Lecture Medical assisting: Administrative and clinical procedures with anatomy and physiology (4e) – Chapter 10

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

Managing the Office Medical Records

Learning Outcomes

10.1 Describe the equipment and supplies

needed for filing medical records

10.2 List and describe the various types of filing

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

• 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)

Importance of Records Management

• The medical records are the most valuable

information in the medical office.

the way patient records are

– Created

– Filed

– Maintained

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

!

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

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

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

Filing Equipment (cont.)

• Labeling filing equipment

– Label outside of drawer

represents its contents – Easily retrievable records

• 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

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

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

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

Apply Your Knowledge

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!

Filing Supplies



 Referred to as manila folders

 Available in 8 ½ by 11 inches and 8 ½ by 14

inches

Tabs - extensions at the top or side of the

folder and used to

identify the contents Smith, A. Adams, G.

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

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

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

Apply Your Knowledge

Which of the following would you use to mark the

place when removing a patient record from the

Filing Systems

• All use a sequential order

• Follow system exactly to avoid losing

or misplacing records

• Avoid changing system

Alphabetic Filing System

• Most common system

• Files are arranged in

alphabetical order

• Follow indexing guidelines

• Each individual must have a separate

file

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

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

Numeric Filing Systems (cont.)

• Terminal digit filing

– Treat the last 2, 3, or 4 digits in a number as a single

– Filing is done based on last group of numbers

• Middle digit filing

– Uses the middle group as primary index for filing

Filing System

• 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

Filing System (cont.)

• 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

5 1 4 3 6 1 0 1

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

Filing Systems (cont.)

– Contents should be distinguished from the

primary file contents

Today is December 17th Which of the information listed below could be added to a “tickler” file?

a Names of patients that missed appointments two

days ago

b June medical conference dates just received in the mail

c Names of patients seen today for their annual check-up

Apply Your Knowledge

RIGHT!

ANSWER:

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

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

The Filing Process (cont.)

Place files in order to save time when storing

Add an identifying mark to ensure that the

file is put in the correct place

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

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

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

Filing Guidelines (cont.)

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

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

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

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.

Active vs Inactive Files

• Active files are files that you use

frequently

• Inactive files are files that you use

infrequently

• Closed files – fi les of patients that no

longer consult the office

• The physician determines when a file is

deemed inactive or closed

Apply Your Knowledge

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

Inactive and Closed File Storage

BasicStorageOptions

Computer Storage Microfilm

Paper Storage

 Files remain in their

original format

 Labeled boxes with lids to

allow even stacking

 If the paper becomes

brittle, transfer documents

Patient records can be scanned and saved on computer tapes, recordable CDs or DVDs, flash drives,

or external hard drives.

Microfilm, microfiche, and film cartridges offer a

paperless way of storing records.

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

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

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

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

Retaining Files in the Office (cont.)

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?

Apply Your Knowledge

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

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

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

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

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

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.

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

We must try to continue to hear patient voices above the din of the machinery.

~ Catherine Lopez

From A Daybook for Nurses

End of Chapter 10