Bringing It Back Home

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Provider organizations disappointed in the results of their outsourcing efforts are discovering the virtues of another industry buzzword: reinsourcing.

Outsourcing information technology services has long been extolled for its ability to save money and increase efficiency. If it can be done cheaper, better, or faster off-site, then why not? A growing number of chief information officers, however, have been turning to outsourcing's polar opposite—reinsourcing—as a way to work more efficiently.

Take the case of Massachusetts General Hospital in Boston. Over the past several years the hospital's health information services department has moved away from outsourcing HIM functions and now processes nearly all 40,000 release of information requests in house by making use of readily available, out-of-the-box technology and a secure delivery server, says Mark Haas, manager of health information services at 790-staffed-bed Mass General. Haas says the impetus behind deciding to reinsource the hospital's release of information requests was both disappointing deals and contracts with outside vendors and less-than-stellar performance from previous outsourcing services.

A Deloitte & Touche USA LLP consulting report on outsourcing concluded that "outsourcing frequently fails to deliver its promise." According to the same Deloitte Consulting report, 64% of organizations surveyed brought some outsourced services back in house. Now, says Haas, many CIOs are finding that rather than renegotiate deals or contract with new vendors, they are choosing to perform those tasks internally.

So how does it work?

In June 2007, Mass General's HIM department began fulfilling all of its Social Security Administration disability determination medical record requests electronically using the SSA online Electronic Records Express secure Web service, Haas says. The hospital employs 12 FTE medical abstractors to process the 40,000 annual requests.

After nearly a year of submitting SSA disability determination record requests electronically, Haas says the hospital has experienced a 119% increase in productivity for the individual assigned to handle disability requests and a 2.1-day drop in turnaround time.

Reinsourcing can prompt questions about the IT department's readiness to handle the additional work, Haas says. Conduct a full-scale pilot to show your team's readiness, or improve service levels in the work your group is already providing, Haas recommends.

"Reinsourcing is a trend in many industries but has made minimal progress in health information management to date," he says. "Yet, given the technology available, the proper vendor relationships, and the need to remain responsive to market changes, HIM managers should seriously consider its potential benefits in their own health information management setting."

Kathryn Mackenzie

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