ANALYSIS OF FILLING SYSTEM AND CONSEQUENCES OF

MISFILED PATIENT CASE FOLDERS

BY

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 CHAPTER ONE
INTRODUCTION

1.1. Background of the Study

Health information system cannot be ignored since health policies and planning in any

country are mostly dependent on the correct and timely information on various health issues.

Health facilities throughout the world keep consistent records of patients/clients. These

medical records are normally kept confidential and in confined places such as records unit or

offices. Medical record is a chronologically written account of a patient's examination and

treatment that includes the patient's medical history and complaints, the physician's physical

findings, the results of diagnostic tests and procedures, medications and therapeutic

procedures. (Anon., 2014). In effect, medical record of a patient is the clinical representation

of the patient that is built over a period by various clinicians with the consent, trust, privacy

and confidence of the patient. It enables continuity of care and again, overtime, it becomes a

comprehensive, clinical database from which various and salient clinical information is

gathered through research. (Mann R, 2013).

Medical records serve many functions but their primary purpose is to support patient care and

in almost all public health facilities in Nigeria, they are kept in folders. Structuring the record

can bring direct benefits to patients by improving patient outcomes and doctors' performance.

On the side of patients, the records function as medical identification. (Mann R, 2013).

Huffman (2016) affirms that the health records of patients are an important primary tool in

the practice of medicine. The whole idea behind it is to provide better care of the patient

through careful recording of every detail having to do with the patient illness and care

rendered. Therefore, health records of the patient should be made available to the health

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professionals whenever patient visits the hospital for continuity of their previous treatment.

Failure to produce patient health record by the health information manager/officer in the

hospital due to mislaying or misfiling of such health record will bring about untold hardship

on the part of the hospital and the patient. That is, the health professionals such as the

hospital management physician (doctors), nurses, laboratory scientists etc. would not be able

to review the previous treatment and diagnosis given to the patient and wrong treatment and

diagnosis may be given to the patient at the end, which at times may lead to the patient’s

death, financial loss on the part of the hospital and the patient’s relatives may sue the hospital

for negligence and malpractice for damage done to the patient during the cause of the

treatment.

Moreover, Yeo (2019) posits that hospitals deal with the life and health of their patients, good

medical care relies on well-trained doctors and nurses and on high-quality facilities and

equipment. Good medical care also relies on good record keeping, without accurate,

comprehensive up-to-date and accessible patients’ case notes, medical personnel may not

offer the best treatment or in fact may diagnose condition which can have wrong

consequences on the part of the hospitals and the patients. In addition, records also provide

evidence of the hospital accountability for its action and form a key source of data for

medical research, statistical report and health information systems.

According to Nandalal (2013), a patient health record communicates information about their

progress to the physicians and other health professionals who are providing care to the

patient. It is a communication link among the patient care-givers. For those health

professionals that provide care on subsequent occasions, the medical records provide critical

information such as the history of illnesses and the treatment given. Also, health records

provide evidence that may assist in protecting the legal interest of the patient, the physician

and the health institution.

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Filling of health records is important for a number of reasons;

a. For communication purposes while caring for the patient

b. For evaluation of patient outcome

c. For continuity of patient care over the course of the patient illness

d. For medico-legal purposes

e. For use as a source of health statistics

f. For research, education and planning

Huffman (2016) affirms that the health records is an orderly written report of the patient

complaints, the diagnosis findings, treatment and end result that in total form clinical picture

and when completed provides sufficient information to clearly identify the patient to justify

the diagnosis and treatment, and to record result. Because “patient forgets but record

remembers,” the health record is of the value to the patient, the hospital, the physician and for

research and teaching. Sequel to the aforementioned, it could be deduced that health records

keeping is the pivot of medicine. Failure to produce patient health records during his

subsequent visits to the hospital by the health records officer due to mislaying and misfiling

of patient health records in the health records department may inflict a lot of problem on the

patient, the hospital and the physician. The continuity of the patient care would be hampered,

wrong diagnosis may be given to the patient, patient may be delayed unnecessarily before

being attended to by the physician, the hospital management will not be able to review the

quality of care rendered to the patient during his stay in the hospital and the patient relatives

may conclude that negligence and malpractice have been committed during the course of

treatment and therefore sue the hospital management for damages. In order to avoid the

above mentioned, the health records managers/officers should be up and doing in the hospital

to make records of patient available whenever it is needed by the health professionals for

continuity of the treatment.

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1.2. Statement of the Problem
Proper filing of patient's medical records ensures easy retrieval, contributes to

decreased patient waiting time at the hospital, and ensures continuity of care. It is therefore,

imperative, that medical records are always kept in the interest of both the clinician and the

patient. The medical folder must always be in the custody of the health facility whiles the

patient enjoys the right of information. Studies in other developing countries have observed

their record keeping systems to be inadequate with about half (52.2%) of the records

retrievable within one hour, some of the records were poorly designed and there is use of

multiple patient health records by patients. (Aziz S, 2018).

Problems of poor record keeping practices in health care facilities such as duplication,

incomplete data, and inaccuracies in data made it difficult for health administrators and

researchers to accurately and reliably identify and define health problems. Therefore, the

strengthening of the medical records in general and a computerized folder retrieval system in

particular, could contribute to its position as a valuable source of information for health care

delivery, public health and policy making.

As attendance in the health facilities increases with time, the volume of medical records

becomes a big challenge to health facility management. This is no different in Nigeria and for

that matter Mother and Child Teaching Hospital, Akure. The hospital is confronted with

filing of medical records especially with the introduction of the national health insurance

scheme, which brought in its wake the introduction of new folders and NHIS identification

cards (ID cards). The hospital is thus saddled with old and new folders for a sizeable number

of the patients having more than two folders due mainly to misfiling or patient forgetting

their ID cards when visiting the facility.

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This project therefore wants to analyze the causes, consequence and available solution to the

problems of mislaying and misfiling of patient health records in the health records

department, as well as developing a system for computerizing patient folder management

which will solve most of the challenges if not all that arises from the manual management of

patient records in the hospital.

1.3. Objective of the Study

folders in Mother and Child Teaching Hospital, Akure, Ondo State.

The specific objectives of the study are:

1. To examine the available filing and numbering system in Mother and Child Teaching

Hospital, Ondo State;

2. To evaluate the effect of mislaying and misfiling of patients health records in Mother

and Child Teaching Hospital, Ondo State;

3. To assess the types of health records personnel involved in filing and retrieval of

patient health records in Mother and Child Teaching Hospital, Ondo State; and

4. To find solution to the problems of mislaying and misfiling of patient health records

in Mother and Child Teaching Hospital, Ondo State;

1.4. Research Questions

1) What are the available filing and numbering system in Mother and Child Teaching

Hospital, Ondo State?

2) What are the effect of mislaying and misfiling of patients health records in Mother

and Child Teaching Hospital, Ondo State?

3) What are the types of health records personnel involved in filing and retrieval of

patient health records in Mother and Child Teaching Hospital, Ondo State?

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 4) What are solution to the problems of mislaying and misfiling of patient health records

in Mother and Child Teaching Hospital, Ondo State?

1.5. Scope of the Study

patient care folders. The study is purely restricted to Health Information Professionals in

Health Information Management Department of Mother and Child Teaching Hospital, Akure,

Ondo State.

1.6. Significance of the Study

Management of MCTH to better buttress filing system and its consequence of misfiled

patient care folders to ensure good delivery in healthcare settings. The findings are expected

to help inform decision making in the area of strategic planning with regard to Health

Records Services. The research will help to improve on efficiency and effectiveness of

administrative work flow in health facilities for better understanding on how records

processing is vital and guide how records are created, distributed, stored, assessed and

retrieved in health facilities.

The findings will also help in the development and implementation of future policies and

practices that will enhance quality delivery in healthcare. The outcome of this study will also

serve as a base for academicians who want to conduct further studies on the analysis of filling

system and its consequences of misfiled patient care folders in health institutions.

1.7. Operational Definition of Terms

Filing System: In computing, a file system or file system controls how data is stored and

retrieved. Without a file system, information placed in a storage medium would be one large

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body of data with no way to tell where one piece of information stops and the next begins

(Lynn, 2012)

Retrieval of Records: Locating a particular document, file, or record, and delivering it for

use (Oromi, 2014)

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 CHAPTER TWO

LITERATURE REVIEW

2.0. Introduction

The review of literature exposes the researcher to available literature and offers new ideas,

perspectives and approaches to the topic. According to Leedy and Omrod (2015) the review

of literature is necessary to describe theoretical perspectives and previous research findings

regarding the research problem at hand. It is always based on secondary sources, that is, what

other people have already written on the subject; it is not concerned about discovering new

knowledge or information. This chapter involves the process of reading, analyzing,

evaluating and summarizing scholarly materials about the research topic. This chapter is

organized under the following sub headings:

 A brief history of Health Records

 Procedures used in processing medical records

 Concept of Health Record Filing System

 Concept of Misfiled Patient Folder

 Record storage and retrieval mechanism

2.1. A Brief History of the Health Records

The main goal of health institutions is the provision of efficient services that enhance health

and prolong life of patients. Achieving this goal therefore requires that there is presence of

reliable and accurate health records. Records are used to hold health institutions accountable

for the service delivery. Mogli (2012) considered health records as documents used by health

institutions and caregivers to record patient history, illness, illness narratives and treatment.

Luthuli and Kalusopa (2017) conceived health records as written account of patients’

examination and treatment that include the patients’ medical history, illness narratives and

complaints; the physician’s findings; and the results of diagnostic tests, procedures,

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medications and therapeutic procedures. Connectedly, the World Health Organization

(2016a) classified health records to include doctors’ clinical notes; recording of discussion

with patient/next of kin as regards disease; referral notes to other specialist(s) for

consultation; laboratory notes; imaging reports; clinical photographs; drugs prescriptions;

nurses’ reports; consent forms; operation notes; video recordings; and printouts from

monitoring records. Advancing the importance of health records, Adeleke (2014), stresses

that health records are needed for delivery of services in health institutions. Among other

purposes, records management provides availability of reliable and timely information to

various end users.

Luthuli (2017), also notes that records management involves accountability, security,

integrity and comprehensiveness. Records Management is therefore considered as the process

of controlling and governing important records of an institution in a comprehensive and

complete cycle. The process includes identifying, classifying, prioritizing, storing, securing,

archiving, preserving, retrieving, tracking and destroying of records. Health records

management also involve appraisal, retention and disposal, which eventually eliminate

ephemeral records that are no longer useful to healthcare institutions. The objectives of

records management as highlighted by Feather & Sturges (2013) include cost reduction,

improved productivity by quick access to needed records, enhanced litigation avoidance and

support, increased audit compliance. Mogli (2012) conceives service delivery as activities

performed by an organization, in line with its mandate aimed at satisfying, responding and

resolving community or citizen problems. Service delivery in healthcare therefore, is

considered as a contact between service providers and consumers. Service delivery in

healthcare institutions manifests in forms of appropriate illness diagnosis, accurate laboratory

tests, correct medication and follow-up treatment. Connectedly, Kemoni & Ngulube (2013)

opined that effective records management is a key factor in the delivery of service in health

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institutions. Thus, achieving service delivery requires that health organizations develop,

promote and implement effective records management philosophy and ideology.

There are agencies and professional associations saddled with the responsibility of ensuring

that records generated by medical practitioners involved in the provision and delivery of

services to patients are efficiently managed in the best interest of patients and healthcare

institutions. With reference to Nigeria, Osundina et.al, (2016) identify Health Records

Officers Registration Board of Nigeria; Nigeria Medical Council, Nurses and Midwifery

Council of Nigeria, among others as agencies and associations that regulate the practice of

medical records management. Against this background, this article provides proper

knowledge and orientation of the subject matter of health records management in the context

of service delivery in healthcare institutions. It is divided into six sections: the

methodological approach towards understanding the subject matter, the historical

development of medical records, issues of medical records management and service delivery

in health organizations and the challenges associated with medical records management in

healthcare institutions.

2.2. Procedures used in processing medical records

Hospitals are dependent on its medical records to deliver care efficiently and to account for

its actions. This procedure defines the structure and processes for the management of clinical

records. Records management through the proper control of content, storage, transporting and

access to records reduces the risk of poor medical care, due to missing records, legal

challenge and financial loss (Oromi, 2014). This procedure sets out the way in which

organizations will meet its legal obligations in relation to the Data Protection Act 1998, and

Freedom of Information Act 2000 and standards set by the Care Quality Commission, The

Health and Social Care Information Centre, and the NHSLA in respect of records

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management. This procedure should be read in conjunction with the Corporate and DET

Records Procedure.

2.2.1. Responsibility and Accountability

Responsibility for the maintenance of appropriate health care records must be

included in the terms and conditions of appointment (including position descriptions) for all

health care personnel. Documentation must be included as a standing item in annual

performance reviews of clinicians. Failure to maintain adequate health care records will have

grave results on the patient care (Abdulazeez et.al, 2016).

2.2.2. Individual Healthcare Record

An individual health care record with a unique identifier (e.g. unique patient

identifier, medical record number) must be created for each patient / client who receives

health care (Musa, 2018). Every live or still born baby must be allocated a unique identifier

that is different to the mother. Where multiple patient identifiers exist for the same patient /

client must be processes established for their reconciliation and linkage, with the ability to

audit those processes. A reference notation should be placed on the health care record to

identify any relevant other documents that relate to the patient’s health care. Index or patient

administration systems must reference the existence of satellite / decentralized health care

records that address a specific issue and that are kept separate from the principal health care

record. Due to the nature of the information contained in sexual assault records these must be

maintained separately from the principal health care record and be kept secure at all times; as

should child protection / wellbeing and genetics records. Staff screening and vaccination

records are considered as personnel rather than health care records and must be maintained

separately.

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2.2.3. Access

Health care records should be available at the point of care or service delivery. Health

care records must not be removed from the campus unless prior arrangements have been

made with for example required for a home visit, required under subpoena. Health care

records are only accessible to: a) Health care personnel currently providing care / treatment to

the patient / client, b) Staff involved in patient safety, the investigation of complaints, audit

activities or research (subject to ethics committee approval, as required) consistent with

relevant legislation d) Patient / client to whom the record relates, or their authorized agent,

based on a case by case basis in accordance with health service release of information

policies and privacy laws and e) Other personnel / organizations / individuals in accordance

with a court subpoena, statutory authority, valid search warrant, coronial summons, or other

lawful order authorized by legislation, common law (Read et. al, 2013). All requests for

information, that is contained in a patient / client’s health care record, from a third/ external

party should be handled by appropriately qualified and experienced health care personnel,

such as Health Information Managers, due to the sensitive nature of health care records; the

special terminology used within them; and regulatory requirements around access to, and

disclosure of, information.

2.2.4. Ownership

The health care record is the property of the health organization providing care, and

not individual health care personnel or the patient / client. Where shared care models or

arrangements exist for clinicians to treat private patient / clients within health facilities /

settings, responsibility for the management of those health care records must be included in

the terms of the arrangement between the PHO and the clinician (Adeleke, 2014).

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2.2.5. Retention and Durability

Health care records must be maintained in a retrievable and readable state for their minimum

required retention period. Entries should not fade, be erased or deleted over time. The use of

thermal papers, which fade over time, should be restricted to those clinical documents where

no other suitable paper or electronic medium is available e.g. electrocardiographs,

cardiotocographs. Electronic records must be accessible over time, regardless of software or

hardware changes, capable of being reproduced on paper where appropriate, and have regular

adequate backups (Lynn, 2012).

2.2.6. Storage and Security

Cuming & Thompson, (2017) establishes statutory requirements for the storage and

security of health care records, health information, including healthcare records, must have

appropriate security safeguards in place to prevent unauthorized use, disclosure, loss or other

misuse. For example, all records containing personal health information should be kept in

lockable storage or secure access areas when not in use. Control over the movement of paper-

based health care records is important (Khumalo, 2017). A tracking system is required to

facilitate prompt retrieval to support patient / client care and treatment and to preserve

privacy. A secure physical and electronic environment should be maintained for all data held

on computer systems by the use of authorized passwords, screen savers and audit trails. If left

unattended, no personal health information should be left on the screen. Screen savers and

passwords should be used where possible to reduce the chance of casual observation.

Consideration may be given to providing staff with different levels of access to electronic

records where appropriate (i.e. full, partial or no access)

2.2.7. Disposal

Health care records, both paper-based and electronic, must be disposed of in a manner that

will preserve the privacy and confidentiality of any information they contain. Disposal of data

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records should be done in such way as to render them unreadable and leave them in a form

from which they cannot be reconstructed in whole or in part. Paper records containing

personal health information should be disposed of by shredding, pulping or burning. Where

large volumes of paper are involved, specialized services for the safe disposal of confidential

material should be employed. The disposal of health care records must be documented in the

health organization’s Patient Administration System and undertaken in accordance with the

relevant State General Disposal Authority (Ginsberg, 2013).

2.3. Concept of Health Record Filing System

Osundina (2014) affirms that for Health Records Department to function efficiently, it is

necessary to have an organized method for storing of the health records. Therefore, filing

system can be described as a set of documents arranged in prescribed order for convenience

of reference and preservation. The purpose of filing records is to facilitate complete and

quick retrieval of patient information from them when the needs arise.

The prime responsibility of the Health Records Department is to undertake the custody,

classification and confidential of the patient case history. The department is also concerned

with the custody of index of diseases and operations. However, an effective filing system

should contain a number of fundamental features, they are:

 Compactness: To take account of storage space and also need to reduce physical effort

in working the system.

 Accessibility: For speed of location and positive means of identification for the items

contained in the system.

 Simplicity of operation to ensure that the method is understood by those who normally

control it but also by those who require occasional access.

 Economy: Economy, both in cost of installation and operation.

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 Elasticity: The system should expand and contrast according to future requirement.

 Cross Reference: This facility must be considered so that a folder can be found under

different heading.

 Tracer System: A tracer card must be placed in position of a removed folder to indicate

the destination of the folder.

 A Method of Classification e.g. Terminal digit or middle digit etc.

 The equipment in use must be effective and efficient of the system.

 The personnel operating the system must be well trained i.e. health records

practitioners.

2.3.1. Types of classification and filing system

Document classification is a problem in library science, information science and

computer science (Unegbo, 2018). The task is to assign a document to one or more classes or

categories. This may be done "manually" (or "intellectually") or algorithmically (Wong &

Bradley, 2019). The intellectual classification of documents has mostly been the province of

library science, while the algorithmic classification of documents is mainly in information

science and computer science (Oromi, 2014). The problems are overlapping, however, and

there is therefore interdisciplinary research on document classification. The documents to be

classified may be texts, images, music, etc. Each kind of document possesses its special

classification problems. When not otherwise specified, text classification is implied (Boyle,

2011). Documents may be classified according to their subjects or according to other

attributes (such as document type, author, printing year etc.).There are two main philosophies

of subject classification of documents: the content-based approach and the request-based

approach (CIA/ICA & Trust, 2016).

Content-based classification is classification in which the weight given to particular

subjects in a document determines the class to which the document is assigned. It is, for

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example, a common rule for classification in libraries that at least 20% of the content of a

book should be about the class to which the book is assigned. In automatic classification it

could be the number of times given words appears in a document (Blais, 1995). Request-

oriented classification (or -indexing) is classification in which the anticipated request from

users is influencing how documents are being classified. The classifier asks himself: “Under

which descriptors should this entity be found?” and “think of all the possible queries and

decide for which ones the entity at hand is relevant” (Edwards, 2017).

Request-oriented classification may be classification that is targeted towards a

particular audience or user group. For example, a library or a database for feminist studies

may classify/index documents differently when compared to a historical library. It is

probably better, however, to understand request-oriented classification as policybased

classification: The classification is done according to some ideals and reflects the purpose of

the library or database doing the classification. In this way it is not necessarily a kind of

classification or indexing based on user studies. Only if empirical data about use or users are

applied should request-oriented classification be regarded as a user-based approach

(Kwatsha, 2010)Automatic document classification tasks can be divided into three sorts:

supervised document classification where some external mechanism (such as human

feedback) provides information on the correct classification for documents, unsupervised

document classification (also known as document clustering), where the classification must

be done entirely without reference to external information, and semi-supervised document

classification where parts of the documents are labeled by the external mechanism (Mampe,

2008). Here are some of the filing systems employed in the management of records;

2.3.2. Alphabetical

There are two types of alphabetical filing according to Tagbotor et al., (2015); Topical filing

arranges files in straight alphabetical Order, such as subject correspondence arranged from A

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to Z, based on the name of the subject. Classified filing arranges related documents under a

major subheading, such as customer complaint correspondence filed under the general

heading of customer relations, its advantages include; avoids the use of an index, effective

filing if adhered to and ease of browsing through files however this type of filing system is

also associated with various demerits which include; increased risk of misfiling versus

numeric systems, retrieval problems arising over name changes, may be inefficient and

cumbersome in large systems and ease with which unauthorized persons can find records.

2.3.3. Numerical filing systems

If a numerical record identification system is used, then a numerical filing system is used

(Ngulube & Tafor, 2006). There are two main systems of filing records numerically: straight

numeric and terminal digit. This filing method reflects exactly the chronological order of the

creation of records. Straight numeric filing is typically used when serial health record

numbers are assigned, however, a unit health record number may also be filed in straight

numerical order. The advantages of straight numeric filing include: people are used to this

"logical" order and training is easy, easy to retrieve consecutive numbers for research or

inactive storage; the disadvantages, however the disadvantages include; easy to misfile, one

must consider all the digits of the number in order to file the record; easy to transcribe

numbers where one digit is wrongly written or read, for example: 1 for 7 and easy to

transpose numbers (reverse digits), for example, record number 194383 is filed as 193483

(Ware & Mabe, 2015).

2.3.4. Numerical filing system

Tagbotor et al., (2015) emphasizes that alpha-numeric filing is one of the most indexing

systems because of how accurately it identifies folders contents and the system involves the

use of numeric numbers and alphabetical letters to index a record. According to Gledhill,

(2015), alphanumeric filing involves using both letters and numbers .In line with this also,

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(Prof & Roux, 2012) argues that alphanumeric filing system is alphabetical filing (arranged

from A-Z) and numeric filing system(ordered from the smallest to the largest.

2.3.5. Chronological filing system

Chronological filing is the filing by date. Usually you will find this used for bills of lading,

copies of freight bills, cancelled cheques, also in some banks or as a reserve file. It is

normally used only where there is little or no reference made to the record once the

transaction is complete; geographical filing system; Geographical filing systems operate

generally by province or country, and then alphabetically or numerically by account name or

number. Reasons for this type of filing can be several. Countries have different laws and

licenses; a commercial enterprise may have to consider these constraints as of primary

importance; subject filing system and according to (Callaghan & Groves, 2015) this is the

arranging of documents by the given subjects. This is the filing by descriptive features

instead of by a name or number. Such filing involves choosing a word to indicate the subject

matter of filing based on the subject matter. It is sometimes known as the matter of filing

based on the subject matter and terminal digit filing system; Marquette (2013) says that this

type is also called “End digit filing”; he emphasizes that terminal digit filing is most

commonly used in large filing systems especially in hospitals, government personnel offices

and financial institutions. Terminal digit filing system is achieved by grouping all the files

ending with the same two digits into one section

2.3.6. Aids to Accurate Filing in Filing Environment

Aremu (2019) affirms that the following will aid the Qualified Health Records Personnel in

solving the problems of mislaying of patients’ health records in the Health Records Library,

they are:

 Introduction of colour coding to Health Records Library

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 Introduction of efficient tracer system to Health Records Library

 Legibility in numbering cases folders

 Introduction of terminal digit filing system

 Adequate ventilation and lightening in the filing areas

 Introduction of centralized filing system

 Largest storage of health records library

 Good spacing between filing shelves as well as good dividers

 Length and height of shelves should be minimized

 Adequate security measures in the filing area

 Constant supervision of the filing clerks working in the library

 Division of labour in the health records library unnecessary burden on staff

 Provision of auxiliary equipment, for example, sorting shelf, ladder, stool guide cards

etc.

 Prompt collection of patients Health Records after patient is discharged from the ward

 Prompt collection of patients Health Records in the clinic after consultation

2.3.7. Problems of Mislaying and Misfiling of Patients file in Health Records

Department

Huffman (2014) opines that regardless of the number of record control system used in the

health records department file area, occasionally, a patient’s record will be placed in the

wrong location (misfiling) or will not be signed out correctly (mislaying). Various

techniques are available to assist a person in locating a medical record that has been

misfiled. Among these techniques are:

1. Look for transpositions of the last two digits of number, or of the hundreds or thousands

digits. The number 46-37-82 may be filed as 46-37-28 or 46-73-82.

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2. Look for misfiles of “3” under “5” or “8” and vice versa; and “7” or “8” under “9”. The

number “9” may be taken as a “7” if it is worn.

3. Look for misplacement or mislaying of health records on the floor, tables, racks, cabinets

and shelves

4. Check for a certain number in the hundred group just preceding or following the number

as 485 under 385 or 585, or under other similar combinations.

5. Check for transpositions of first and last numbers.

6. Check the folder just before and just after the one needed. It sometimes happens that a

folder is put into another folder rather than between two folders.

2.4. Record storage and retrieval mechanism

Medical Record Storage is a vital concern for Practices, Clinics, and Hospitals of every size.

As the requirements for Medical Records Management continue to change, practices need to

stay updated on the latest Regulations and ensure that they're in compliance with the latest

Records Retention Requirements. With these additional responsibilities, it's more important

than ever that Healthcare Organizations have a trusted Partner for Medical Records

Management. The available literature is scant. The problem was identified as critical in 1965

by Whitston (1965) of the Kaiser Foundation, but he provided no discussion of possible

solutions. A year later Chelew, (1996) working at the Mount Zion Hospital and Medical

Center in San Francisco, reported the results of a study of the utilization of active and

inactive records; the age of the record and the purpose of the retrieval was noted. Records

more than 12 years old made up less than 2 percent of all record retrieval at Mount Zion, and

on this basis Chelew concluded that there was "little economic justification for retaining

medical records beyond the minimum legal requirements." Chelew did not attempt to define,

except by this implication, when records become "less active"; the legal limit, of course,

varies significantly from state to state. Recently Lennox 2010 has suggested that records

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should be culled and only summary documents (in most cases the discharge letter with a few

other items) be kept available. In this system the bulk of the culled record would be kept in

quite inaccessible storage. The method currently most used to identify and separate active

from inactive records is based on a single variable-the elapsed time since the patient's last

visit to the clinic or hospital. At arbitrary intervals all records are examined for the length of

time since the patient's last visit or the last use of the record. Records not used during some

previous number of months are sent to the inactive file or, in some hospitals, microfilmed;

records that have been used within this time period are left in active status.

According to Chinyemba, (2005) record storage and retrieval faces myriad challenges that

include included limited qualified staff such as a records manager and archivist; Lack of

records management policies and procedures; Records management costs that are not

immediately apparent. Cost may only become significant over a period of time and thus not

attract management’s attention and Limited resources to implement a system according to

requirements (legislation).

According to Chavez-borja, (2012) limited guidelines was cited as the major problem to

record storage and retrieval; employees need guidelines to manage all the information

resources on their desktops, in their files, and in the computer systems with which they

interact. Further, they need to determine which of those information resources are records

and how much of that information is subject to open records laws.

Although mandated by governments (Bigirimana, Jagero, & Chizema, 2015), records

storage has been unevenly implemented with few agencies devoting a full-time position to

the task. Even then, the job of records management has been driven by the need to destroy

vast amounts of paper rather than to systematically control, manage, and use information

and knowledge of the agency. As budgets have tightened and governments have turned to

technology to “do more with less,” e-mail, Web portals, databases, and other electronic

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applications have been typically implemented without regard for managing the information

or for ensuring the creation and preservation of records.

The electronic office poses unique challenges to recordkeeping (Webster, Hare, & Mcleod,

2019). As noted in a previous section of this paper (Joseph, Debowski, & Goldschmidt,

2012), the most essential qualities of a record are that it is authentic and that its content is

fixed over time. In other words, people must have confidence that a record is what it says it

is. Electronic records, unfortunately, do not intrinsically inspire this confidence in the same

way that paper records do. The ease with which electronic documents can be created,

altered, accessed, duplicated, and shared jeopardizes their value as records. Ironically, the

most appealing aspects of creating electronic documents are what weaken our confidence in

electronic records.

In a study that examined the challenges of Record storage and retrieval in two Health

Institutions in Lagos State Abdulazeez et al., (2015), Nigeria where the specific objectives

include: to investigate the challenges being faced in handling health records by the surveyed

health institutions in Lagos State; and to suggest some solutions on the preservation and

conservation of health records in the surveyed health institutions in the State, the findings

showed that the major challenges faced in handling health records in the surveyed hospitals

include: poor funding, inadequate computer and other ICT devices, poor skill in computing,

harsh environmental conditions, lack of preservation and conservation policy.

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