Medical record filing systems enable providers to store information securely and retrieve it efficiently. Filing systems also protect patient-identifiable data. The type of health information system that a provider uses often depends on the type of facility, its size, the number of patients it treats and the volume of records it keeps. Smaller facilities that deliver specialized care for fewer patients may choose paper records, while larger organizations with multiple departments and locations might use electronic records. Some care providers use a hybrid of paper and electronic medical record filing systems.
Types of Filing System
Three types of numeric filing systems are commonly used for filing medical records- straight numeric, terminal digit, and middle digit.
1. Straight numeric filing
Straight numeric filing refers to the filing of records in exact ascending order according to medical records number. Thus, simultaneously all the numbered records would be in an ascending series on the filing shelves. For e.g., the following four medical records would be filed in the following order on a shelf: 65023, 65024, 65025, and 65026.
Clearly it is a simple matter to pull fifty continuous records from the filing area for study purpose or for inactive storage. Perhaps the greatest advantage of this type of filing system is the ease with which personnel are trained to work with it. However, this approach to filing has certain disadvantages. It is easy to misfile since a staff must consider all digits of the record number at one time when filing a record. The greater the number of digits that must be recalled when filing, the greater the chance for error. Alteration of numbers is common: medical record 65424 can be misfiled as record 56524.
A more serious problem to straight numerical filing is that the heaviest filing activity is concentrated in the area with the maximum number of new records. Several staff filing records at the same time in such areas is bound to get in each other’s way. Since staffs are usually filing in the area of the most current records, it is not possible to fix responsibility for a section of the file to one staff.
Terminal digit filing
A six-digit number or a seven-digit number can be used and divided with a hyphen into three parts, each part normally containing two digits. Within the number, the primary digits are the last two, secondary digits are the middle two and, the tertiary digits are the first two or three digits.
In a terminal digit filing, there are 100 primary sections, ranging from 00 to 99. A staff must first consider the primary section while filing the records. With each primary section, groups of records are matched according to the secondary digit, after locating the correct secondary digits section, the medical record staff files in numerical order by the tertiary digits. In medical records, the second tertiary digits changes with every record.
Note the following example in a terminal digit file
The terminal digit method of filing is described using six numbers, but as mentioned earlier it can be adapted for using five, seven, or even nine digits. With a five-digit number, one could break it into three sections, as follows:
There are numerous advantages of terminal digit filing. When new records are added to the shelves, their terminal digit numbers are equally distributed throughout 100 primary sections of the shelves. Every 100th new medical record will be filed again in the same primary section of the shelves.
The obstruction that results while straight numeric filing is followed when several staff are filing in the same area is avoided. Staffs may be assigned responsibility for certain sections of the shelves. When four staff are filing, the first staff can be responsible for terminal digit sections 00-24, the second for 25-49, the third for 50-74, and the fourth for 75-99.
As registration numbers are still assigned in straight numerical order, the work is evenly distributed amongst each staff in each section. Numbers 463719, 453720, and 463721 are assigned in strict sequence, but the records would be filed in terminal digit section “19”, “20”, and “21” respectively.
Inactive records may be pulled from each terminal digit section as new records are added. In this way the volume of records in each primary section is controlled and large gaps in the file which require back shifting of records is prevented. This volume control also simplifies planning for filing equipment.
Advantages of terminal digit filing
Misfiling is considerably reduced with the use of terminal digit filing. Since the staff is concerned with only one pair of digits at a time, the transposition of numbers is less likely to occur. Even if the tertiary digits are increased to three, e.g., 245-68-90, recalling three digits is easier than recalling seven.
The training period for medical records assistant is usually a little longer for a terminal digit system than for a straight numeric filing, but most of the staff can learn it in a few days time.
Initial setting up of file shelves may be required from the starting stage, which may require more units of shelving since expansion capabilities must be planned for the total medical records area.
Middle digit filing
In this method the staff files according to pairs of digits, as in terminal digit filing. On the other hand, the primary, secondary, and tertiary digits are in different positions. The middle pairs of digits in a six-digit number are the primary digits, the digits on the left are the secondary digits, and the digits on the right are the tertiary digits
From the example given, the staff can see that blocks of 100 records (e.g., 76-78-00 through 76-78-99) are in straight numerical order.
This has several advantages:
First, it is simple to pull out 100 consecutively numbered records for research purposes.
- Second, conversion from a straight numerical system to a middle digit system is much simpler than converting to a terminal digit system.
- Third, blocks of 100 records pulled from a straight numerical file are in exact order for middle digit filing.
Middle digit filing provides a more even distribution of records that does straight numerical filing, although it does not equal the balance achieved by a terminal digit filing system.
As in terminal digit filing, the staff is filing by pairs of digits rather than by six or seven digits; therefore wrong filing is reduced.
There are certain disadvantages to middle digit filing. More training may be necessary than the straight numeric or terminal digit filing.