Record Management Plan

Dr. Smith Family Practice

Created by Alexander Galiana 2/3/2012

RMP for Dr. Smith written on 2/3/2012 effective from 2/5/12 through 2/4/13

Why this plan is important Adhering to this record management plan in your office will assist in your responsibility to practice proper use and destruction of office records including all patient information. Following this plan will benefit you in improving your efficiency accessing important information, upholding appropriate information privacy matters for your records and your patients, and minimizing operating costs.

Who does this plan apply to? This plan applies to Dr. Smith and all faculty members working at her family practice. It is essential that all faculty members handling any office records or patient records are aware of this policy and adhere to its procedures. It is the duty of the management of the office to ensure support staff maintains due diligence to this plan.

What records are included in this RMP? Administrators should conduct an initial inventory of all materials within the office (paper and electronic) and document all items. After all items are documented a sorting process must categorize what is considered a record versus a non-record. Records include any body of information or data that is vital to the productivity of the office and confidentiality of sensitive client information. Reference materials, personal papers and extra copies of documents are considered non-records.

How are records stored? Most of the practices records are currently paper based and transferring to an electronic storage medium. Records will be stored on a centralized network server. As the progression towards all records being stored electronically moves forward it is important to establish organization. Proper file naming conventions are essential to ensure a high level of efficiency. Filenames should be indicative to all staff members needing access to the contents of the document. All company files stored on the new server must be also be copied onto the backup server by the records custodian.

How records are currently organized Records are currently organized in paper filing cabinets. These cabinets take up lots of office space, files can easily be lost, and take staff members too long to search for the right files. How long will records be retained? A strict data retention policy is crucial to this RMP. Record retention time should be judged using the National Records Management Program website for specific record types. Who will destroy records? Records should be destroyed with upmost caution. Staff members will be given the ability to destroy certain types of records depending on their network login settings pertaining to their company roles. File deletion privileges will be given based on employee job functions and individuals. The record custodian should be consulted in any question of importance of a file. Record Destruction Records that are no longer needed will be deleted from the main server first. Records that are not needed on a regular basis but important to hang onto should enter an offsite archive. The backup server must hold onto any deleted file until it is confirmed again that the file is no longer needed and the appropriate retention period has been met. Who can access records? The ability to view and read specific file types will be managed through the network login privileges and using record based access control. Employees will only be able to access certain files based on their authorized role assignment. Roles will be defined based on job functions and individual persons; permissions will then be granted.

Workflow of documents from when a patient arrives in the office

Patient arrives in the office and fills out preappointment paperwork Front office staff uses records system to ensure patient contact and insurance information is current and physician is prepared to assist patient

Physician inputs EMR information into EHR system using portable

Front office reviews EMR and gives the patient the bill

Resources
In class handout - http://www.epa.gov/records/tools/10plan.htm http://www.sh.lsuhsc.edu/policies/policy_manuals_via_ms_word/Info_Mangement_Plan10_15.pdf http://www.hits.virginia.gov/pdf/VA%20HIT%20P-APD%20V1%201%20Public%20version.pdf