This is a great question... to centralize or not to centralize.
In my experience there as many ways to approach this as there healthcare organizations, meaning that each organization will have different needs and challenges. I don't think there is a one-size-fits all approach, rather a change management approach that incorporates an appreciation for the HIM department staff skill set and expertise aligned with the organization's needs. A hybrid model seems to work for those who are spread out, such as you've described below and similar to my organization.
As an example in practice, what we've done is identify the areas that our team should own (100%) and keep those work flows local/in the department (indexing, ROI, eMPI, etc..). Other workflows that can and should be de-centralized are kept to a minimum and are closely monitored and audited by our team (using system generated reports, etc.). This helps to support our goal of HIMs as the subject matter experts, and data collection for performance improvement across the health system.
There are two areas that are decentralized (in a limited way), release of information and scanning. Since we use Epic, the ROI functionality (Quick Release) is appropriate; some very large clinics (more than 10-providers) use the ROI application, and their releases are patient and payer only. Scanning and indexing (limited though it is) is a requirement, simply because of the geographical reach of the health system.
Hope this helps, happy to chat off line (direct email is listed below).
Maria C. Alizondo, MOL, MLC, RHIT, FAHIMA
Director | Health Information Management Services
ISS | Information Services & Solutions
Office: 310-267-7603 | Cell: 818-590-7504