This is an overview on the organization andd function of the medical records department in a hospital. It would be of help to administrators and planners, as well as for teachers.

1. MRS DEPARTMENT
Dr (Gp Capt) Suchitra Mankar MD MMS Assoc Fe Av
Med

2. Functions of MR Services
 Outpatient
 A&E service
 Inpatient
 MR Library

3. Outpatient Services
 Central Registration and Appointments
 24X 7, 3 shifts
 Functions
 Outpatient Clinics
 OPD timings
 Functions

4. A & E Service
 24 X 7, 3 shifts
 May take on the 3rd shift of admission office (small
hospitals)
 Functions
 Casualty Nos, folders,regist’n
 Appointments, admissions
 Medico legal
 Statistics and A&E records

5. Inpatient Services
 Admission Office
 24 X 7, 3 shifts
 Functions: waiting list, Regist’n of A&D, bed occu
chart, pt property
 Ward
 Ward nurse/clerk/CWM
 Functions

6. MR Library
 24 X 7, 3 shifts
 Functions
 Processing outpatient records
 Processing inpatient records
 Generating and analysing stats
 Filing and retrieval of records
 General MR functions

7. Filing and Retrieval
 Straight numeric filing
 Terminal digit filing
 Middle digit filing
 Colour coding

8. MRs Department
 Main factors that govern the organisation of work:
 MRs should always he available when required
and in the form they are required
 Adequate liaison should exist between
different staff using MRs to enable proper
design and
 contents, methods , storage availability,
 Procedures should cause patients the
minimum inconvenience

9. Personnel Section
 Personnel requirement
 Job description for – MRO, MRT, Asst MRT
 HR functions

10. For 500 bedded hosp
 MR Officer 1
 MR Technician 4
 Clerks 3
 Peon 1
 Statistician 1 (on part lime basis)
 Computer literate

11. Norms for Personnel
 Working days X No of shifts
Man days
 2 persons for any hospital + 1 person for every
100 beds (up to 500) + 1 person for every 10 beds
 Calculate for 800 beds

12. Categories of Personnel
 MRO
 MRT
 Asst MRT
 Transcription/ Medical Secretary
 QA Specialist

13. Job Description MRO
 Qualifications
 Graduate with 01 year diploma in MR, 03 years
experience
 University degree in MR with exp
 Line of reporting/ promotion
 Duties & responsibilities

14. Operational Policy
 To guide the functions of MR dept
 Includes
 Working hours and shift
 Duty rosters
 Orga’nal chart
 Training schedules
 Fire safety
 Disaster plans, etc

15. Interdepartmental Relationship
 Medical Staff
 Nursing Staff
 Diagnostic departments
 Computer section
 Stats section
 Administration

16. Physical Facilities
 Areas required: primary records, sec
records, conference room, MRd
staff, teaching, research, admin reqmts, legal
reqmts
 Upto 99 beds: 50 sqm + 1 sqm for each bed
 More than 100 beds: 100 sqm + 1 sqm for
each bed

17. Equipment Requirement
 Shelves, Pigeon hole rack
 Cupboards, Bookshelves Filing cabinets, Index cabinets
 Table, chairs, stools, steps
 Typewriters, computers
 Label dispenser, numbering machine
 Photocopier, duplicator
 Microfilming etc

18. Location of various sections
 Admission and Inquiry Office:
 A space of 125-175 sq ft is considered adequate.
 facilitate easy communication between
 General office equipment will mainly be required for the staff
 Separate counters for admitting clerk, receptionist and billing
clerk
 Adequate waiting space Telephone with facility local
calls1STD must be made available

19. Central Record Office
 A rough guide
 2 to 3 sq ft per bed may be sufficient. The details
are as under:
 50 bed hospital-1 50-175 sq ft
 100 bed hospital- 225-250 sq ft
 200 bed hospital--450-500 sq ft
 500 bed hospital-1000-1200 sq ft

20. Calculation of space
 Measure one full shelf.
 Count the number of files on the shelf.
 Calculate the number of files per linear metre.
 Count the number of new files created last year.
 Calculate the number of linear metres required
per year.
 You can then calculate the number of linear
metres required for one, five or 10years.

21. Security
 There should be procedures to protect MRs from
fire, water damage ,pest damage, and unauthorized
access.
 Lock on all doors. Access should be restricted . There
should be one open entrance to the MR file room and
a fire exit.
 No smoking policy in the file room.
 Fire equipment and written procedures on in case of
fire
 There should be regular pest control in the file room.

22. Coding and Indexing
 International Code Number based on
"International Classification of Disease" issued
by the World Health Organisation
 Accuracy and uniformity in reporting

23. Indexing
 Alphabetic or Master Index: Indexing based on patient's name
sequenced in
 alphabetic order. The primary purpose of a name index is to provide entry
into
 the filing system and finding out MR for a patient. The patient index
 card is usually 3"x5" card giving identification data, registration
number etc
 Disease index: Disease index is a catalogue of cards of 3"x5" or
S"xX",
 maintained to find out groups of clinical records of patients having the same
 diagnosis.

24.  Operation index: It is a catalogue containing
the details of patients who have undergone
operations.
 Physician's index: Catalogue containing
details of all patients treated by particular
physicians.
 Unit index: Details of all the patients treated in
a particular unit are indexed.

25. Storage and Retrieval
 Effective filing system
 Compactness to reduce physical effort and cost of
storage
 Accessibility for speedy location and identification.
 Simplicity for understanding of all concerned.
 Economical both in the cost of installation and
operation.
 Elasticity to expand according to future requirement.
 Tracer system for document in circulation

26. System of Filing
 Decentralised system: Under this system inpatient and
outpatient department
 have their own individual records and file them independently
 If a patient is transferred from one department to another the file
may
 be loaned to other department. This system is labour intensive and
the operating
 cost are higher.
 Centralised system: In the centralised system, MRs are filed
centrally
 The centralised system is more efficient, provides better control and
followed in most hospitals.

27.  Numerical method: This method is most
suitable
 for retrieval of files. disadvantage of –new files
(most active) are added to one
 end of the system, which usually is the furthest
from the working area

28. Alphabetical method and
Chronological order
 filing is done in alphabetical sequence of
names and sequence based on their date of
admission respectively. Requires maintenance
of indexes to allow access to the documents
maintained in the libraries.

29. Terminal digit System
 6 digits . First two primary, second two secondary and
last two numbers, are the sequence number of the file
 Storage spaces is divide into 100 equal parts from
00 to 99 The primary section.
 Each primary section is further sub divided in 100
equal parts again running from 00 to 99.
 File number 123456; is located section 56 and
secondary section 34. File number 12 is the required
file

30.  12 34 56
 Tertiary secondary Primary
 Sorter shelf for records waiting to be filed

31. Middle digit system
 Middle two digits are the primary
number, the first two digits the secondary
number last two is the file number

32. Misfiling
 Look for the transposition of digits in a number. For
example, 131234 may be filed as 131243 or 121334.
 Look for missing files under similar looking numbers
such as "3" under "5" or "8" or vice versa
 Check for a certain number such as 584 under 583 or
585 or under a similar combination.
 Check the transpositions of first and last numbers.
 Check the MR just before and just after the one
needed.
 Check the shelf immediately above and below

33. Culling/Purging
 Based on last date of admission
 Based on retention policy
 Done every year usually in the same month
 Records kept
 Make a committee in charge, Med record
member may be present, but MRO should not
be part of the committee

34. Filing Procedure
 Different color for different years
 Types of filing
 Vertical
 Suspended
 Horizontal

35. Microfilming
 Answer for inactive MR storage. Advantages of
microfilming are:
 Saving of space: 90% of the space can be saved if
records are microfilmed.
 Easy accessibility: Due to easy storage in a
smaller area
 Protection:
 Elimination of incorrect filing
 Saves manhours

36. Computerisation of MRs
 Automation is not the same as electronic MRs
 EMRS improve access and sharing of
information.
 A well run and organized manual system is a
must. before EMRs
 EMRs will not remove the problems of a
Medicl records dept

37. Retrieval of MRs
 Depends on system of storage
 Record removed and tracer inserte’. Keep a
copy if records are moving out of the hospital
 Treat the records with as much care as the
original.
 Destroy the copy after original is received

38. Thank