Those of us who have been in the DME industry for enough years remember when every DME organization in the country had a storage room full of vertical files and/or bank boxes full of old patient records. The boxes were stored in piles, often piled up to the ceiling. Usually there were labels or writing on the boxes—something like “April 1987-January 1988” or “1990—A-L”. The boxes and filing cabinets were full of manila and Pend-a-flex folders labeled with patient names and chock full of medical records, billing information, social security numbers, dates of birth, and enough demographic information to make a telemarketer’s day.
At some companies, the room was purged or thinned out on a regular basis. Who remembers the Iron Mountain trucks coming out to haul off the records for offsite storage or bringing industrial sized shredders to help rid the company of old, outdated records? At other companies, that purging never took place, and DME organization’s filled space and paid for real estate to house these dusty old records into eternity.
A funny thing happened a couple decades ago. That method of storing records became outdated and each year, more and more companies “got with the times” and started storing data electronically. Now, the rooms that were formerly filled with banker’s boxes and vertical filing cabinets were full of computer servers. And of course, as the years went by, the size of the servers decreased; replaced by CD and DVD storage, thumb drives, and eventually “the cloud”.
The rooms with these old medical records were dusty and a good place for mildew and mold. The boxes and filing cabinets were sometimes stored/stacked precariously, presenting a safety hazard. And maybe once or twice a year, the organization had occasion to access one of these old records, which required digging through these old boxes and files. Companies scratched their heads and wondered if it was worth it. Was keeping those old files really useful and necessary?
Regardless of the technology – manila folders or a file in the cloud – it absolutely was, and is, necessary to maintain those files. In fact, accreditation standards and law and regulation both address that need/requirement.
The accreditation standard requires organizations to follow applicable law and regulation and at a minimum retain records for seven years.
PRO 4 is the HQAA standard that addresses this requirement:
PRO 4: Retention of Client Records
The organization will retain all records of all clients served, within confidentiality and privacy practices for at least seven (7) years or longer as required by law or applicable regulation. These records include those for services and billing. All records must be maintained in an easily retrievable manner. Pediatric patient records must be kept on file until the patient is at least seven (7) years past the age of majority or as required by state law.
To comply with this standard, you’ll need to develop a policy & procedure for “record retention”. The policy and procedure should address how long you store records, how they are stored (Electronic? Paper?), and should describe how you ensure their security and maintain confidentiality and privacy practices. Be sure to include language that assures you are following state regulations, which can occasionally exceed the seven-year retention “gold standard”. Also include language that describes that you maintain files for pediatric patients for seven years after they reach the age of majority.
At HQAA, you’ll be asked to upload your organization’s record retention policy & procedure into your workroom during the application phase. The surveyor will verify that you are following the policy during survey through staff interviews and also by reviewing patient care records for patients who are no longer on service. They will most likely ask about where and how the records are retained. If it’s the “old school” room full of banker’s boxes, they might ask to see the records. If its electronic, they will most likely ask the same questions and verify record retention the same way.
Also, keep in mind the surveyor will review state regulations in your home state and any other states that you do business in prior to survey. So, if you happen to work or provide care in a state that has a requirement that exceeds the seven-year rule, they will expect your company to understand that and be compliant with the law. If you provide care to pediatric patients, they’ll verify that you have a system that maintains the records until the patient has gone seven years beyond the age of majority.
Finally, remember that record retention is mentioned in other standards. Your policy & procedure should address patient records, but other records have similar requirements. These include:
- FS 1- Financial records for the organization
- HR 8- Human resource records for current and past employees
- DEL 1- Delivery records
Although the PRO 4 standard does not address these records directly, it is fairly typical to see a record retention standard that lists out all types of records and how long they should be maintained and available.
Those old file storage rooms of the past may be a distant memory, but it has never been more important to retain and maintain those records. Put the policy & procedure in place, educate your staff so they are aware of it, and make sure you are compliant. It may never come up in your organization, but if it does, you’ll be ready!