PHYSICAL STORAGE OF FILES IN MEDICAL RECORD DEPARTMENT

PHYSICAL STORAGE OF FILES IN MEDICAL RECORD DEPARTMENT – AN EASY & ACCOUNTABLE METHOD Dr. Naveen Chitkara Asian Editor, Neurosurgical Science Editor, Oncosure-Neuroscience Associate Editor, Neurology India 50 International and National publications Head, Neurosurgery Nasa Brain And Spine Centre, Jalandhar Category K 2 (Health care-Small)

MRD is an integral part of the hospital. Storage, retention and retrieval of medical records in an important constituent of medical record department. It is a big task to physically verify that the filing is in order, there are no misplaced files and during the MRD audit to ensure both of these.

Source ……. Mc. Graw Hill Publications Inc. , (2011)

Type of storage Filing is systematic arrangement of records, so that retrieval is fast and easy Storage options Tracking options • Paper (physical) storage • Radio tracers • Micro film, Smart Card, Cartridges • Computer –drives • Cloud based storage .

Type of storage • Alphabetic • Numeric Straight numeric Terminal digital Alpha numeric • • Special flagging Supplemental files Color coding Ticker files

Numeric type of storage: Advantages Logical and easy to train Easy to retrieve Terminal digit: equally distributed, inactive records can be pulled out, misfiles are reduced • Disadvantages 1. Easy to misfile: all digits of the numbers to be considered to file 2. Easy to transcribe no. where one digit is wrongly written or read e. g. 1 / 7 3. Easy to transpose no. e. g. 194383 193483 4. In Terminal digit filing: there are gaps in between the files

Alphabetic type of storage: Advantages Simplest form of record identification Easy for record retrieval • Disadvantages Pt. confidentiality, Impractical in larger setups where there could be multiplicity of names, Spelling mistakes in names can lead to errors, Aliases and changes in names make it difficult

Color coding – types can be used with either types of filing system Alphabetic Numeric • Complicated- each letter is given a color: 1 st two letters of the names are used as identifiers • Numeric- each digit from 19 is given a color • Especially convenient for terminal digit filing • Color bars are used in various positions around the edges of the folders

Color coding - advantages • Record manager studies show that 80% of cost in managing a MRD is that of people’s time. • Time spent for searching misplaced files is the largest cost associated with filing.

Color coding - advantages 1. Saves time on filing 1. Decreases retrieval times by 40% 2. Avoids filing errors and detects these errors if 2. Decreases risk of any missing file 3. Facilitates sorting 4. Simplifies auditing 5. Improves efficiency

• A break in the color pattern signals a misplaced file

Color coding in terminal digit filing e. g. 14 50 69 A color for 1 st of primary digit –’ 6’ Second color for –’ 9’ Third color can be added for first of the secondary digits- ‘ 5’ Another band can be added for 1 st of tertiary digit’ 1’

Color coding in terminal digit filing Or these can be lesser no. of bands, It is better to keep color codes on folders to 2 or 3 to keep it more simple

Color coding with alphabetical system of filing One file Multiple files

Looking for a file which is not in its position of filing? • Misplaced in MRD? • or, Missing? No way to identify misfiles?

Locating misplaced file: WHO Medical Records Manual, 2002 1. Look for the transposition of digits in a number. For example, 131234 may be filed as 131243 or 121334. 2. Look for missing files under similar looking numbers such as "3" under "5" or "8" or vice versa. Or "7" or "8" under "9". 3. Check for a certain number such as 584 under 583 or 585 or under a similar combination. 4. Check the transpositions of first and last numbers. 5. Check the medical record just before and just after the one needed. 6. Check the shelf immediately above and below where the record should be filed. 


Locating misplaced file: Mc. Graw Hill Publications 1. 2. 3. 4. 5. Look for transposition of numbers e. g. 194383 193483 Look for missing files under similar looking numbers 3 under 5 or 8 Look for in adjacent files Check for transposition of first and last numbers Check the shelves immediately above and below Repeat the process with another employee If still not found, labeled as lost

Need for the project ? • observation that even after deposition of file with MRD, there were missing files and some times files were placed in inappropriate position. • In hospitals with large volumes of discharge patients there was no method to check for these aberrations. Aim : To reduce human errors

Our 6 step process of filing. Printing of file –its spine Color of files. Color of stickers label. Font selection for printing IPD. Pasting of stickers label in a particular row on file. • Special stickers. • • •

1. Printing of the file cover Special indicators Rows – representing the tens

2. Color of the file (cover) For “multiple of thousands” Color of file cover changes after every 5000 Cream: 001 -4999 Blue: 5000 -9999 Pink: 10, 000 -14, 999 And so forth…. .

3. Color of the labeling stickers For “thousands” Labeling stickers are chosen of different colors: Yellow : 0 -999 Blue : 1000 -1999 Green : 2000 -2999 White : 3000 -3999 Red : 4000 -4999 and then repeated

4. Font selection for printing IPD. For “hundreds and units” Two digits on each sticker are printed bold and in bigger font the left digit represents the “hundred” and the right represents the “single unit” Cream files: with in 5000, yellow stickers: with in 1000, Row no. 20’s and 30’ 3

5. Pasting of stickers label in a particular row on file. For “tens” Stickers are pasted in rows, and each row represents the next ten letters 1 st row: 0 -09 2 nd row: 10 -19 3 rd row: 20 -29 And so forth……….

6. Special labels: Death files: Black MLC files: Red Diabetic pts: Yellow Operated pts: Green

Representation /Identifiers • • • Multiple of five thousands: color of file Thousands : color of label stickers Hundreds : left bold letter Tens : rows of tens Units : right bold letter

Files no. 20 -33 All cream colored files (0001 -4999) with yellow labels (001 -999) having bold single digit from 0 -1 are in sequential order and in each successively lower row representing ten’s.

Storage of files with IPD numbers 120 -134 All cream colored files (0001 -4999) with yellow labels (001 -999) having bold left digit 1(100 -199) and bold right digits from 0 -1 in sequential order and in each successively lower row representing ten’s.

Storage of files with IPD numbers 1220 -1231 All cream colored files (0001 -4999) with Blue labels (1000 -1999) having bold left digit 2 (200 -299) and bold right digits from 0 -1 in sequential order and in each successively lower row representing ten’s.

Storage of files with IPD numbers 1970 -2036 All cream colored files (001 - 4999) with Yellow labels (001 -999) with Blue labels (1000 -1036) having bold left digit 9 (970 -999) and bold right digits from 0 -1 in sequential order and in each successively lower row representing ten’s.

Storage of files with IPD numbers 4970 -5036 All cream colored files (4970 -4999) with Red labels (4970 -4999) with Yellow labels (5000 -5036) having bold left digit 9 (970 -999) and bold right digits from 0 -1 in sequential order and in each successively lower row representing ten’s

View of typical file storage/audit Files with IPD Nos. from: 971 -1045 6 MLC files 7 Death files 2 Operated patients No diabetic patient

A misplaced file:

A misplaced file:

No one colored sticker should be found in between other color (limiting to 1000)

Misplaced file with IPD 216 DM DM DM DM OPTD OPTD OPTD OPTD DEATH DEATH DEATH DEATH MLC MLC MLC MLC 0 -9 0 -9 0 -9 0 -9 10 -19 10 -19 10 -19 10 -1]]9 10 -19 120 121 122 123 124 125 226 127 128 129 20 -29 30 -39 30 -39 30 -39 131 132 133 40 -49 40 -49 40 -49 40 -49 50 -59 50 -59 50 -59 50 -59 60 -69 60 -69 60 -69 60 -69 70 -79 70 -79 70 -79 70 -79 80 -89 80 -89 80 -89 80 -89 90 -99 90 -99 90 -99 90 -99

Distinct advantages: • Any inappropriately placed file can be identified by color of files, color of labeling stickers, row of placement of stickers and alignment of bold digits

Distinct advantages: • Convenience to audit that all files are in order. • Can pull out special type of file for research and other purposes e. g : Death, operated, MLC, Diabetic and so forth.

Reproducible: • Easy and simple • Is easily replicable at other hospitals. • It increases the accessibility for speedy location and identification, and

is economical, elastic and helps in storing the files in an accurate and accountable fashion and at no extra cost

Thanks.