Release of Information: Where did the paper charts go? by Deborah Gustavsen

I LOVE the bell curve (sometimes called the Normal or Gaussian curve). I mean, I really LOVE it. I love it the way that any university professor loves it, insisting that every graduate student in the department internalize every facet, know how it works, why it works and adjust grades accordingly. The beautiful bell curve (I can call it beautiful - A geek, I taught probability theory and genetics for a number of years) provides not just an appreciation of the normal, the usual, but also the scales upon which we appreciate the far ends of any spectrum, the more than usual , the less than usual . Without the bell curve, I could not accept or acknowledge greatness or weakness, brilliant or dull, or the simple growth and behavior of my children (I have two that insist on living at opposite ends of the bell curve on every measurable and miserable data point.)

In my business life, I've spent a lot of time thinking about the darling bell-shaped curve that depicts the different categories of adopters - Innovators, Early Adopters, Early Majority, Late Majority, and Laggards (isn't laggard an awful word?) that made sense of the transition to the Electronic Health Record (EHR) adoption. Everett Rogers developed the concept and applied it to hybrid corn adoption by Iowa farmers but it is equally applicable to the iPad or electronic medical records (EMR). Adopting the EHR is one of the major drivers of change in the Release Of Information (ROI) workflow, but not in the way that you might immediately suspect.

Yes, retrieving information from the EHR for a ROI request was a different workflow, a different place to capture the information needed, but the steady beat of the ROI drum remained. Electronic information was married to the paper chart as needed to produce a releasable copy, whether electronic or paper.

In terms of the adoption of the EHR, the Innovators, Early adopters and a good portion of the Early Majority no longer have room or a need for the legacy paper charts. The paper charts need to be kept for retention and ROI but they are seldom summoned for patient care and audits.

ROI was, is, and will remain the responsibility of the Health Information Management (HIM) department. In the day, it just made sense to have ROI sit close to the paper records. Tucked into desks and cubicles next to the file room, ROI specialists had ready access to the information contained in the paper records and could easily capture the electronic portions of the record. As the HIM department moves its attention from the quantity of the paper to the quality of the patient record, the Data Integrity specialists need those cubicles far more than ROI specialists. Clinics, hospitals, indeed, entire health systems are moving the remaining paper records offsite as the EHR rumbles through (did you feel the earth shudder?). File rooms are often the source of much needed space. ROI will now snug up against the paper records offsite. Sounds cozy and it is.

Iron Mountain's ROI program now sits beside the paper records in a lean production environment, avoiding the need to transport records back to the facility. Customers save money and enjoy the reduced liability associated with records being transported. The folks in Data Quality took our desks. It's okay. Things just weren't the same after the coders went home.

LINK:	http://blogs.ironmountain.com/2013/industry/healthcare-information-man...
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