10/11/22

ž Numbering Systems
ž Filing Systems
ž Filing Equipment
ž File Folders
TOPIC 6 ž Filing Controls
ž Loose Filing

ž Circulation Systems
ž Security of Health Information

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ž Explain the differences between serial, unit and serial

unit numbering systems
ž Organize records according to serial, unit and serial unit
numbering
ž Name and define the two major categories of filing:
alphabetic and numeric
ž Define and organize records according to alphabetic and
numeric filing systems
ž Cite advantages disadvantages in the use of alphabetic
and numeric filing systems
ž Explain the rules for straight numerical, terminal digit
and middle-digit filing.
ž Arrange records in alphabetic, straight numerical,
terminal digit and middle digit order
ž Compare the types of filing equipment used to store
file folders
ž Calculate record storage needs
ž Discuss the components of a file folder
ž List and define the types of controls used in filing
systems
ž Explain the procedure for organizing and managing
loose filing
ž Describe circulation systems that are used to trasport
patient records
ž Identify security measures that occur to safeguard
patient records and information from theft, fire, and
water damage

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ž A new patient number is assigned and a new patient

record is created each time the patient is registered.
Serial
ž Patient records are filed in multiple locations in the
permanent file system.
ž Adapted by provider without
Admission/Discharge/Transfer (ADT) software.

Numbering Systems

Serial-Unit Unit

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Advantages
Computer software
is not needed to
track assignment of
patient number
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Social Security Numbering
• A patient’s social security
number (SSN) is assigned
as their patient number
• Concerns:
• Privacy
• Length of the number
• Multiple social security
number
• Duplicate pseudo
numbers
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ž Patients receive a new number each time they are
registered by the facility
ž Records from a previous admission or encounter are
reassigned the new number
ž All records are filed in the most current folder in one
location
ž Blended of both systems
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Disadvantages
Patient records are
filed in different
locations in the filing
system
Multiple locations
must be accessed to
retrieve patient
records
Family Numbering
• Each household is
assigned a unique
patient number, and
each family member is
assigned a two-digit
modifier number that
serves as a prefix to the
patient number.
• Health information for
the entire household is
filed together according
to the family number
• Often used by providers
who treat entire families.
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ž A patient is assigned a patient number the first time
he/she registered and the patient is reassigned that
same number for all subsequent admissions and
encounters.
ž Adopted by provider with ADT software to manage
patient number assignment
ž All patient records are filed in one folder in the file
system
ž Two variations:
¡ Social security numbering
¡ Family numbering
Advantages Disadvantages
Patient records are filed in one Computer software must be
location in the filing system purchased to manage unit
numbering system
Patient is assigned same number
for each subsequent admission
Folders can become thick and
cumbersome
Patient records can be easily
retrieved and refilled
Multiple folders may be needed
System is cost-effective because to house all records for one
just one file folder per patient is patient
needed
Advantages Disadvantages
Computer software is not needed to track
assignment of patient number
Previous folders must remain in file
system with a note providing new patient
number information
Patient is assigned new number for
subsequent visits and previous records are
brought forward to the new number
Patient records are filed in one location in
the filing system
Folders can become thick and
cumbersome and multiple folders may be
needed to house all record for one
patient
Patient records can be easily retrieved and
refiled
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ž The patient’s last name, first name, and middle initial

are used to file patient records and MPI cards.
Alphabetic
Filing System
• Arrange patient names according to the alphabet, beginning with the surname, given name
or initial, and middle name or initial.
1 • Example: Smith, William E.

Middle- FILING Numeric

• Disregard all punctuation, and close up the letters or words and file them as one unit
• Example: Dresserton, Cynthia
Digit Filing Filing 2
SYSTEMS
• Prefixes included as part of the patient’s last name are filed alphabetically
• Example: La Comb, James, McDonald, Petra
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Terminal- • Professional and religious titles and suffixes are often filed according to a variety of
Digit Filing methods
4 • Example: John Simpson, II, Simpson, John II

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Advantages
It is easy to learn
Staff members can be
quickly trained
Disadvantages
Patient names must be
spelled correctly or the
entire system will fail
Misspelled patient names
result in misfiling of records
ž Phonetic indexing system that allows surnames that
sound alike , but are spelled differently to be filed
together.
ž Allows MPI cards to be filed according to sound rather
than spelling of the patient’s surname
ž Example: Choi, Chai, Choy

Files do not expand at an

Record retrieval can be even rate, causing
performed quickly reorganization of shelves

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ž Patients are assigned a health record number and the ž Consecutive numeric filing
records are organized according to the number. ž Records are filed in strict chronologic order according
ž Types: to patient number, from lowest to highest.
¡ Straight numeric filing ž Example:
¡ Terminal digit filing
1234567
¡ Middle digit filing
1234568
1234569

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Advantages
Office staff can be easily and quickly
trained.
Patient records are more secure
because unauthorized personnel
cannot retrieve a record according by
name
Retrieval of consecutive records for
research or purging can easily be done
Disadvantages
ž Assign six-digit (or longer) patient numbers because
the number can be easily subdivided into three parts:
Office staff must consider all digits of
primary, secondary, tertiary digits.
the number when filing
ž Written with a hyphen (-) separating each part of the
number and terminal digit numbers are read from
Misfiles increase as the number of
digits increases
right to left.
ž Example: 13-30-05
Work flow problems arise because
activity in the file area focuses on that
section with the highest consecutive
numbers

Files can be easily expanded to add

additional file space at the end of files
Work space is restricted when more
than one staff member files records
because they usually must file in the
same location
13 Tertiary
30 Secondary
05 Primary

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Advantages Disadvantages
ž Variation of terminal-digit filing
High degree of record security as ž Assigns the middle digits as primary, digits on the left
compared with other filing systems as secondary and digits on the right as tertiary.
Files expand evenly as new records are
added Training time for staff is lengthier as ž Example:
compare with other filling methods
More than one file clerk can easily work
in the file area
Even distribution of records simplified
planning for file equipment
Large gaps in files will not occur and
records will be shifted infrequently

Misfiles are reduced

Transposition of digits occurs less

Initially, more space and equipment will
be needed to organize the file area. The
file area must be well organized from
13 Secondary
50 Primary
05 Tertiary
the beginning to include room for even
frequently expansion of files
Inactive records can be easily retrieved as
new records are added to each section

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Advantages Disadvantages
Decentralized
Centralized Filing
Same as terminal digit Filing
filing
Organizes patient Organizes patient
Same as terminal digit
filing
records in one records throughout
Patient numbers should central location the facility in
be limited to six digits to under the control patient care areas
easily, divide the number of the facility’s under the control
into primary, secondary health information of the department
and tertiary digits
department that creates them.

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Centralized Filing Decentralized Filing ž Combination of centralized and decentralized filing

system.
Advantages:
Advantages: -Records are located near providers that create and use ž Establishes the health information department
-Responsibility for record keeping is easily identified them .
-Effective use of equipm ent, supplies, space and -No ‘extra’ space is needed in the health inform ation
departm ent to store files.
manager as responsible for facility records
personnel is m ade
-All inform ation about a patient is organized in one -Providers control
inform ation
filing and retrieval of patient management.
location
-Consistent services are provided to all users ¡ Manages the record storage plan and ensures that established
There is im proved security procedures are followed.

Disadvantages
ž Facility must select a record-keeping method that best
Disadvantages: serves patient care needs.
-Confusion can occur regarding w here patient
-Records m ay be too rem ote from staff for adequate inform ation can be found
patient care
-’Fragm ented’ docum entation can result because
-It can result in increased personal filing system s inform ation related to patient care is filed in m ultiple
-It requires additional staff to handle filing and retrieval locations
of records Providers m ay not know how to properly m aintain
-It requires investm ent in m ore efficient filing equipm ent patient records
and autom ation. -Lack of uniform ity or consistency n records keeping and
storage result.

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FILING EQUIPMENT DESCRIPTION

ž Open-shelf file Open-shelf file Six-to-eight shelf unit, which resembles a book shelf

ž Lateral file Lateral file Two-to-eight shelf unit with retractable doors.

ž Movable (compressible file) Movable Both manual and power types.

(compressible) File • Manual files are mounted on tracks that are
ž Power filing machines secured to the floor and are moved by using a
handle or crank.
ž Vertical file • Power movable files are motorized systems that
ž Visible file move when the file clerk touches a button.

Power filing Designed to utilized ceiling height rather than floor

machines space.
Vertical File Resembles a file cabinet in which records are stored in
a drawer.
Visible file Allows user to easily view contents of a file drawer

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ž Calculating record storage needs ž Protect the paper-based patient records.

¡ Determine the current linear filing inches used to store records
¡ Project linear filing inches needed for the time period during
which records will be stored Inpatient •Store records for hospital patients who are currently
receiving care
¡ Calculate the linear filing inches provided by the shelving unit Binders •Pp 208
(s)
¡ Convert linear filing inches to the number of shelving units to
be purchased •Store paper-based records and are color-coded, durable,
come in a variety of sizes and weights and ca be
File folders customized by vendors
•Pp 209

•Store X-rays and other oversized materials (open at the top

Jackets and closed on three sides
•Pp 209

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ž Selecting file folders: ž The assignment of color to primary patient numbers or

¡ Color-coding letters used for filing patient records
¡ Fastener position ž Color bars are placed on the sides/edges of file folders
¡ Preprinted information
¡ Scoring and reinforcement

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ž To prevents reports from becoming separated from ž At a minimum include an area for the patient’s name
the records and number and the facility’s name and address
ž Standard positions include the top or sides of the files (outside of the folder)
folder ž Other information:
¡ Allergy alerts
¡ Activity legend
¡ Confidentiality statement

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ž Reinforcing:
Charge-Out
¡ Provides extra rigidity so a higher-point stock folder doesn’t have to System
be purchased (more durable)
ž Rounding:
¡ Prevent crushing folder when filed
ž Scoring:
¡ Embossing a crisp line on the edge of the folder so it can be folded to
expand its capacity
Filing
Controls

Periodic Chart
Audit of File Tracking
Area System

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ž Control the movement of records in and out of the file ž Controls of release and return of patient records and
area and account for the location of each record uses record requisition forms to retrieve and track
removed. requests for patient records.
ž Policies established: ž Types of requisitions:
¡ Identify authorized personnel who may requisition a record ¡ Planned
from the file area
¢ The request of a patient record for a scheduled
¡ Indicate how long the record may be removed
service (routine outpatient follow-up visits)
¡ Establish a procedure for the transfer of a record from one
patient care area to another ¡ Non-routine (emergency)
¢ Patient record is needed for an unscheduled
service (emergency room visits)

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Manual Chart Automated Chart

Tracking System Tracking System ž Ensure that all records removed from the file area are
returned in a timely fashion
ž Completed on a daily, weekly or monthly basis
Use paper which are submitted to the HID to Request records using a
retrieve the record and track its return
computer and the HID clerk
references a computer
screen to process all
Form:
requests.
1 original (chart tracking index box)
2 copies (patient record/inserted into an
outguide)

Facilitates tracking of patient

Outguide: record movement
Replaces the record in the file area to indicate throughout the facility and
it has been removed and to identify its current eliminates the need to
location (contain patient name, number, date
of removal, current location of record,
manually track records using
requestor’s name or signature) requisitions slips.

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ž Individual reports that must be filed in the patient ž Used to transport records from one location in the
record after discharge from the facility facility to another
ž Sent to the HID for chart assembly, incomplete chart ž Most common: Hand-carries records
processing, coding and abstracting and permanent ž Mechanical circulation system devices:
filing ¡ Pneumatic Tube
ž Should be immediately filed in the patient record ¡ Dumbwaiter
¡ Conveyor Belt
ž New technologies:
¡ Facsimile Machines
¡ Computers

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ž Transports a single record in a tube through a tunnel ž Small elevator that transport records from one floor to
another

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ž Device similar to a pneumatic tube, except it uses a ž Computer device that transmits a document’s image
belt instead of a tube and records are clipped to the via telephone lines
belt for transport from one area to another

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ž Allow for rapid circulation of patient information
ž Patient information must be secured in a locked file or
in a locked room (accessed by authorized staff only)
ž Stored in file units that protect records from fire and
water damage (fire wall, fire door, sprinkler system,
fire extinguisher)

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ž Protection of computerized health information:

¡ Establishing policies and procedures that address
portable technology
¡ Educating and training users of portable technology
about facility policies and the potential for theft and
loss of patient information
¡ Using appropriate encryption and password security
¡ Purging information from portable computers when
the computer is assigned to a new user

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