Ensure ROI Training Evolves as the Industry Changes

Today’s healthcare regulatory landscape and the need to balance expedient access to health information while ensuring the privacy rights of patients creates quite a balancing act for organizations and health information (HI) professionals.   

A number of federal and state regulatory requirements — from the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to the 21^st Century Cures Act — outline the appropriate release of protected health information (PHI). And don’t forget the myriad of state laws that govern these intricate processes. With the ever-changing nature of these complex regulations, having trained, knowledgeable, and competent staff is crucial to successfully navigating this challenging landscape. 

For many organizations, the complexity surrounding release of information (ROI) might be viewed as a “tug of war,” pitting the priorities of protecting patient’s privacy against ensuring open and unimpeded access to protected health information. On one side is HIPAA, ensuring that patient privacy is protected, and on the other side, the Cures Act, requiring patients have expedient access to their information. Unlike a real game of tug of war with one side winning, the goal for HI professionals is for the outcome to be a draw with a balanced result protecting privacy and offering patients prompt access to their information.

The need to deliver a balanced result is especially acute for professionals working in ROI, with specialists requiring extensive training and education to expertly navigate the variety of requests received every day. For instance, ROI specialists must understand the complexities of releasing a minor’s records for confidential care, ensuring appropriate safeguards are in place, and making sure the release is processed in accordance with applicable state laws.

Additionally, ROI staff must navigate the complex process of responding to subpoenas or law enforcement requests and distinguish between permittable and required disclosures by law, while ensuring expedient access to appropriately requested information. Understanding the types of requests that fall under treatment, payment, and healthcare operations (TPO) ensures these types of requests are not mishandled or delayed. This foundational knowledge also helps determine when an authorization is needed and how to validate whether all the required elements are included. With the right foundational training and education, ROI specialists will gain confidence in their ability to process requests in an accurate and timely manner.

At the same time, employee turnover continues to be a persistent issue across the industry and many entry-level professionals handling ROI requests may lack detailed familiarity with requirements and protocols. This lack of expertise creates risks for organizations and patient information security as employees attempt to fulfill ROI requests.

Some organizations may choose to create in-house training programs to ensure their ROI teams are proficient in handling requests. However, maintaining and overseeing a robust training program internally often requires a significant investment. Fortunately, there are other options for individuals and leaders seeking to improve ROI proficiency for themselves or their teams.

New Opportunities to Advance ROI Skill Set

Familiarity with ROI and its constantly changing regulations benefits both individuals and employers. It’s a valuable skill for professionals seeking career advancement as well as for more senior professionals, managers, and organizations seeking an understanding of current ROI issues to oversee teams and reduce risk of non-compliance more effectively and efficiently. But individuals and organizations alike have had no formal mechanism to recognize competency in this complex area of health information. Until now. 

AHIMA recently launched an ROI microcredential, underscoring the importance of ROI proficiency to the industry. A microcredential is designed to provide short, competency-based understanding to demonstrate aptitude in a particular area. Individuals who earn AHIMA’s ROI microcredential will have industry-leading certification recognizing their ROI proficiency and expertise.

In the rapidly evolving HI industry, change is a constant requiring new and long-serving professionals to regularly test and update their knowledge to remain proficient. Entry-level training and regular continuing education benefit both individuals and employers. ROI education and training are no different. Astute leaders and professionals should regularly evaluate and adjust their training efforts to ensure they, and their teams, are well-positioned to succeed in our dynamic industry and balance the “tug of war” in meeting competing priorities, particularly around ROI.

Jennifer McCann, RHIA, CHPS, CTR, is director of client relations and strategy for Haugen Consulting Group. Haugen Academy, a division of Haugen Consulting Group, partners with AHIMA to provide education, including ROI coursework that provides foundational education, including common, yet complex, real-world scenarios. Learn more in the AHIMA Store.