lead to a license revocation, a suspension of operations or even a permanent shutdown.
In the new digital age, Release of Information services is an example of a relatively new administrative services area that is putting increasing pressure on provider operations. Facilities are hiring dedicated personnel and/or redistributing internal resources to man rising ROI submission requests. Unfortunately, these requests are often being handled via inefficient manual data entry processes combined with a hodgepodge of inadequate health record search and retrieval procedures and technology support.
Healthcare providers should not be focused on becoming ROI processing experts. Yet, it is incumbent upon them to deliver data accurately and within mandated deadlines. This is irrespective of whether the requestor is a patient, a health insurance carrier, another provider needing medical records of a transferred patient or any other authorized health data processing requestors. Furthermore, providers cannot afford to lose patients due to poor ROI engagement experiences or delivery of inaccurate or incomplete data requested.
Lifting the ROI Burden With Automated Processes
The reality for providers is that there is no room for error when it comes to ROI. Data delivery delays, inaccuracies or errant public health information releases can expose facilities to crippling compliance violations, penalties and fines. Throwing more manpower at the problem or “experimenting” with making adjustments to ROI workflow processes will not ensure protection against these risks. In fact, it will only continue to raise costs for already financially fragile providers.
The time has now become critical for providers who need to be relieved of any concerns about the integrity and dependability of their ROI services. They must quickly identify outsourced ROI solutions that can accelerate their ability to capably manage increasing health data requests, stress-free. The sustainability of their operations depends on it.
What an Outsourced, Automated ROI System Should Look Like
Health providers must move to technology-centric systems that address two key ROI functions. These systems must optimize efficient processing of incoming ROI requests, on the one hand. They must also leverage smart engines that can precisely search and retrieve the medical data sets requested in any format, error-free, and deliver analytics showing ROI bottlenecks and why. At the same time, efficiency must not be sacrificed for personalized ROI engagement experiences delivered cost-effectively, especially with patients. Finally, any next-gen ROI systems should not displace existing data and legacy infrastructures, platforms and applications but integrate with them to further maximize ROI process efficiencies.
Today, there are a range of Release of Information services solutions like GRM’s Healthcare ROI that maximize technologies working together to advance the state of health data request processes. Such solutions offer both a positive front-end requestor engagement experience as well as an intelligent back-end patient data capture platform.
Adopting these future-proof ROI services delivery systems will become a necessity for providers in order to avert Release of Information operational breakdowns. Right now it’s an overwhelming amount of data under pressure from an overwhelming demand for access to it… and that’s overwhelmingly unsustainable.