By Barbara Carr, RHIA

Hospitals are facing a severe labor shortage of both skilled and unskilled workers.  COVID stress and burnout, on top of retirement of the baby boomers, as well as the new vaccine mandates have all contributed to the shortage of labor. 

American economic growth is highly dependent on the quality and quantity of workers. According to recent Forbes article, “Currently, the United States is facing a severe skilled and unskilled worker shortage that has long and short-term economic implications. In addition to the 9.3 million job openings, various economic indicators strongly support the idea that there aren’t enough workers in the United States:  The number of people voluntarily leaving their jobs rose by 164,000 to 942,000 in June 2021.” 

Labor shortages impact both the skilled and unskilled workers’ categories. Clinicians fall into the skilled worker category. While there is an acute shortage of clinicians, skilled workers with “middle skills” requiring more experience than just a high school diploma yet less than a four-year college degree are also contributing to the labor shortage. Middle skills requiring a better-than average understanding of the tools they need to do their job, technical knowledge, problem solving skills, and the healthcare landscape are in short supply. Now COVID vaccine requirements have added to the staffing issue that health care institutions need to address to keep operating. 

During our December 14^th Webinar, “Managing and Maintaining Productivity During a Time of Labor Shortages” we heard from experts at Verisma on how they leveraged Verisma’s technology to help several hospitals’ Health Information Management (HIM) and Patient Financial Services (PFS)/Business Office Departments that experienced labor shortages related to processing requests for records.  PFS departments were faced with the need to keep payments coming in and any backlog in processing claims requests was going to cause a delay in payments. HIM departments dealing with labor shortages and lack of on-site staff were faced with quickly accumulating backlogs that needed to be addressed. Technology and creative out-of-the box thinking were urgently needed to address both types of challenges.

The PFS/Business Office Departments staff were working remote and experiencing labor shortages all at the same time.  The Verisma Release Manager® (VRM) platform, along with Verisma Inbox™ were deployed to allow the remote staff to enter and track claims processing requests for records, respond to denials, as well as ADR Requests. The PFS/Business Office Department was provided access so they could see the status of their requests. Confirmation of records receipt by the payors was available to them and an important tool they could then use when on the phone with a payor. In addition, they had the use of Verisma Analytics™ so they could see volume and turnaround time statistics. Prior to implementation of this tool they were just processing record requests without knowing exactly what was received by the payors and without volume information.

In another real-world example, COVID and then subsequent labor shortages in the HIM department required a solution to handle walk-in requestors.  The remaining HIM staff on site needed to take care of STAT requests and process the incoming mail requests and staff was also hesitant regarding in-person engagement with requestors. The time the existing staff on-site spent on walk-ins was taking away from processing of the paper requests received via the mail and thus a solution was needed.

The Verisma Request App® was installed on the hospital’s website along with the authorization for patients to complete with all the required information of what was being requested.  Patients were able to upload a copy of their driver’s license for verification. Flyers and announcements went out within the healthcare system regarding the new app that was available for patient requests.  Patients walking into HIM were given information for the app as well as access to a kiosk with a PC to complete their request. The request would be sent directly into VRM for processing. This freed up the on-site staff for other duties that were needed to be performed.

Another scenario addressed a health system experiencing a large backlog of requests due to high volumes and staffing shortages. Verisma Inbox™ was implemented where requests from multiple locations were centralized into one location and uploaded by bar code sheets into VRM. Requests were reviewed for duplicates and then sent for processing and distribution by Verisma staff. This relieved the HIM staff of having to process the workload for these requests and allocated time to other priorities.

All the scenarios discussed required thinking outside of the box and creatively using technology to tackle the ever-growing volume of requests coming into the hospital. 

The panelist concluded with a discussion on how to retain talented staff. Ideas such as joining daily staff huddles, keeping work/life balances in mind for your staff, competitive salaries, and showing appreciation for staff were top of mind. Letting staff know they are appreciated and celebrating their achievements goes a long way!

The Healthcare labor shortage is not going away anytime soon. Investing in technology that promotes higher staff satisfaction, reduces turnover, and increases retention is a true investment in higher quality healthcare and organizational longevity. Training and technology can improve a worker’s overall experience as well as reducing the feelings of stress and burnout.   Partner with local educational facilities, find ways to use the technology you already have in place and think outside the box to create new more efficient processes. Looking for a vendor partner that has the technology capability you are looking for and is willing to work with you to achieve your goals, is vitally important to mitigate labor shortages during these times of uncertainty. 

By Barbara Carr, RHIA

As leaders in HIM, we understand that attorney requests for medical records are more complicated and require additional scrutiny and time than the average request for medical records. There are usually many calls back and forth regarding the status of their requests, questions over payment, and rejections due to missing information. Subpoenas are issued at the last minute and your HIM staff is expected to drop everything to respond. The attorney requests are mixed in with all the other release requests, making it more difficult to manage. The time required to stay on top of and ensure timely release of these requests often takes time away from the general release requests.

Verisma presented a webinar on October 28^th featuring ChristianaCare, a 1,000+ bed teaching organization located in Newark, DE as they discussed their deployment of the Verisma Request App® (VRA) to offer attorneys the ability to easily submit, track and receive records. Stefanie Brumberg, RHIA, Corporate Director of HIM at ChristianaCare presented the business case, rationale and implementation of the app along with Anupriyo Chakravarti, Verisma’s CIO and SVP of R&D and Marcy Caudill, VP, Client Operations.

Stefanie described that ChristianaCare has a centralized Release of Information service that supports both acute care and ambulatory operations. She described their partnership with Verisma to implement VRA which required very limited support of the organization’s IT resources.

The Verisma team worked with ChristianaCare to install a link on their website specifically for attorney requests. The webpage is completed, supporting documents such as authorizations and subpoenas are uploaded and attached with the submission and electronically delivered to the ROI specialists for processing. The requestor receives a tracking number upon completion, as well as an e-mail with the tracking number, so they can keep track of their request. A busy attorney’s office can even see all their active requests by just entering one tracking number.  An attorney can submit payment and once paid, can securely receive the records. No more phone calls back and forth regarding the status of the request, there is full visibility from start to the receipt of the requests. In addition, turnaround times and delivery are much faster because there is less missing information and data entry errors.

This was followed by a live demo of the solution by Anuyprio Chakrakarti.  Following the demo, Stefanie and Marcy described the benefits seen thus far.  Major benefits noted include:

• Improved effectiveness of the ROI Process
• Improved quality controls and overall compliance
• Decrease turnaround time – cut in half
• Significant decrease in inbound customer service calls
• Enhanced attorney satisfaction

A survey performed of the attorney’s that have used VRA was also conducted and showed great results!  A summary of the responses received are:

• 100% would recommend this method to colleagues
• 100% will continue using this method
• 4.65 out of 5 rating for ease of use over other previous methods
• 5 out of 5 overall rating for overall experience

Some highlighted comments are as follows:

• “We receive the records MUCH quicker than we did requesting them via fax or by mail.”
• “Absolutely no comparison to old methods. I do not have to continue to follow up on requests.”
• “If you get rid of this Verisma Request App, I’m retiring.”
• “Very easy, straightforward, and love that a receipt confirmation comes through.”
• “I wish other facilities used something similar to Verisma. I like knowing my request was received and that I have a point of contact person to reach if I have any questions about the request.”

As you can see the Verisma Request App® has achieved the goals of improving the attorney request process and overall satisfaction, and thus has made HIM’s dealing with attorney requests a much more efficient and positive experience.

To receive a recording of the webinar, please contact Davy Simanivanh at dsimanivanh@verisma.com.

AHIMA21 was unlike any I can remember in recent years. Of course, my first AHIMA Convention was 40 years ago. AHIMA’s focus today is nothing like it was back then. Back then there were dictation systems with tapes and discs, transcription was still being done on a typewriter and vendors were selling the latest in file folders and filing systems. The name of this year’s convention was “Transforming the Future of Health Data”, and the convention was all about data: data integrity, data interoperability, data governance, and data sharing. The content this year was rich with information on the latest technology, data interoperability, and management trends that HIM professionals need to be prepared to execute in our fast-changing technology-focused world. AHIMA CEO, Wylecia Wiggs-Harris, reminded us that “health data is human data” and “data needs to be translated into information that is accurate and can be trusted.”

Reflecting on all that I heard and witnessed at this convention, I found a few key takeaways that I would like to reflect on:

1. Top trends in data interoperability and information blocking – The number of healthcare Apps that are available to patients for accessing and downloading their health information is growing. The development of these healthcare apps is continuing to explode thanks to the 21^st Century Cures Act. Apple is the most common 3^rd party app, but many other apps are also available and in development. We learned that HL7 FHIR (Fast Healthcare Interoperability Resources) is now the standard API (Application Program Interface). This game changer is enabling the healthcare market to employ faster and easier methods to exchange EHI as well as enable mobile app integration.  The Verisma Request App® is one app that is helping organizations meet the demand for apps that are easy to use and provide the patient with direct access to their healthcare information regardless of the EHR where their information is stored.
2. Data Integrity and Patient Matching – The importance of accurate patient matching and avoiding duplicate records for a patient is becoming even more important under information blocking. HIM professionals have always known how important correct patient matching is for patient safety and data integrity. However, now incorrect patient matching can cause your organization to be out of compliance with the 21^st Century Cures Act. The patient would not be accessing ALL their health information they request due to duplicate patient records. Technology is advancing to enable smart fault tolerant searches within clinical systems to do a better job of patient matching. We learned how artificial intelligence (AI) is being utilized to improve the accuracy and integrity of both patient and clinical information. However, it still requires human oversight.  AHIMA CEO, Wylecia Wiggs-Harris, stated that “It’s our profession that drives all aspects of integrity and protection of data and health information.”
3. New Era of HIM Leadership – Speakers addressed how HIM leadership has evolved during the pandemic and managing virtual workplaces. Speakers stressed how HIM professionals need to be ready for the new world of technological advances and prepared for it ahead of time. Innovation in management as well as technology were driven forth at a faster pace over the last 18 months due to the COVID-19 Pandemic. Monday’s speaker, Seth Jeremy Katz, MPH, RHIA, FAHIMA, spoke on what HIM needs to focus on during this decade. There will be a continued growth in AI in many areas of healthcare, big tech such as Apple and Google are getting in on healthcare and we will see this grow stronger in the future. What new issues will this cause for HIM and data integrity and accuracy? We will see a continued growth in telehealth and remote patient monitoring.  Remote work will be the norm as the HIM department becomes a virtual one. The one fascinating thing I heard about from one speaker was robotics. Robots will be able to do many simple tasks that are now performed by humans. This will create a new area for HIM oversight of the information produced/collected by the robots. For instance, robots, or chat bots, will be able to help fill out ROI requests, and know what information you requested and be able to go into the clinical system and release the information to you without any human interaction. HIM leaders need to be prepared and plan for all the new technological changes and how they will manage these changes. It will be up to HIM professionals to ensure that the data they produce is accurate. The new technology will create a huge disruption if you are not prepared for it. New roles will be open to HIM professionals who are prepared. One speaker at the conference, Dr. Daniel Kraft said it best; “Uber yourself before you get Kodaked.” Start preparing for the future now.




4. Protecting Healthcare Data – OCR Director, Roger Severino was quoted by one speaker, “Hacking continues to be the greatest threat to privacy and security of individual health information.” We heard about many threats to healthcare data and ways in which those threats are growing. This creates new areas for HIM professionals to focus their expertise in protecting the healthcare data. One speaker, Michael Stearns, MD, CPC, CRC, CFPC, noted that “value-based care initiatives coupled with interoperability mandates are creating a data tsunami and a desperate need to tame it.” The 21^st Century Cures Act which requires that patients have access to structured and unstructured EHR information has led to concerns for privacy and security. Ensuring the patient gets the right record they are requesting is essential to maintaining privacy.

I have to say I’ve missed all the personal connections and conversations that occur at the annual conventions and I hope we are able to go back to the in-person events in the future. I did enjoy the participant chats and found out that there were many people who were able to attend this year because it was virtual as their employers are no longer paying travel expenses.

As a final observation, I was very proud of Verisma and the many AHIMA members who made possible the company’s $5,000 donation to the AHIMA Foundation.  This donation reflects individual and state association pledges to protect truth and accuracy of health information.  Add your name to this pledge embracing the values of HIM at: https://verisma.com/pledge-to-protect-truth-and-accuracy/.

By Linda Kloss

HHS officials discussed the nuances of how Right of Access is handled under the HIPAA Privacy and Information Blocking Rules in last week’s Verisma-sponsored Webinar HIPAA Right of Access and Information Blocking.[i]  We are grateful to Elisabeth Myers, Deputy Director, Office of Policy, HHS Office of the National Coordinator and Timothy Noonan, Deputy Director for Health Information Privacy, HHS Office for Civil Rights for customizing a presentation to compare and contrast Right of Access elements of the two Rules, spotlighting areas that have generated questions. I urge everyone to access the Webinar archive as it is a very useful reference. 

The laws giving rise to Right of Access regulations were passed two decades apart (HIPAA in 1996, 21^st Century Cures in 2016). Both are complex multi-part laws dealing with health system effectiveness from different perspectives. HIPAA focuses on health insurance and administrative functions while 21^st Century Cures focuses on facilitating clinical research and improved therapeutics. How their regulatory framework handles Right of Access reflects different contexts and purposes. The Information Blocking Rule concerns electronic health information which Myers and Noonan described as a “a subset of the protected health information (PHI)” covered by the Privacy Rule.

Myers and Noonan underscored another helpful distinction that can guide compliance. Access to protected health information under the HIPAA Privacy Rule is governed by permissions.  Patients, of course, have a right to access and they or their legal designees grant permission for release to third parties. The Rule grants permission to use protected health information (PHI) for treatment, payment and healthcare operations and specifies other parties who are granted permission under certain circumstances. The Information Blocking Rule picks up where permissible requests leave off and assumes that electronic PHI (ePHI) be shared unless the request meets one of eight exceptions. This distinction reminds us that we should be advocates for legitimate and customer friendly access. We should focus on eliminating barriers,  reducing turnaround times, and shifting to e-release whenever possible. 

The Rules differ in their breadth of who must comply. Under the HIPAA Privacy Rule, we deal with covered entities (providers, health plans, and clearinghouses) and their Business Associates. The definitions of providers are aligned under the two Rules. The list of “Actors” who must comply with the Information Blocking Rule includes health information exchange entities and technology developers. This is a welcome expansion that better reflects who is involved in today’s health information ecosystem. EHR vendors, private exchanges, or other entities will no longer be able to block the exchange of health information needed for continuity of care.

Information Blocking aligns to HIPAA regarding timelines for release. Myers and Noonan reinforced that the Rule reads no later than 30 days. We should be doing all we can to reduce turnaround times by putting in place systems and workflows to avoid any “unnecessary delay.”   We were reminded that such delays are currently resulting in enforcement action by OCR, the nineteenth such action announced earlier this month. Enforcement for Information Blocking Rule will be administered by HHS’s Office of the Inspector General and the rules for this have yet to be released or approved.

Fees for ePHI are handled similarly in both Rules. Reasonable, cost-based fees for labor are allowable. The Information Blocking Rule adds a requirement that they be uniformly applied and not anticompetitive. The trend is that providers are making access available to patients on a no fee basis and this is driving adoption of use of Apps such as Verisma’s Request App ™ (VRA), a practice very much in line with the intent of both Rules. 

Verisma recognized the rapidly changing landscape by sponsoring Health Information Access Week, June 14-18. The OCR-ONC Webinar was a highlight of the week along with guest bloggers covering topics from consumer advocacy to HIM leadership. The Information Blocking Rule and proposed changes to the Privacy Rule underscore once again the need to upgrade ROI practices with technologies, including access and management tools, to stay ahead of the curve.   

We continue to grapple with a patchwork of federal and state laws and regulations concerning health information and privacy. The Information Blocking Rule provides some much needed modernization, particularly in bridging to a broader cast of actors. For ROI, HIM, and Compliance experts, the Right of Access is inviolable. At the same time, we know that when a custodian discloses PHI, today’s protections for individuals fall far short of where they should be. I know we will sort out how to comply with Information Blocking and future modifications to the Privacy Rule. But I also know that our work won’t be done until we can help people have real choice in how they want to handle their confidential health information, in identifiable and deidentified formats, when it moves beyond the protections of current law. 

[i] Please e-mail Davy Simanivanh at dsimanivanh@verisma.com to receive a recording of the webinar.

This first Health Information Access Week has brought together a range of perspectives on serving consumers, mitigating risks and deploying technology. We’ve been privileged to learn from experts who bring a lifetime of experience and insight to the changing challenges of  access and disclosure.  I am closing out this week with some reflections about leadership and management of access and disclosure operations. It is my belief that there is an urgent need for HIM leaders to address the health information access and disclosure disparities within their organizations. This is a key stepping stone to being able to modernize our approaches.  We have the expertise to do this and the time is now.

As a HIM leader, I made it one of my goals to achieve centralized health information access regardless of where the patient may have been treated within the healthcare organization. I view this as having three benefits: improved patient satisfaction, risk reduction and cost savings. It was clear to me several years ago, that HIM professionals needed to broaden our thinking beyond the hospital’s four walls and reach out to our physician practice administration, outpatient satellite and other facilities that make up our health system. Ultimately, the entire organization can benefit from centralizing the release of healthcare information.   

In leading the charge at Einstein Health in Philadelphia, I first called a meeting of our Hospital Administration staff, Physician Practice administrators, Risk Management and Compliance.

I described a recent scenario where an elderly patient had to go to three separate locations to acquire the healthcare information they needed for an upcoming appointment with a specialist. I then posed questions regarding why we persisted in this approach. All the patient’s information was stored in our Clinical Information System (CIS) regardless of location of treatment. Everyone agreed this was not ideal and agreed to work with me on a solution. 

The physician practices, at the time, were all doing their own individual release of information with various copy vendors, or their own in-house staff. There was no tracking, and very little quality control. At that time, all the HIM Departments were being handled by one vendor and covered by the same policies. Therefore, it was decided that we would tackle the practices first.

We started with bringing our release of healthcare information vendor to the table and put them to the task of working with us on a solution for the physician practice locations first. Since there are over 200 locations, this was a large change project. A project plan was developed, and a team of key stakeholders was assigned carry out the project. After 6 months of planning and strategizing, the first group of practices went live, followed by the next group, until all practices were handled by one group of release of information staff. Our vendor staffed the central location. 

Once we standardized and centralized the physician practices, we were able to move quickly with outpatient locations. In all, it took about 18 months to accomplish. In the end it was merged into one centralized release of healthcare information site. Now a patient can make one request for their information, which is then processed all at the same time, and delivered to the patient via whatever media and route they have specified. We were able to monitor quality and track all released information. We reduced costs and duplication of effort. Patients were less frustrated and more satisfied with our service. 

Risk and Compliance are less concerned with surprises and have one place to go to check on any issues. We are far less likely to receive a complaint and if we do, we have protocols to  resolve any before they become investigations. Importantly, having a standard way of handling access and disclosure across the enterprise, positions the organization to broaden the scope of release of information. For example, it possible to handle access requests from financial services, case management, utilization review and other health system function that rely on access to information.  When going through our release of information we are assured of the same quality control and tracking.

This experience not only helped me grow as a HIM leader but helped to expand my role in the organization beyond the HIM borders.  I was given more opportunities to work across the organization to streamline other processes. All this really helped fulfill my own goals to grow within my organization. 

In the end, I believe it is up to us as HIM leaders to have the vision, and then use our leadership to organize and lead others towards that vision.

Barbara Carr, RHIA a Verisma Advisor formerly served as Assistant Vice President Health Information Management at Albert Einstein Health Network in Philadelphia and as Corporate Director of Health Information Management at ChristianaCare, Wilmington, DE.

TAKE QUIZ

With years of HIM leadership experience under my belt, my current role as Director of Corporate Compliance requires me to step back to see the big picture. As I read about the nineteenth OCR HIPAA settlement, it should give pause as to how we got here. HIM professionals are ingrained to protect patient privacy at all costs, but it begs the question if we are trying to protect the wrong people. Patients absolutely have a right to their information and unfortunately, too many roadblocks have existed in the past. When managing release of information (ROI), I agree it is cleaner and less complex to routinely require a written authorization from the patient before releasing any PHI to anyone. But, in some scenarios, we are doing a disservice to the very patient whose information we are trying to protect.

Patients are more technology savvy; they want their information and they want it now. We have an opportunity to speed up this entire process and in so doing, improve service to our customers. If you haven’t already, it is time to think creatively about ROI. If a patient calls your department asking for their records, figure out a process for verifying their identity over the phone versus requiring the patient to come into your department or submit a written request. Use the technology available to you for delivering records to patients, whether that is through your patient portal, an app, email or another electronic method. Speaking of email, we also need to accept the fact that not all patients will be comfortable handling encrypted emails containing their records. They may not want to make up a password and, in my opinion, it should be their choice. You may need to work with your Information Services Department to ensure you can email records unencrypted, if that is the patients’ preference.

I don’t believe we should charge our patients for copies of their own medical information. They are entitled to the information and I think it is just the right thing to do. As we increase the capabilities of apps, our patient portals and methods of delivering medical information to patients, the task of covering our costs should become easier. We also need to get more efficient at this process – 30 days is a long time to wait for delivery of anything – think how we would feel if our typical Amazon orders took this long to arrive? I applaud the 15 day turnaround requirement in the proposed HIPAA Rules. We cannot ignore requests from our patients – the HHS Enforcement Actions demonstrate examples of frustrated patients not getting what they request in a timely manner, or not getting the information at all.

I am hopeful the use of electronic signatures will be specifically noted as allowable under the Proposed Modifications to the HIPAA Privacy Rule. I have seen health information departments differ in their decisions to allow or disallow their use. The use of electronic signatures is a well- established practice and we should move away from requiring only handwritten signatures from patients.

Another thought about patient portals – we are now pushing much more information to the patient, i.e. test results, notes, pathology reports, discharge instructions, in some cases very quickly after creation. Having test results at your fingertips  as soon as they are available is not intended to replace those critical discussions between provider and patient. We need to reassure our patients that these discussions will still occur, even if they see the results via their portal account before they have spoken to their provider. Informing the patient of this during the office appointment when the tests are being ordered needs to become the norm. Placing a “results disclaimer” on the patient portal is another method to communicate this to patients.

As a compliance officer, I want to ensure we are following the law and exceeding our patient needs at the same time. It is also my job to ensure our policies/procedures minimize risk for my organization. It is very important for HIM leaders to step up controls to make certain that access and disclosure management is a sound and reliable process. With each enforcement announcement, the OCR is sending a strong message – no more barriers for patients to get their own information. If access and disclosure management has not been top-of-mind before, it sure needs to be now. If we consistently and efficiently meet our patients’ needs for access, we can all sleep soundly at night.

Wendy Mangin, MS, RHIA is Director of Corporate Compliance for Good Samaritan, Vincennes, Indiana where she served as Director of Health Information Management for over four decades with responsibilities as Executive Project Director for the health systems EPIC implementation. She served on the Board of Directors of AHIMA and its President in 2008. 

TAKE QUIZ