By Linda Kloss

This is the third blog highlighting lessons learned by HIM leaders at health systems in New York, New Jersey, Boston, Delaware, and North Carolina in the midst of the COVID-19 pandemic. Their experiences teach us much about release of information best practices. They also identify broader health information access and disclosure challenges of dealing with this public health emergency. The first blog focused on best practices for protecting the safety of staff through rapid transition to work-from-home and protecting staff that must continue to perform their work on site.

The second blog addressed best practices in adapting release of information practices. By optimizing electronic workflows, health systems are flexing to ensure compliant and accurate work from request through fulfillment. A game changer is use of the Verisma Request App (VRA), which when integrated with the Verisma Release Management, is providing seamless continuity of work regardless of shifting workflows, who is doing the work, and where it is being done.

Our interviews with HIM leaders also described stepped up involvement with patient portals and a new focus on policies and procedures for telemedicine. I might not have anticipated these two areas of best practice as early responses, but it has quickly become clear that this pandemic is accelerating all aspects of virtual health services. In addition to experiences with Verisma’s VRA, interviews highlighted an uptick in use of patient portals. Thus, we identified Support for use of patient portals as a best COVID-19 practice for HIM working in collaboration with IT and others.

Despite years of somewhat sluggish use of patient portals, many health systems are now seeing a marked uptick as patients seek ways to connect and communicate, get test results, and general information. HIM leaders report stepped up involvement in helping patients enroll in patient portals and in supporting them in their use. This has required allocating HIM staff to focus on portal support. An important lesson is to be certain that current portal policies and procedures are documented and capturing changes or special procedures relating to reporting COVID test results and handling questions about those results.

Long standing barriers to broad adoption of telehealth services have been eliminated by recent federal and state regulatory changes. Virtual visits and remote monitoring services have surged for routine primary and specialty care, behavioral, and employee health. In the midst of the pandemic, this is a lifeline. Rapid adoption, however, may strain organizations who may not have robust policies and procedures or a broad understanding of them.

HIM leaders report greater involvement with the ramp up of telehealth and Support for telehealth information needs is another important HIM emerging best practice.  As with portals, they recommend telehealth policies and procedures be reviewed and adjusted as needed. Issues such as enrollment procedures and consents may need sharpening. Identity proofing — provider and patient, handling attachments, coding and health record protocols are cited as areas where HIM expertise is needed.  Telehealth may also increase patient access requests because patients and providers need to review current information to have an effective virtual encounter.

Long after this public health crisis comes under control, virtual health and health information applications will be indispensable elements of care delivery and patient engagement. There are sure to be many important health information best practices associated in this nascent era of virtual health and now is the time to capture these lessons. There is no going back…only going forward.

Once again, I want to thank the HIM leaders who continue to share their experiences as they learn and adapt for business continuity while supporting the needs of their staff, health systems, and the communities that they serve. Please join us on April 29^th for our Webinar, COVID-19 Response:  Emerging Best Practices for Health Information Disclosure Management – Part 2. 

By Linda Kloss

This is the second blog highlighting lessons learned by HIM leaders at health systems in New York, New Jersey, Boston, Delaware, and North Carolina in the midst of responding to patients ill with the COVID-19 virus.  Once again, I want to thank these leaders for agreeing to be interviewed to share their experiences in the midst of this chaotic and frightening professional and social experience.

Their experiences pointed to 8 emerging best practices based on these leaders first several weeks of COVID-19 response efforts. We label them emerging because they describe adaptive, not static changes. Adjustments will continue to be made as disaster–and recovery–response circumstances evolve. The best practices comprise three key initiatives:

• physical distancing – staff and patients
• optimizing electronic workflows, and
• adapting policies to remove barriers

The first blog described two best practices for protecting staff through work at home and by changing the on-site environment. Today, we share two more important best practices directly relating to release of information practices.

Best practice #3: Close in-person R-O-I request services turned out to be easier than expected. First, health systems were limiting all public traffic in and out of buildings. Interviewees uniformly reported that in-person requests dropped off abruptly simply because traffic was so diminished.  Second, routine and elective referrals were delayed, physician practices closed and this further depressed the volume of routine requests. In closing in-person services, interviewees advised careful attention to posting clear instructions, updating signage, web pages, and automated messaging systems.

Protected health information may be requested in five ways :  1) by completing request/authorizations at an in-person service window, 2) accessing a request/authorization on the health system website and submitting it via mail, 3) accessing a form on the health system website, scanning and e-mailing it, 4) processing verbal requests, and 5) using a request App.

Five routes have rapidly become four.  Routes 2, 3 involve handling and processing residual paper and these routes represent the biggest barriers to work from home. Verbal requests, route 4 may be tolerable alternative in a public health emergency, but shouldn’t become a new routine.  It is labor intensive, does not permit rigorous authentication, and can’t easily be audited.

The need to optimize electronic workflows is thus the key initiative and a key lesson from health systems on the front line. Thus, another best practice is to Use R-O-I workflow technology and the Verisma Request App.  Workflow technology and request apps eliminate paper, permit rigorous authentication, and create records of requests and their fulfillment.

One of the health systems interviewed had fully implemented the Verisma Request App (VRA) and integrated it with its patient portal 18 months ago.  For this large health system at the epicenter of the pandemic,  minimal adjustments were needed in request procedures. The HIM leader noted that the VRA provided “peace of mind” because the request, authentication and release processes were fully automated. Another interviewee was planning to implement VRA to eliminate in-person requests for security reasons.  This health system accelerated implementation, delaying full portal integration, but getting the App in place to ensure an electronic route.

In addition to using request apps, other workflow best practices involve redirecting whatever work you can to your R-O-I vendor. Because health system staff and the vendor staff use the Verisma Release Management (VRM) workflow platform, work distribution can keep pace with changing demands. Health systems that have centralized R-O-I across facilities and practices using VRM are in the best position to respond to the rapid changes in workflow required for these vexing times. One health system that was in process of centralizing R-O-I from hundreds of physician practices at the outset of the crisis. Their current challenges are with the practices that have yet to be centralized and are now closed, with unprocessed requests buried in incoming mail and virtually irretrievable. This health system also implemented a call center operated by Verisma, so all requests are processed uniformly and seamlessly.

In August of 2005, Hurricane Katrina hit the gulf coast and New Orleans leaving millions of people displaced and caregivers without any trustworthy information about their health conditions and medications.  We all remember the photos of people with their pill bottles in paper bags.  We remember photos of wet piles of records, detritus of the flood. Only the Veteran’s Administration hospitals could easily access electronic medical and medication records when people relocated. COVID-19 and the lessons being learned will irrevocably change health information access and disclosure. It is already clear from the experiences of the HIM leaders interviewed that automated ROI systems, including the request application,  is providing R-O-I business continuity and security flexibility.

Next week we will feature lessons learned about the importance of HIM engagement with portal and telemedicine workflows and policies. Our continued wishes for your safety and health in this very sad time. Please jump in and share your experiences and questions, request an archive of the April 1 Webinar by e-mailing Davy Simanivanh (dsimanivanh@verisma.com) and plan to join us on April 29 for a follow-up webinar.

By Linda Kloss

I want to recognize and applaud our HIM colleagues who are adapting quickly and smartly to the urgent needs of their health systems in this growing pandemic.  On behalf of Verisma, I had the privilege of interviewing HIM leaders at health systems in New York, New Jersey, Boston, Delaware, and North Carolina to understand their experiences to date.  They were eager to share what they are learning, so everyone does not have to figure this out on their own.   In a time of extreme disruption, it’s important to share, learn and adapt as quickly as possible.

Verisma hosted an important Webinar on April 1 entitled “COVID-19 Response:  Emerging Best Practices for Health Information Disclosure Management.”  The interviewees joined the Webinar to answer questions from hundreds of participants at various stages of their own planning and adaptation.  I want to congratulate and thank each HIM leader for the great work they are doing and for their willingness to invest some time to engage and share.

Two high level lessons capture their experiences to date:

• • First, this is an empowering time when one needs to draw from and trust their experience. Interviewees quickly prioritized and acted, not waiting for perfection or permission.
  • Second, it is a time for innovation where interviewees quickly discarded unworkable and outdated methods, staying focused on the desired outcomes, adapting process and policies as needed. Interviewees noted over and over that they acted knowing full well that they may have to make further adjustments.

We identified eight emerging best practices based on these leaders first 3 to 4 weeks of COVID-19 response efforts.  We called them emerging because the changes are not static.  Adjustments will continue to be made as disaster response circumstances evolve. The best practices can be rolled into three key initiatives:

• • physical distancing – staff and patients
  • optimizing electronic workflows, and
  • adapting policies to remove barriers

Change came abruptly as health systems issued work-from-home orders for non-clinical teams. Some organizations were given a 2-3 week period and were able to send staff home in phases.  One hospital got orders on Friday for staff to be working at home by Monday! Physical distancing of staff is the focus for emerging best practice #1: Accelerate and expand work from home. 

Interviewees recommended preparing work from home staffing plans that require as little residual on site work as possible.  They also recommended that continency plans be developed in case illness in a family or other circumstances keep a knowledge worker from contributing for a time.

HIM may have sent coders and transcriptionists working at home.  This means that the technology platform requirements are known and tested.  If this is not the case, part of staff planning is technology planning.  Interviewees urged that technology plans assess the needs of individuals as wifi speed, secure work site, and other factors have to be assessed for each staff member.  To meet a deadline, health system technology was sent home with a staff member.  An action like this can be adjusted later, but these leaders are empowered to take the steps necessary to meet a work from home deadline.

Interviewees advise careful attention to the needs of individuals, including supervisors, who may be very unprepared for an abrupt transition.  Good practices include using video conference for frequent –daily at first—one-on-one and group status and coaching meetings.  Reluctant supervisors need special coaching as do certain staff.  Understanding and supporting the needs of individuals is the bottom line.

The same holds true for the staff that must remain on site for critical jobs such as birth certificates, and scan residual paper into EHRs and direct mail.  Emerging best practice #2: Protect on site staff.  While most at home staff are grateful to be able to work from home, on site staff may be anxious and frightened of contracting COVID.  Interviewees describe approaches to distancing through longer shifts but fewer days on site and creating physical distance through their office layout.  The other important lessons involve infection control protocol for handling paper and the redesign of workflows to reduce paper handling.  We’ll take this up in our next blog that will cover the remaining emerging best practices.  In fact, we have three more blogs planned to cover the balance of the 8 emerging best practices. Coming next, emerging best practices #3: Close in person R-O-I request services, #4: Support use of patient portal, and #5 Use R-O-I workflow technology and request app.

In the meantime, be safe and stay well.  Please jump in and share your experiences and questions.  You can also request an archive of the April 1 Webinar by e-mailing Davy Simanivanh (dsimanivanh@verisma.com) and be on the lookout for upcoming webinars.