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10 Release of Information Pitfalls to Avoid in an EMR Environment. Presented by. Fig Gungor CEO. Agenda . Introduction - ROI has Changed 10 ROI Pitfalls to Avoid in Relation to: Electronic is not Always Effortless Preserving Security Providing Reporting Capabilities

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10 Release of Information

Pitfalls to Avoid in an EMR Environment

Presented by

Fig GungorCEO



  • Introduction - ROI has Changed
  • 10 ROI Pitfalls to Avoid in Relation to:
    • Electronic is not Always Effortless
    • Preserving Security
    • Providing Reporting Capabilities
    • Maintaining Data Integrity
    • Following Labor Cost Guidelines
    • Updating HIPAA Compliance Policies
    • Data Breaches
    • Responding to Meaningful Use Requests
    • Managing the Business of ROI
    • Overcoming Common Misconceptions
  • Summary
  • Q&A

Release of Information has Changed

  • HITECH Act promoted the adoption of Electronic Medical Record (“EMR”) systems
  • EMR systems boast benefits but ROI is not their focus
  • Evaluate how your new EMR, Meaningful Use, Labor Costs and compliance updates could affect your organization’s ROI practices
  • Take the proper steps to ensure compliance

Are you ready?


1. Electronic is not Always Effortless

  • Challenge:
  • Hybrid charts
  • Automatic file retrieval
  • Loss of tangibility
  • Increased turnaround time
  • Employee capabilities
  • Solution:
  • Implement a well defined process that guarantees that all elements of the requested chart are included in duplication
  • Store electronic and paper PHI in a single central location
  • Train users to identify parts of charts based on naming conventions and image previews

2. Preserving Security

  • Challenge:
  • Open access
  • Vulnerability
  • Access to unnecessary information
  • Solution:
  • Restrict unlimited access to patient’s records
    • Create and implement user roles
  • Implement a Disaster Recovery Plan
  • Create procedural safeguards

3. Providing Reporting Capabilities

  • Challenge:
  • Some providers who have implemented EMR’s are struggling to track:
    • Meaningful Use requests
    • Accounting of Disclosures
    • Turnaround time
    • Cash/self pay
    • Charts of patients who are involved with litigation
    • Verbal authorization to release proof of immunization
    • Incomplete/deficient charts
    • Payments for records (if applicable)
  • Solution:
  • Develop a plan that allows you to track these types of requests
  • Work with your EMR system provider to tailor the system to your needs

4. Maintaining Data Integrity

  • Challenge:
  • Minimum Necessary Standard
  • Some EMR charts contain information that should not be released:
    • Medical records, release forms and correspondence documents from other facilities
    • Internal hospital records
    • Records of different patients with duplicate medical record numbers
  • Human error
  • Lost records
  • Solution:
  • Institute strict guidelines for uploading data and processing requests
  • Work with your EMR vendor to organize how your data is stored
  • Implement quality review measures
  • Follow a detailed plan when converting paper charts to digital format

5. Following Labor Cost Guidelines

  • Challenge:
  • Labor Costs- Reasonable fee that covers the cost of skilled technical staff time spent creating and copying electronic files
    • Compiling, extracting, scanning, burning discs, distributing media
    • Cost of supplies and postage or courier
    • Can not charge retrieval fee
  • Eligibility
    • Eligible: patients, qualified representatives and claimant’s attorneys (with healthcare POA)
    • Ineligible: defense attorneys, claimant’s attorneys/third parties lacking healthcare POA and insurance companies
  • Must charge the lower of Labor Costs and State mandated pricing
  • Solution:
  • Perform a cost analysis to determine your organization's Labor Costs
  • Inform your staff of eligibility and guidelines for charging different requestors

6. Updating HIPAA Compliance Policies

  • Challenge:
  • Compliance Policy
    • Documented policy that outlines the steps taken by an organization to ensure a diligent attempt to protect the privacy and security of patient records
    • Must dictate how the organization will react to a breach
  • Risk Analysis
  • Designate officers
  • Encryption
  • New BA Agreement- Equally as liable as Covered Entities
  • Solution:
  • Consult with experts to build a program that complies with the standards set forth by HITECH
  • Distribute policy to employees
  • Follow policy

7. Data Breaches

  • Challenge:
  • Breach - “Generally, an impermissible use or disclosure under the Privacy Rule that compromises the security or privacy of the protected health information.”
  • Breach response process
    • Investigate and document incident
    • Risk Assessment - Determine threat, if any, to patients
    • Breach notification requirements
    • Review and update protocols, procedures and policies to mitigate future risk
  • Solution:
  • Implement detailed Breach Policy
  • Designate an Incident Response team/lead

8. Responding to Meaningful Use Requests

  • Challenge:
  • Meaningful Use -When the requested records exist on an EMR system and the records are requested to be delivered in electronic format, you must respond to the request within 3 days
  • Solution:
  • Qualifications -Familiarize yourself and your staff
    • Patient or qualified requestor submit written or oral request
    • Fully electronic records (not paper or hybrid)
    • Records delivered in electronic format
  • Outlined process -Develop and follow a plan
    • Screen mail
    • Determine if request meets Meaningful Use criteria
    • Document in EMR system
    • Process request
    • Burn to encrypted disc or use other encrypted transfer
    • Mail encrypted disc or arrange pick up
  • If records are unavailable, the patient must be notified within 3 days

9. Managing the Business of ROI

  • Challenge:
  • Staffing
  • Billing
  • Status request calls and correspondence
  • Release of records
  • Track completed requests
  • Solution:
  • Implement a comprehensive ROI practice that encompasses the issues
  • mentioned throughout this presentation
    • Highly skilled and knowledgeable of industry guidelines
    • Appropriate for volume
    • Allows your facility to meet the restrictive guidelines established by HITECH and Meaningful Use
  • Implement a system to generate invoices at proper rates, monitor payments
    • Quality assurance - check files & authorizations
    • Encryption
    • Tracking

10.Overcoming Common Misconceptions

  • Challenge:
  • HIM staff can be reduced because of EMR systems
  • All other systems are up to speed with EMR system
  • Once the EMR system is rolled out, the job is done
  • Solution:
  • Prepare for EMR system transition:
    • An implemented EMR system requires:
      • Upgrades
      • Training
      • User management
      • Physician Adoption
    • Staff your department appropriately
    • Consider temporary staff or outsourcing
  • Improve imaging systems, billing systems, administrative scheduling systems etc…


  • HITECH and Meaningful Use aim to maximize patient care
  • Implementing an EMR system is a tool to realize that goal, not the goal itself
  • Providers must consider the unintended downstream effects when choosing their EMR system and make the necessary changes to their procedures and policies to comply with recent rulings