How To Implement Electronic Medical Records Retrieval In Your Firm
By W. Roger Smith, III, J.D.
Can you remember when your secretary typed your brief on an electronic typewriter? Can you remember when Westlaw or Lexis wasn’t available for legal research? Without a doubt, the advent of the personal computer and the internet has pushed the legal profession – sometimes kicking and screaming - quickly into the age of automation. Although many lawyers are averse to change, most have now embraced the “computer age.” From electronically filing lawsuits to communicating with opposing counsel or clients via e-mail, from electronic legal research to document management systems, most firms now utilize some form of computer system to handle day-to-day legal functions. In fact, many larger firms now employ IT staff to manage the complex computer software necessary to operate today’s law office efficiently.
A fairly recent option available to lawyers is the electronic retrieval and management of client medical records. For firms involved in medical-related litigation, this type of system is essential, as it can save significant amounts of time, cost, and liability for missed deadlines. It certainly did for our firm! Additionally, some firms are finding expanded revenue opportunities through undertaking larger or more complex cases without significantly increasing support infrastructure.
A quick review of the decision process in my own firm may be instructive on how an automated medical record retrieval and management system solved our problem with medical record overload.
We are a firm of 40 attorneys focused on personal injury, consumer fraud, toxic tort and mass tort pharmaceutical cases. We average about 1,350 medical record requests per month. Generally, we obtain a limited set of medical records at the initiation of a case to determine merit and fit. Statute of limitations deadlines require fast turnaround of records requests. Cases we ultimately pursue require a large number of detailed records from numerous sources to complete trial preparation.
Initially, we handled all medical records requests internally. This presented a number of serious challenges, including:
- Volume: the sheer volume of medical record requests was overwhelming, even after adding additional staff to assist in the process. For each record, there was the initial contact with the provider (after tracking down appropriate contact information) and, frequently, a number of follow-up calls.
- Accounting issues: payment logistics became burdensome, as checks had to be cut for individual invoices to each provider before records would be released.
- Tracking: when attorneys needed to know the status of a records request, the information was rarely available, and a separate call had to be made to the provider.
- Time: turnaround time suffered as many records languished in the request cycle.
We investigated different ways of improving the system, including building up our in-house capabilities. But, as we looked into it, we realized that to build an efficient system would require a much larger staff than we currently had or wanted to bring on.
After studying many of the problems we were facing, and after researching the options we had available to us, our solution was to automate the retrieval and management of our clients’ medical records. We realized relatively quickly that our solution was the right one!
Is Automated Retrieval and Management of Medical Records Right for Your Firm?
Any legal practice that regularly orders medical records should consider it. Based upon our own hands-on experience with these systems and input from a variety of other firms, we’ve put together this list of essential questions to consider:
Is your current staff able to quickly retrieve the records you need? Firms that order large amounts of medical records for multiple clients, such as the firms involved in mass tort or pharmaceutical litigation, must typically employ large numbers of staff to order, follow-up on, and process medical records requests. By utilizing an electronic retrieval and management system, these firms can employ fewer people and save precious time and space.
Are you getting the records you ordered quickly? It is critical to get medical records back as quickly as possible. Electronic retrieval and management of medical records can shed weeks, or even months, off the lengthy process of obtaining client medical records.
Are you out of space, or is space at a premium? “Paperless” offices are becoming essential to an efficient law practice. Paper copies of medical records can easily consume most, if not all, of your office storage space. The maintenance of electronic client files, including electronically scanned medical records, saves time and space.
Is your medical record staff constantly getting pulled to help on other projects? Moving to an automated system can free up staff to work on other important areas of your case.
Are you interested in saving money? Automation provides another area for bottom line-focused firms to realize additional cost savings and profitability improvement.
Moving Ahead – Inside or Out?
So you think an electronic system of retrieving and managing medical records may be right for your firm? Your next decision is whether you want to implement an internal system with in-house managed software and hardware systems, or whether you want to completely outsource this function to an online medical record retrieval supplier.
While it is often tempting to keep the process in-house, there are a number of key considerations in this decision:
Headcount. Behind the automated tracking systems, records retrieval can be fairly labor intensive. Outsourced suppliers specialize in this type of work and are able to spread their expertise and provider contact experience across many clients. An internal solution also increases the load on IT resources.
System Cost and Expertise . An internal solution requires the acquisition and maintenance of an automated system, including software, software maintenance and upgrades, and depending on your current setup, some additional hardware (e.g. high-speed scanners, servers for databases, etc..) Outsourcing eliminates this need entirely as the expertise in operating the system and the associated costs are included in the retrieval fees.
Training and Turnover. Another consideration for an internal solution is ramp-up, training and turnover of personnel. Again, with an outsourced solution, these headaches are, well, outsourced.
In the final analysis, these additional costs and challenges must be weighed against the outsource supplier’s per-transaction fee, and their ability to deliver records in a timely manner.
Must Have’s Short List
- Reputable supplier
- Fast turnaround
- On-line, web-based
- Simple, intuitive interface
- Real-time status tracking
- Cost controls
- National/international reach
Because of the expense and administrative issues involving with handling this function in-house, my firm chose to outsource the entire medical record retrieval and management function.
What Should You Look For in an Outsourced Provider?
Like anything else, there are the “Must Have’s” and the “Nice to Have’s”.
Reputable Company. Not only do you need an easy-to-use system, which I discuss below, you need to use a company that is 100% behind your goal, which is the quick and efficient retrieval of client medical records.
Fast Turnaround. Typically, in moving from a manual to an electronic system, you should expect turnaround times to drop from one to three months to about three weeks. Suppliers should be able to document their performance over time and across a sampling of firms.
On-line, Web-based System. The company should provide an on-line, web-based system for ordering records. Delivery and management of the records, including storage and backup, should also be through the same web-based interface, available 24 hours a day, 7 days a week, 365 days a year.
Simple, Intuitive Interface. A simple user-interface is crucial to ensure that the initiation of records requests is quick and easy, and that status tracking and reporting are routine and intelligible.
Real-Time Status Tracking . With a few clicks of your mouse, you should be able to determine the date of an initial medical record request, see dates and detailed call logs of conversations with medical providers, and determine the current status of a request and the estimated date of delivery.
Dedicated Account Management. The company should provide to your firm a dedicated account manager available during your normal business hours. The account manager should assist your firm with implementation and training needs regarding their system, and should quickly address your questions and solve any concerns or problems.
National/International Reach. The best outsource suppliers have developed a vast network and capability to quickly access records from virtually any medical provider in the U.S. and increasingly, overseas if necessary.
Nice To Have
Searchable Documents. OCR (optical character recognition) technology can turn medical record images (scanned copies which are not searchable) into searchable documents with annotation capabilities.
Record Consolidation. Multiple records for a client can be consolidated and indexed into one complete indexed record for easier review and case preparation.
Provider Cost Controls. Suppliers now help control costs by requiring that provider fees stay within appropriate state statutes, and by setting limits on provider fees by flagging any request that may exceed that limit before the request is approved for payment.
Nice To Have’s Short List
- Searchable documents
- Specialized services
- Record Consolidation
- Provider cost controls
- Online, individual client billing detail
- Interface to case management systems
- Customized controls and system flexibility
- Expanded cost control options
Online, Individual Client Billing Detail. Access to online tracking and invoicing data for all transactions and retrieved records related to a particular client. This feature can be an enormous time saver in approving fees and reconciling with your own accounting systems.
Interface to Case Management Systems . Ready-made interface capabilities with your own proprietary or popular off-the-shelf case management system can provide the ability to order and receive medical records without ever leaving your electronic case files.
Customized Controls and System Flexibility . Has the ability to quickly customize the system to fit your firm’s needs and is flexible enough to modify or enhance based on your user experience and feedback.
Expanded Cost Control Options . A simple interface which allows managers to review status and reasons for over-limit charges and take appropriate action.
Specialized Services. Additional services often offered include:
- Page and bates stamping
- Record sorting and indexing
- Medical reports and summaries
- Document coding
- Missing provider searches
- Records backup and storage
Ultimately, Beasley, Allen selected an online, outsourced solution from MediConnect. A key factor in that decision was MediConnect’s RapidRetrieve™ web interface. From any Internet-connected computer, our staff can quickly and easily manage all aspects of medical records retrieval, from initiating new requests, to tracking pending or past request status, to downloading completed records. They can also order additional services without leaving the system.
A crucial piece of the solution for us was MediConnect’s willingness to work with us in designing an internal system which allows medical provider information to be collected from each client’s electronic file and imported directly into MediConnect’s web-based system, eliminating the need to manually enter the information into the system.
Our firm has realized significant time and cost savings with the outsourced MediConnect solution. Turnaround times have improved dramatically, and we are more productive at lower staffing levels. Not only did we avoid hiring more people, we were able to move several employees who had been involved in requesting and tracking records to more productive work.
Automated medical records retrieval gives attorneys today one more good option for streamlining their practices. While there are many options and questions to consider, using an objective checklist to carefully select an outsourced supplier will help keep your firm profitably at the cutting edge.