Healthcare facilities specialize in providing healthcare, not records management. As the healthcare industry continues to tighten its supply chain and become leaner, the C-Suite continues to search the complex and ever-changing healthcare field for cost-cutting solutions. Third party archival document management vendors are normally not an area supply chain executives focus on. With the continued pressure of compliance with the Health Insurance Portability and Accountability Act and standards from The Joint Commission, patient records and other records are overlooked to avoid destroying needed information. What many do not know is that putting a structured records management program in place may lead to significant archival document management cost savings.
The image above represents the different stages of the record lifecycle. Storage, activity and destruction all have high costs associated with them and create an arena where lean functionality and effective management must come into play. This will result in a more efficient process and savings. Records management is the practice of maintaining an organization’s records from the time they are created up to their eventual disposal. This may include classifying, storing, securing and destroying (or in some cases, archival preservation of) records. A record can be either a tangible object or digital information (e.g., medical x-rays, office documents, birth certificates, purchasing data, etc). Records management is primarily concerned with the evidence of an organization’s activities, and is usually applied according to the value of the records rather than their physical format. Business records, as well as patient records, hold tremendous operational, financial and legal value. However, they also generate risks, with cost and management challenges that must always be addressed.
Creating the record
Hospitals hold records of all kinds, including patient records, financial records, purchasing records and pathology paraffin block and slides. Any information created is a record that must be managed. A major factor that affects the management of records is the controls that the facility has in place. Much like the controls that are used to manage vendors coming into the operating room, the controls to manage records must force the vendors and the department creating the record to communicate. With firm controls in place, the cost associated with third-party records storage vendors will be reduced. The two steps below are essential controls that must be implemented to obtain a successful low-cost records management program.
- Prior to sending any documents (box or file) to the vendor, a spreadsheet, pre-populated with the barcode numbers, must be completed and sent to the records management program and the vendor. The two areas that must be completed are the box content description and destruction date. The vendor should only schedule pick-up upon receipt of this spreadsheet. The importance of destruction dates come into effect later in the record lifecycle. These destruction dates create a timeframe of the life of that particular record, which results in records being destroyed and facilities not keeping records longer then needed.
- Identify and add destruction dates to all inventory at third-party vendors that currently do not have destruction dates. Then, ensure they destroy all inventory with past destruction dates
Securely storing the record
Record storage is broken down into two different categories: box storage and open shelf storage. It is important to note that box storage is calculated by cubic footage, and open-shelf storage is calculated by linear footage. Vendors typically have their own classifications for box types and sizes, which makes it difficult to compare vendor prices. The normal box classifications are archive, legal and x-ray. All vendors also accept odd-size boxes. Institutions must manage and be aware of all boxes sent to the vendor for storage. Storage rates are charged by the cubic ft or linear ft, but are increased for odd-sized boxes. Storage for paraffin blocks and slides are typically charged by the storage drawer size in cubic feet.
The costs associated with box storage and open shelf storage must be compared, and there are pros and cons to each method. The major reason for box storage is that records are covered in a secure container. The box storage price is usually less expensive than open-shelf storage as well. The major disadvantage to box storage is that boxes may not be filled to capacity, so your facility is essentially paying to store air. The benefit of open-shelf storage is that it is easier to locate record. However facilities need to consider that with this method, records are not fully secure; anyone in a warehouse can access them. For that reason, not all vendors choose to offer open shelf storage.
Different types of records have different lifetimes, so it is important to manage what records are stored together. Pediatric records must be stored until the age of majority plus three years. This can result in records being kept for over 20 years. Separating records can reduce spending on storage month over month, year over year because only specific, necessary records will be kept.
Moving the record
The typical split in spending for a third-party records vendor is 50 percent storage, 50 percent activity. Activity is defined as the movement of records. Every time a record is needed at a facility, a cost is associated with its movement. These fees are only associated on a per-movement basis, yet vendors may charge a minimum activity fee per month.
Many different fees are associated with activity, so it is important for the records management program at your facility to understand the charges, as this will help reduce costs. Access charges are billed every time a box or file is touched. Retrieval charges are associated with activity of moving of boxes or files. Delivery charges refer to actual delivery of boxes. Add fees and re-file fees refer to actual pick up of boxes and files, and adding into inventory. Some other fees include minimum service charges, unsuccessful searches and handling charges.
In addition to the high security standards, vendors’ automated inventory systems are monitored by record storage software which tracks boxes, as well as individual files. Barcode labels are affixed to boxes and files, which are scanned with handheld computer technology. The systems allow the end users to manipulate data, see reports, track history and much more. With these robust systems, vendors can track every movement during a record’s lifetime. Actively managing records’ movements can result in significant savings by consolidating deliveries and pick-ups. Reduced activity costs can help reduce minimum charge fees.
Implementing policy around all vendor activity will reduce spend and create an effective method of control and inventory management.
Securely destroying the record
The end of a record’s lifecycle is its secure destruction. Although some records may have a lifetime of forever, those records would be managed by the facility’s archives and should not be sent to storage. The two main challenges associated with destruction are obtaining approval to destroy the record and the cost associated. Since many records are kept for long periods of time, the chances that the individual who sent them to storage is available to sign off on their destruction are minimal. This is where the destruction date on the record comes into play, as well as the record management program. Having a robust records management program creates a manager who has the authority to authorize destruction based on retention schedules that are supported by destruction dates originally assigned to the record. Since record destruction is usually not a topic in budget meetings, obtaining the funds to destroy records can also be a challenge.
Destroying one type of record — x-rays — creates a revenue-generating opportunity to reclaim silver. The typical x-ray box weighs approximately 40 pounds and comprises 50 percent paper and 50 percent x-ray. Based on the commodity rate of silver, a facility will receive a 60 percent — 40 percent client/vendor split of profits. It is important to note that x-rays created before 1990 have more silver, as the amount of silver used in x-rays has been reduced since then.
Keys to improving efficiency and seeing savings
Though managing records is a daunting task for healthcare facilities, implementing change and cost-reduction strategies should not be. While the current processes a facility follows may appear to be working, a records management program should be developed to efficiently manage records. Controls are the key to an effective process. The procedures and consolidation efforts, as well as addition of destruction dates to all boxes will lead to an efficient and effective lean program. Although EHRs are the way of the future, properly managing archival documents now can result in significant savings for healthcare facilities now.
Kenneth Scher is a consultant at Nexera, Inc., a wholly owned, for-profit business of the Greater New York Hospital Association. Mr. Scher provides strategic, supply chain and fiscal advisory services to healthcare organizations, including academic medical centers, health systems, and non-acute care facilities aimed at growing business performance. Mr. Scher has created integrated performance improvement solutions to identify and implement sustainable comprehensive strategies to increase supply chain efficiency, reduce costs, increase revenue, improve work flow processes and accelerate cash.
