Navigation in a Hybrid Environment

C. Matheson, RHIA, CCS EMR Leave a Comment

Ann-Dooley-image Ann Dooley, RHIA,
Director of Disclosure Management

The iPhone 6 was released a couple weeks ago and Apple lovers around the world rejoiced. The new model includes advanced technology and improvements to the last version. But there’s a problem. The iPhone is breaking in half, partly because of how it’s being used and cared for.

Similar to the iPhone challenge is the introduction of electronic medical records (EMR) to healthcare organizations. The intended goal of the EMR was to improve efficiency and embed advanced technology into patient care. But there’s a problem: old systems are still in place at many healthcare organizations. Release of information associates and/or HIM departments are sometimes scrambling to locate a complete medical record. Or similar to the new iPhone, their patient information is broken in half.  This is partly because of how the new and old systems are being used and cared for. Compiling a complete medical record in the hybrid environment can be a daunting task. Let’s review a few considerations when dealing with electronic and hard copy storage of patient information.

A new EMR is one more system to search for information since legacy systems, hard copy and other formats such as microfilm and fiche must also be searched. In addition to different storage formats, there are various departments and disclosure points within any given healthcare organization. For example, according to a recent For the Record article “the growing prevalence of EMRs under meaningful use and the need to deliver these records electronically have increased the volume of requests and the number of disclosure points in a typical hospital. In the current digital environment, an organization may contain more than 40 PHI disclosure points, including HIM, risk management, billing, lab, radiology, and hospital-owned clinics and physician practices. As a result, PHI often is accessed or disclosed by employees who haven’t been fully trained on guidelines.”

Tech-savvy Employees

Employees responsible for compiling and releasing information must be proficient in technology.  They should have good investigative skills as well as a solid understanding of the systems and methods to properly search and produce the correct documents for each type of requestor.  It is crucial that staff know where to look for information in each system and in every format. Response times and consistency are important for requests, especially legal ones. Unlike the hardcopy record, the EMR offers many ways to search for and produce information. However, only one is considered the legal record format.


Don’t Make Hard Copies Hard to Find

Legacy systems don’t perform as well as they did many years ago, making retrieval difficult and time consuming. Hard copy and scanned records may be kept in many locations and are not always destroyed according to the time frame required by state and federal regulations. Even when electronic records are in place, a formal process for hard copy retrieval is important since employees must understand how to properly search for and locate stored paper charts. Be sure your healthcare organization has a formal system or workflow in place.


Questions to ask for success in a hybrid environment:

1. Is the legal medical record defined for each format?
2. Can all staff reproduce the same information?
3. Do you have record destruction procedures in place and are they consistently followed?
4. Have you compiled a grid for the management of your information?


What are your thoughts? 

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