Medical Records Department Planning

Departmental Location
Every day, many members of the medical staff visit Medical Record department for completion of medical records or for records reference. Proper location of the medical record department and the provision of proper facilities are essential.

If the medical record department is not staffed 24 hours a day, it should be located within easy walking distance from the admitting or outpatient department to ensure that the staff can easily refer files and retrieve records on an emergency basis. Secure surveillance to safeguard medical record information and equipment during non-working hours should also be considered.

Layout:
Proper layout of the medical record department adds to its efficiency and attractiveness.

The key considerations in layout are

Workflow
Equipments should be near the user.
The flow of record work from desk to desk.
Placing desk side be side in the same direction is said to be the most compact desk arrangement.
The records room should not be near the main office entrance. Placing it at the rear end of the department helps to reduce the accessibility of medical records to unauthorized personnel.
A supervisor should be placed behind the group of workers he supervises.

Space:
Space allocation is determined by departmental services to be provided, equipment and systems to be used and daily workload. Although services may vary somewhat from hospital to hospital, services and tasks to be considered in allocating space include the record filing cabins, master patient indexing cabin (manual), coding and indexing desk, correspondence desk, op registration area, admitting and discharging office. However the best guide is the past experience in the particular hospital, or that of a similar institute.

1. Records file maintenance:
Record file maintenance includes retrieving, dispatching, receiving and filing methods of records.

First, it is important to estimate how many shelves will be required to house an estimated number of patients. As a guide line the following estimate can be used for this study.
A 36-inch open shelf file may house on an average75 IP records or 300 OP records.
To finalize the numbering system used (i.e.) if a unit numbering system is used, adequate space must be provided on the shelf for growth of records as a result of repeat hospital visits and readmissions of patients.
The number of years the medical records are to be retained in the active medical record room has to be determined.

2. Master patient index:
Space allocation for master patient index will depend on the type of equipment or system used for immediate identification of current and past patients by name, address and medical record number.

E.g.: the information may be stored on 1 inch by 3 inch or 3- inch by 5 inch cards in upright cabinets.

3. Coding & indexing desk:
This desk may be used for medical records, coding forms, and coding books, for compiling disease and operative indexes manually. If an automated data process mechanism in used, adequate space for systems (computers) must be accommodated on the desk.

4. Correspondence desk:
Space for telephone, typewriter or computer and duplicating equipments (stencil or photocopier) will also be considered.

5. OP registration area:
A separate area with a table and system is necessary for the registering clerk to register the new and review patients visiting the hospital. The number of tables may be decided on estimating the number of patients visiting the hospital every day.

6. Admitting and discharge office:
The chief function of the admission office is the admission of patient. In addition it is concerned with discharge, transfer, death and other related information. Hence the admitting office should be located in a quiet section near the entrance in close proximity to the OPD and emergency services on the ground floor and must also be easily accessible from the business, administrative sections and the MRD. The area may vary from 125-175 5q.ft. It should have two rooms, one for the working area and the other for storing stationery, forms etc.

7. Billing Process:
In many hospitals collection of payment is carried out by the OP registration and admitting and discharge office. This will reduce the number of billing staffs needed for this service. The medical record clerk collects the registration charges and the consulting fees from the patient during the new and review registration process. When a patient needs hospitalization, an advance amount is collected from the patient for surgery, treatment and medication during the process of admission. During discharge, a final bill is produced to the patient based on the surgery and the treatment tariff.

Equipments:
In general, equipment needs for the individual hospital medical record department are affected by:

Planning the work environment
Part of the planning function is providing employees with the proper work environment. This includes planning for office space and location, office furniture and equipment, and spatial conditioning factors such as lighting, color, sound and air.
Temperature, color and lighting
When designing an office layout, the medical record technician should also consider environmental factors such as temperature, humidity and ventilation. These factors have been proven to have a direct effect on employee productivity and comfort. Recommended means of keeping the air moving in the office include air conditioning, window fans, and ventilators.

The proper use of color is another important consideration in office design. Effective use of color not only spruces up an office, but also improves working conditions. Psychologically color can affect human emotions, senses, and thought processes, as well as individuals ability to relax.

Lighting is another environmental factor, which cannot be over looked. Light sources on the ceiling can usually provide enough light for the entire office area at a prescribed level of illumination. It is recommended that the medical record technician consult a lighting expert about the most efficient methods for obtaining adequate illumination.

Safety & Security
Protection from fire:
The entire medical record department, especially the filing area of records and X-rays, should be protected from fire by installing fire extinguishers in key areas. Important documents such as medico legal cases should be preserved in fire-proof cabinets. All electrical cords should be covered to avoid short-circuiting.

Safety control:
Necessary safety measures should be taken for the welfare of both the departmental staff and visitors to the department. Filing shelves and other mechanical equipment devices should be well erected to avoid accidents.

Infection control:
Adequate measures should be taken to protect employees from infections and other diseases. Regular medical checkups and examinations should be available to the staff.

Manpower planning:
The manpower planning deals with the personnel requirements according to the bed strength and patient load of the hospital and the job description of the medical record staff.

Formula for calculating number of personal required for MRD.

A minimum of two persons for any size of the hospital + 1 personnel for every 100 beds (50-100) + 1 person for every 10 beds.

E.g: Number of staff required for medical record department
of 100 bedded hospitals =2 + 1+10 = 13.
of 500 bedded hospital =2+5+50 = 57.

Categories of Staff for MRD According to Bed Strength.

S.NO.	Category	Bed
S.NO.	Category	30	50	100	250	500
1.	Medical record officer	-	-	1	1	1
2.	Medical record technician	1	1	2	6	12
3.	Asst. Medical record technician	4	7	10	23	44
4.	Other staffs	-	1	2	4	7
5.	Quality Assurance specialist	-	-	1	1	1
	Grand Total	5	9	16	35	65

Note: The number recommended is optimum, but varies according to workload, record retention policy and other related activities.