By Mariela Twiggs, MS, RHIA, CHP, FAHIMA

Patient satisfaction is one of the most critical aspects of the release of information (ROI) process. Patients deserve respectful and trustworthy customer service to ensure the best possible patient experience. Especially during this time of unprecedented crisis and uncertainty, empathy at every level of patient interaction is critical.

A patient often reaches out to ROI staff to request protected health information (PHI) when it is needed to receive further treatment, resolve a medical bill, or apply for a benefit, such as disability or financial assistance. Others request PHI because they are fully engaged in managing their own care.

Release of information is complicated. The utmost goal is to meet the patient’s needs, but the ROI specialist must consider HIPAA compliance and other applicable rules and regulations with regard to sensitive records and facility policy. Most patient access rules are designed to make it easy for a patient to obtain their medical records. To that end, ROI specialists are trained to explain each step in the process and assist with completion of required forms or authorizations.

During COVID-19, patient satisfaction depends heavily on an efficient and comprehensive portal experience. The Interoperability and Patient Access final rule (CMS-9115-F) puts patients first, providing access to their health information when they need it most and in a way they can best use it. This rule finalizes new policies that give patients access to their PHI and moves the healthcare system toward greater interoperability. The new rule specifically mandates access to more information through a portal, so many patients can avoid going through the traditional ROI process. However, facilities should set up an internal workflow designed to provide access to information that is not available on the portal.

Alternative Workflows

The COVID-19 pandemic has required that workflows for ROI be adjusted. Building alternative workflows is an effective strategy to support business continuity of PHI disclosure management during COVID-19 and any future crisis that may arise. As many hospital walk-in windows remain closed, alternative workflow options enable patients to continue submitting record requests and ensure proper disclosure of PHI.

Onsite Options

Secure Drop-Box

Set up a secure drop-box within the walk-in area with blank authorization forms and pens/pencils. The patient can complete the authorization form and drop it into a secured box. Requests can then be picked up regularly for processing by the internal ROI staff or sent to your ROI vendor for processing.


Provide empty envelopes and authorizations at the walk-in area for patients to complete and mail later.

Virtual/Electronic Options


Create a virtual/standard fax number to allow patients to fax requests for fulfillment.


Create an email, if not already in place, for patients to email requests. Example: Authorization forms can be made available on the website to be printed or downloaded, completed electronically, and saved to a patient’s device. The patient can then upload, scan, or take a photo of the completed form and email it from their phone or other device to the email address.


  • Enable patient portals to allow for receipt and/or delivery of requests
  • Expand permitted PHI that flows through the portal
  • Expand staffing support
  • Extend hours for receiving/delivering requests

To fully accommodate and support crisis-driven change, it’s important to maintain vigilance and real-time awareness throughout the organization. The overarching requirement is to uphold privacy of PHI according to strict protocols while making it easy for patients to request their records, especially if they don’t have access to a portal. Even during crisis, ROI must remain timely, compliant, and accurate.

Case Example of Workflow Changes

At one southeastern nonprofit academic healthcare system, MRO’s operations team worked with the facility registration departments and information desks at the entry points of the facilities to assist with providing patients options for obtaining their medical records without coming in to the ROI departments.

“The packets given to the patient included the authorization form and options to submit requests without face-to-face staff contact. The patient could easily complete the form there and drop it off,” says Alicia Elfer, regional operations manager at MRO. “Our staff makes pickups two to three times a day to collect completed authorizations. Patients could also elect to take the form with them or submit a request via portal, fax, mail, or email.”

“Offering support, listening, and then providing various options can ease their stress and give them some semblance of power. Patience with patients goes a long way.”

In addition, the maintenance departments were engaged at each facility to ensure protective and precautionary measures for anyone who did come to the office. To accommodate the new norm, the team found new ways to educate patients and other departments within the system about all available ROI options that did not involve face-to-face contact.

“In our experience, offering a patient several options for obtaining their PHI has always been the best method of providing a sense of patient satisfaction and control,” adds Elfer. “The facility may have physical control of the PHI but the patient has control over how to receive the information or have it sent to a third party. After all, it is their information so they should have control over how it is used and how it can be obtained. And, it is best to inform patients up front of any fees and the approximate timeline so they know what to expect.”

Patient Satisfaction and Advocacy

Many healthcare organizations conduct patient satisfaction surveys that are effective measures of patient engagement and satisfaction. It’s important to review the data with regard to patient experiences with ROI, and then set goals for improvement.

We find that offering options and suggestions works well with patients, rather than telling them what they should do. For many, the ROI process is a new experience. And chances are, the patient or a family member is dealing with a medical condition, which is stressful enough. A patient could be frustrated prior to even reaching HIM due to dissatisfaction with provider care, receiving misinformation, being transferred from one place to another, and more. Offering support, listening, and then providing various options can ease their stress and give them some semblance of power. Patience with patients goes a long way.

Finally, the role of the patient advocate has become increasingly critical for patients and families as the industry grows more complex. During this time of crisis, advocates can provide professional support and guidance to help patients manage their care and navigate the virtual ROI process.

Managing Stress and Anxiety

Stress and anxiety are at an all-time high due to the pandemic, both for staff members and patients. It’s important to educate and support staff on self-care and ways to boost mental health at this time.

Here are a few key points to consider:

  • Crisis situations sap energy
    • You can’t give what you don’t have
    • When depleted, small problems seem hard
  • Low power mode turns off unnecessary items
    • What can you put aside?
    • What’s restorative for you?
  • How can you be your best self?
    • Mentally:
      • Ease anxiety
      • Rely only upon reputable sources
    • Physically:
      • Take care of your body—strengthen immune system with sleep and exercise
      • Avoid bad habits
    • Emotionally:
      • EQ is more important than IQ
      • Don’t diminish disappointment, worries, and fears


Mariela Twiggs ( is the senior director of motivation and development at MRO.

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