1. Managing the Office Medical Records10
Managing the Office Medical Records

2. Learning Outcomes
10.1 Describe the equipment and supplies needed for filing medical records.
10.2 List and describe the various types of filing systems.
10.3 Discuss the benefits of each type of system.
10.4 Discuss the advantages of color coding the files.
10.5 Explain how to set up and use a tickler file.

3. Learning Outcomes (cont.)
10.6 Describe each of the five steps in the filing process.
10.7 Explain the steps to take in trying to locate a misplaced file.
10.8 List and describe the basic file storage options and the advantages of each.
10.9 Identify criteria for determining whether files should be retained, stored, or discarded.

4. Introduction Management of patient records
Vital to patient care and smooth operation of medical office
Paper-based medical records
Electronic Health Record (EHR) or Electronic Medical Record (EMR)

5. Importance of Records Management
The medical records are the most valuable information in the medical office.
A records management system refers to the way patient records are
Created
Filed
Maintained

6. Super! Apply Your Knowledge What is a records management system?
ANSWER: A records management system is the way patient records are created, filed, and maintained.
Super!

7. Filing Equipment Place where the medical records are housed
Choice of type is based on space consideration and personal preference
Filing shelves
Files are stacked upright on shelves in boxes or heavy-duty envelopes
Allow more than one person at a time to retrieve files

8. Filing Equipment (cont.)
Filing cabinets
Sturdy pieces of office furniture Both vertical and lateral (horizontal) file cabinets are available
Compactable files
Kept on rolling shelves that slide along permanent tracks on the floor
Seen often in offices with limited space for files

9. Filing Equipment (cont.)
Rotary circular files – files are stored in a circular fashion resembling a revolving door
Plastic or cardboard tubs or boxes
Organized like filing cabinet drawers
Inefficient for a large number of files
Files can easily be misplaced with this system
Heavy to carry around

10. Filing Equipment (cont.)
Labeling filing equipment
Label outside of drawer represents its contents
Easily retrievable records
A-D
Security measures
Protect confidentiality of medical records
Cabinets should lock or be in a lockable room
Limit who has keys

11. Ergonomics
Science of adjusting the elements of the working environment to the human body
Maintain a healthy and safe posture while working
Overexertion – increases risk of injury
Common causes of workplace injury
Improper lifting
Repetitive motions
Being struck by an object
Slipping and bending

12. Ergonomics (cont.) Tips
Place a footstool next to the examination table
Take a course in proper lifting
Ensure good lighting
Wear proper shoes
Select storage and shelving that will aid in reducing muscular strain

13. Filing Equipment (cont.)
Equipment safety
Post safety guidelines
Ensure that everyone follows rules to prevent injury
Purchasing filing equipment
First determine space availability
Then determine number of files to store

14. Apply Your Knowledge
1. When restocking the examination rooms in your workplace, you are constantly having to obtain frequently used items from the lowest shelves in the supply room. At the end of the day, you notice that your lower back is achy. What can you do about this situation?
ANSWER: Rearrange the supply room so that the more frequently used items are on waist-level shelves to eliminate the need to bend down.

15. Apply Your Knowledge Good Answers!
2. A busy medical office is considering changing the current filing equipment. Which equipment would you recommend to this non-computerized office that will allow more people to retrieve files at the same time?
ANSWER: Filing shelves would be a great system if adequate space is available.
Good Answers!

16.   Filing Supplies File folders Tab Referred to as manila folders
Available in 8 ½ by 11 inches and 8 ½ by inches
Tabs - extensions at the top or side of the folder and used to identify the contents 
Smith, A.
Adams, G.

17. Filing Supplies (cont.)
Labels
Identify contents
Print clearly or use computer- generated labels
Cover with tape to prevent smearing
File jackets
Resemble file folders but have plastic or metal hooks on both sides for hanging them inside filing drawers
Files are placed inside these jackets

18. Filing Supplies (cont.)
File guides
Heavy cardboard or plastic inserts that identify groups of files
Out guides – used as placeholders for removed files
File sorters – large envelope-style folders with tabs that store files temporarily

19. Filing Supplies (cont.)
Binders
Some offices use three-ring binders to keep patient records
Tabs are used to separate individual charts
Require more storage
Effective for management of active patient records
Purchasing filing supplies is a common responsibility of medical assistants

20. Apply Your Knowledge
Which of the following would you use to mark the place when removing a patient record from the file?
File jacket
File guide
Out guide
File sorter
ANSWER: A
GREAT!

21. Filing Systems All use a sequential order
Follow system exactly to avoid losing or misplacing records
Avoid changing system

22. Alphabetic Filing System
Most common system
Files are arranged in alphabetical order
Follow indexing guidelines
Each individual must have a separate file

23. Alphabetic Filing System (cont.)
Indexing rules – guidelines for sequencing files
Each part of name is a unit
Last name
First name
Middle name / initial
Titles (Jr., Sr. ,Rev., Dr., etc.) are the fourth indexing unit

24. Numeric Filing Systems
Organizes files by numbers instead of names
Patients are assigned sequential numbers
This system is often used with highly confidential information
A master list of patient names and numbers must be kept

25. Numeric Filing Systems (cont.)
Terminal digit filing
Treat the last 2, 3, or 4 digits in a number as a single unit
For example, the numbers 024 represent the last three digits of a longer number
The numbers 024 are then considered ending or terminal digits, so all folders ending in 024 are grouped together
Filing is done based on last group of numbers
Middle digit filing
Uses the middle group as primary index for filing

26. Filing System Color Coding
Used to distinguish files within a filing system
Can be used with either alphabetic or numeric filing systems
Using classification with color coding
Identify how files are to be classified
Select a separate color for each classification
Post codes so all are aware of them

27. Filing System (cont.) Color Coding 51 61 01 43
With alphabetic filing systems
Each letter is assigned a color
The first two letters of the last name are color-coded with colored tabs
Can easily tell if files are filed correctly
With numeric filing systems
Numbers 1 to 9 assigned a distinct color
Helps identify numeric files that are out of place 51 61 01 43

28. Filing Systems (cont.) Tickler files Reminder files
Check on a regular basis
Organized by month, week of month, or day of week
Computer systems offer tickler files in the form of a calendar
Reminders set to alert prior to event

29. Filing Systems (cont.) Supplemental files
Separate files containing additional information
Prevents cluttering of primary files
Stored in a different location than primary file
Contents should be distinguished from the primary file contents

30. RIGHT! Apply Your Knowledge
Today is December 17th. Which of the information listed below could be added to a “tickler” file?
Names of patients that missed appointments two days ago
June medical conference dates just received in the mail
Names of patients seen today for their annual check-up
ANSWER:
RIGHT!

31. The Filing Process Medical assistant responsibilities
Pulling and filing patient records
Filing documents
Follow practice policies for returning records to the files
Immediately vs. at the end of day
Place records to be filed in a secure file return area

32. The Filing Process (cont.)
Generally the medical assistant files three types of items:
New
patient
record
folders
Individual
documents
for
existing
folders
Previously
filed
patient
record
folders

33. The Filing Process (cont.)
Place the files in the appropriate location for easy retrieval when needed
Storing
Place files in order to save time when storing
Sorting
Add an identifying mark to ensure that the file is put in the correct place
Coding
Name the file using the office classification system
Indexing
Inspecting
Make sure document is ready to
be filed
5 Steps to Filing

34. Limiting Access to Files
Limit the number of people in the medical office who have access to patient records
Original patient records should not leave the medical office (Exceptions noted in Chapter 9)
Identifying information is often recorded when files are retrieved

35. Filing Guidelines
Take a close look at the contents of patient records each time you pull or file them
Keep files neat
Do not overstuff file folders
Papers should not extend beyond edge of folder
Remove file from drawer when adding documents
Prevents damage to documents

36. Filing Guidelines (cont.)
Do not crowd the file drawer
Allow space for retrieving and replacing files easily
If possible, use both uppercase and lowercase letters to label the folders
Use file guides with a different tab position to aid in finding files
It is better to provide too many cross-references than too few

37. Filing Guidelines (cont.)
File regularly
Do not store anything other than files in the file storage area
Train all staff who will be retrieving files on the system in place
Periodically evaluate your office system

38. Locating Misplaced Files (cont.)
Determine where the file was when it was last seen or used
Look for the file while retracing steps from that location
Check filing cabinet where it belongs
Check neighboring files

39. Locating Misplaced Files (cont.)
Check underneath files in drawer or on shelf
Check items to be filed
Check with other staff members
Check other file locations
Similar indexes
Under patient’s first name
Misfiled chart color
Ask if someone inadvertently picked up the file with other materials

40. Locating Misplaced Files (cont.)
Have another person complete the steps to double-check your search
Straighten the office, carefully checking all piles of information
Check charts that have been pulled for the next day appointments
Check physician’s desk

41. Locating Misplaced Files (cont.)
File may be considered lost if not found within 24 to 48 hours
Lost files can have potentially devastating consequences
Recreate a new file
Physicians and staff record recollections of information in the file
Duplicate documents from labs, insurance companies, etc.

42. Active vs. Inactive Files
Active files are files that you use frequently
Inactive files are files that you use infrequently
Closed files – files of patients that no longer consult the office
The physician determines when a file is deemed inactive or closed

43. Apply Your Knowledge Terrific!
The medical assistant is training a new employee who will primarily be responsible for the medical records. The new employee asks “Can I first sort the charts, then inspect them?” List the 5 steps to filing in the correct order and provide an explanation to answer her.
ANSWER: The 5 steps to filing are:
1. Inspecting 2. Indexing
3. Coding 4. Sorting
5. Storing
The charts should be inspected first to be sure all necessary documents are in the charts and that they are ready for sorting and storing.
Terrific!

44. Inactive and Closed File Storage
Paper Storage
Microfilm
Computer Storage
Basic
Storage
Options
Files remain in their original format
Labeled boxes with lids to allow even stacking
If the paper becomes brittle, transfer documents to another storage medium.
Microfilm, microfiche, and film cartridges offer a paperless way of storing records.
Patient records can be scanned and saved on computer tapes, recordable CDs or DVDs, flash drives, or external hard drives.

45. File Storage Facilities
Some offices have extra storage space on-site
Smaller offices require the use of off-site storage
Use a facility that takes precautions against fires and floods
Maintain a list of all files stored at off-site locations

46. File Storage Safety
Inactive and closed files must remain safe and secure
Evaluate storage sites carefully
Preferably place files in fireproof and waterproof containers
The storage site should be safe from
Fire and floods
Vandalism and theft
Extremes of temperature

47. Retaining Files in the Office
Retention schedule
Specifies how long patient records are to be kept once they become inactive or closed
Details when files should be moved to storage and when they can be destroyed
Generally determined by the physician

48. Retaining Files in the Office (cont.)
Certain records have legal criteria for the length of time they must be maintained in the office, such as
Immunizations
Employee health records
Medical office financial records
Criteria from
IRS – financial records
AMA, American Hospital Association
HIPAA law
Federal and state laws

49. Retaining Files in the Office (cont.)
Destruction of records
Maintain Confidentiality
Shred
Retain list of documents destroyed

50. Excellent! Apply Your Knowledge
An employee who quit two years ago telephones and requests that copies of her annual physical examination forms, which she submitted while employed, be mailed to her home address. How would you handle this?
ANSWER: You should get this request in writing and then proceed to locate the records. The Labor Standards Act specifies that employee health records must be kept for three years, so they should be on hand at the office.
Excellent!

51. In Summary
10.1 Equipment and supplies needed for filing medical records are
Filing shelves and cabinets, rotary circular files, plastic index boxes
Labeling equipment
Hanging file folders and filing supplies such as folders and binders
10.2 There are various types of filing systems, including alphabetic, numeric and color coding.

52. In Summary (cont.)
10.3 The benefit of using an alphabetic system is that it is simple to use, but you have to make sure that you know the spelling of the person’s name in order to retrieve the file. The numeric system keeps files confidential, and names are recorded elsewhere.
10.4 The advantage of color coding the filing system is that it distinguishes files within a system and can add additional information to the system.

53. In Summary (cont.)
10.5 Set up 12 file folders (one per month) and arrange with current file on top. Make a list of upcoming responsibilities and activities, file notes by month, and check tickler file at least weekly.
10.6 The five steps in the filing process are:
Inspect a file
Index or name a file
Code a file
Sort
Store documents neatly within a proper sequence.

54. In Summary (cont.) 10.7 Steps to assist in locating a misplaced file:
Determine the last time you saw the file and retrace steps
Look in the filing cabinet where the file belongs
Check underneath the files in the drawer or shelf
Check the pile of items to be filed
Consider whether it might be cross-referenced
Check with other staff members

55. In Summary (cont.)
10.7 More steps to assist in locating a misplaced file:
Check under the person’s first name
Stand back from the file cabinet
Check to see if someone else has taken it out
Ask other staff members to do the previous steps that you have done.

56. In Summary (cont.)
10.8 There are many ways to store inactive files. Paper storage, computer storage and microfilm, microfiche, and cartridges are basic storage options.
10.9 The criteria for retaining, storing, and discarding files vary from state to state. It is always advisable for doctors to request legal advice before destroying records
Employee health records – retained for three years
Immunization records should be on file permanently
Financial records must be kept up to 10 years.

57. End of Chapter 10
We must try to continue to hear patient voices above the din of the machinery.
~ Catherine Lopez
From A Daybook for Nurses