Paper health records (PHRs) are the traditional, physical documents containing a patient’s complete medical history, including clinical notes and test results. Although many healthcare facilities have transitioned to electronic health records (EHRs), paper records still form the basis of documentation in numerous smaller practices and represent the historical foundation for medical information management. Maintaining these physical files requires detailed, systematic procedures to ensure patient information is secure, accurate, and quickly accessible for ongoing care. The systems for managing these charts address their organization, location, and eventual compliant disposal.
Internal Organization of the Paper Chart
Individual paper charts are structured to maximize information retrieval efficiency. The file folder or binder typically uses tab dividers to separate documentation into distinct sections, allowing clinicians to rapidly locate specific information like lab work or physician orders.
A common organizational method is the source-oriented record, which groups all documents from a single source together. Regardless of the grouping method, documents within each section are arranged in reverse chronological order, meaning the most recent note or test result is placed on top.
Physical Filing and Retrieval Systems
Filing Methods
The core challenge in maintaining paper health records is quickly locating any single chart among thousands. Alphabetical filing, which organizes charts by the patient’s last name, is intuitive but inefficient for large populations due to the high risk of misfiling. Straight numerical filing assigns a sequential number to each patient. This method causes new files to concentrate at the end of the storage area, requiring frequent shifting of all records.
Terminal Digit Filing
The most effective system for managing large volumes of paper health records is Terminal Digit Filing. This method uses a six-digit or longer patient number, divided into three parts and read from right to left. For example, in a six-digit number like 12-34-56, the last two digits (56) represent the primary filing section, the middle two (34) are the secondary section, and the first two (12) are the tertiary section. This structure ensures that new records are evenly distributed across the entire filing area, eliminating the need to constantly shift older files.
Physical Storage and Tracking
Physical storage is typically accomplished using open shelving units or lateral file cabinets, which provide easy access to the chart spines. When a chart is removed for patient care, a brightly colored placeholder, known as an “out-guide,” is inserted in its place. This out-guide contains information about who has the record and when it was taken, serving as a tracking mechanism to prevent charts from being lost.
Retention and Secure Destruction
Paper health records cannot be destroyed until the required retention period has passed. This period is governed by federal and state regulations, with state laws often establishing longer minimum timeframes. While HIPAA mandates that certain related documents be kept for six years, many state laws require patient records to be retained for seven to ten years following the last patient encounter.
For pediatric records, the retention period is often extended until the patient reaches the age of majority plus the state’s standard retention period. Once the retention period ends, records must undergo secure destruction to protect patient privacy and comply with HIPAA. Approved methods include cross-shredding, pulping, or pulverization, which render the protected health information unreadable.