Hospitals are moving away from the conventional paper-based record keeping towards an electronic-based format. The transition, however, has not been attained entirely, with most hospitals choosing to retain the paper records. Hybrid formats combine both electronic and paper records. An essential step in a hybrid environment is to acknowledge the multi-format reality. It is also important to identify and recognize the original official record at all times. Adopting a framework to guide the recording keeping process is essential. Such a policy goes a long way in creating a policy framework for the conversion of paper-based records into digital formats. This framework has to consider directives from various stakeholders such as requirements from insurer carriers, statute limitations provided by law as well as regulatory requirements by state and federal authorities.
In this way, therefore, it can be looked at as a crucial risk mitigation approach. On the downside, however, the process is time-consuming and costly considering the processes that have to be followed in identifying the data elements that can be made part of the legal electronic-based health record. Duplication is another major challenge that is faced by the hybrid record keeping system since it is impossible for the user entering the data to determine its existence within the system (AHIMA, 2005).
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From a legal point of view, a medical record is considered legitimate when it resides in the place it was created. For most hospitals with hybrid data records, the challenge becomes identifying the exact files that can be defined as legal. In other words with both electronic and paper copies available, identifying the document that can be admissible in court has become a challenge. Storing information in a hybrid environment has to adhere to a coded format.
Willow Bend vs. Florida
Florida State asserts that medical doctor records have a five-year lifespan after the last patient contact. ( The State of Florida, 2010). Any duplicates that are made from the records are held until they are rendered obsolete, or their administrative value is lost. According to the state of Florida, requirements for patients' records must satisfy four conditions that give a reason for their creation and maintenance. The values include historical, fiscal and legal. Audits must be conducted by an independent body to provide an opinion on financial statements as to whether the records comply with the internal controls and regulations. The state also requires the institution to provide a retention schedule of the medical records as well as set a minimum of retention timeline ( State of Florida, 2015) . Thus, a medical record can be destroyed based on the retention schedules developed by the institution. Moreover, the file generated or maintained in electronic format should be retained as per the minimum retention requirements outlined in these schedules.
Hospitals, on the other hand, are accorded a seven-year span from the previous time of entry into the hospital. This thus places Willow Bend Hospital policies way below those of the State of Florida. In regards to the destruction of records, the Florida state regulations assert that the physical destruction of electronic records includes: “shredding, crushing, or incineration; high-level overwriting that renders the data unrecoverable; or degaussing/demagnetizing. "For Willow Bend Hospital, on the other hand, the destruction of electronic records is stated as follows: "Methods of destruction and disposal will be reassessed annually based on current technology, accepted practices, and the availability of timely and cost-effective destruction/disposal services." Willow Bend hospital can be said to be compliant since their regulations can easily be made to fit into those of the state.
Willow Bend vs. CMS
According to MCP health records have five major categories. They include scanned records, claim records, microform records, non-claim records, and fiscal and administrative records. CMS requires providers to retain records in their legally reproduced or original format for at least five years after the closure of the cost files. Providers for Medicare managed programs must retain a file for ten years. Besides providing accurately written, promptly finished, accessible and well filed and retained records; suppliers must keep medical files for all Medicare beneficiaries ( CMS, 2012) . Moreover, CMS has no specifications for media format; however, medical data must be in their legally duplicated or original forms to facilitate quick reviews and audits by accredited entities. This implies that providers must have a medical record system that allows prompt accessibility and retrieval.
Willow Bend's Policy is in line with MCP guidelines on a number of fronts, beginning its recommendations on the destruction of medical records. Willow Bend transfers all medical records into electronic format before destroying them. The Medicare Conditions of Participation asserts the need for shredding, burning or pulverizing of paper-based documents, a factor that is well adhered to by Willow Bend. In keeping in line with the Medical Conditions of Participation of using an approved third party in electronic record destruction, Willow Bend outsources the destructions of its electronic records, and the process is monitored by the Health Information Management department director ( CMS.gov, n.d) . With these facts considered, it can be asserted that Willow Bend Hospital exceeds in adherence to the set criteria for Medicare Conditions of Participation.
Moreover, given the lack of explicit definition as what the law of limitations is connecting to trivial medical records, it is impossible to tell whether Willow Bend is following the CMS guidelines for retention. However, Willow Bend’s policy provides an unambiguous method of maintaining files by stating that files shall be kept in safe and secure place to avoid destruction, tampering, and loss. This statement equals CMS’ condition that medical records must be kept in protected areas away from unauthorized access. CMS advocates for the use of author identification and record preservation to facilitate the integrity of verification and enhance the security of all record entries ( CMS, 2012) .
Willow Bend vs. HIPAA
HIPAA Privacy Rules do not provide for medical records retention requirements for covered entities (Linford, 2017). The state provides the period for retention of medical records in the case. On the other hand, HIPAA privacy rule requires that proper administrative, physical and technical measures are put in place for protected health information (PHI) for the period that the information is under the covered entity (Linford, 2017) . In this case, Wi llow Bend Hospital is required to apply the State’s regulation on retention of medical records since HIPAA rules do not provide a specific timeline.
In regards to electronic data disposal, HIPAA Privacy Rules Section 164.310 requires that covered entities address the final disposition of protected healthcare information, hardware or any media where the information is stored. Complete removal of electronic protected health information has to be carried out before the device is made available for re-use. Disk-wiping software and degaussing equipment may be used to wipe out data from hard drives and other media (Semshred, 2017) . Willow Bend hospital adheres to these guidelines on data removal since hard drives are overwritten, an d reformatted. HIPAA rules also require the documentation of the disposal process. The rules require that paper information including x-rays be shredded with appropriate equipment. Willow Bend destruction guidelines are at par with HIPAA policy requirements since the destruction process is well documented and done according to regulations. It’s therefore right to conclude that Will Bend scores well according to HIPAA Privacy Policy requirements.
References
AHIMA. (2005). Update: Maintaining a legally sound health record—paper and electronic . Retrieved on 2 November 2017, from http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_028509.hcsp?dDocName=bok1_028509.
AHIMA. (2010). Managing the transition from paper to EHRS . Retrieved on 2 November 2017, from http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_048418.hcsp?dDocName=bok1_048418.
CMS. (2012). Medical record retention and media formats for medical records. MLN Matters . Retrieved on 2 November 2017, from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1022.pdf.
CMS.gov. (n.d). 100-07 State operations manual: Chapter 2 - the certification process. CMS Manual System Pub. Retrieved on 2 November 2017, from https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/som107c02.pdf.
Linford. (2017). HIPAA Record Retention Requirements: How Long to Retain Data? Retrieved November 16, 2017, from Linford & Company LLP: https://linfordco.com/blog/hipaas-record-retention-requirements/.
Semshred. (2017). HIPAA - Health Insurance Portability and Accountability Act . Retrieved November 16, 2017, from Semshred.com: https://www.semshred.com/hipaa.
State of Florida. (2010). 1B-24.003: Records retention scheduling and disposition. Department of State . Retrieved on 2 November 2017, from https://www.flrules.org/gateway/ruleno.asp?id=1B-24.003.
State of Florida. (2015). General records schedule Gs1-Sl for state and local government agencies. Florida Department of State, Division of Library and Information Services . Retrieved on 2 November 2017, from http://dos.myflorida.com/media/693574/general-records-schedulegs01-sl.pdf.
