Hospital planning and designing

MEDICAL RECORD DEPARTMENT

Contents

• Introduction
• Definition
• Objectives
• Functions and importance
• Admission and Enquiry Office
• Indoor Wards/Nursing Units
• Medical Records Office
• Key Planning and Design Parameters

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Introduction

• The history of medicine is parallel to the history of medical records, which is

substantiated by the fact that "Hippocrates", the father of modern medicine is
known to have kept record of fever cases
• In a modern hospital, the medical records department (MRD) is the hub for
patient care activities related to hospital statistics, quality initiatives in the form
of peer review, clinical research, medico-legal issues and others

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Definition

• Medical records has been defined as a "clear concise and accurate

history of patient's life and illness written from a medical point of
view"
• lt is also defined as a “Restorative and Legal document related to
patient care in which is recorded sufficient data written in sequence of
events which is used for the diagnosis and warrant the treatment and
end results

Dr. Lawrence Weed is considered “ father of problem-oriented medical records

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Use of medical records ?

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 Period of retention ?

According to MCI – 3 Years from date of commencement of treatment

According to NABH (which follows US standards)
Inpatient records – 7 years
Outpatient records – 5 years
Medico- legal cases – 15 to 30 years ( until final court hearing )
Records of minor patients – age of 23 (18 +3 years) or 10 years from
commencement of treatment

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Objectives

• To maintain records and documents related to patient care so as to ensure

continuity of treatment and care to the patient
• It also helps in dealing with medico-legal cases and serves as a working document
related to research and training
• Indexing and coding of documents along with quick retrieval will be the main aim
of planning and designing a medical records department
• Safeguarding the information in the medical records (until the time of completion
of retention)

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Functions

• Admit, transfer and discharge

• Generate patient records
• Payment details
• Reservations (for future admissions)
• Disseminate information
• Arrange for safekeeping of patient’s valuable
• Coordinate pre admission tests
• Arrange patient’s escort services
• Safeguarding the information in the medical records
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 Introduction of
Hand written
typewriters and HIS
documentation
computers

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Importance

• It documents the medical problems of the patient, assists in the

continuity of care, avoids omissions/ repetition or duplication of
investigations, and helps in settling legal and insurance claims.
• Helps collecting information about patient’s background and also, in
preliminary diagnosis (clinical decision making)
• It helps in medico-legal cases and evaluation of quality of care (QUALITY
AUDITS)
• It also helps the hospital administrator in resource allocation and
defense of litigations
• The medical records department also contributes to external databases
in the form of information mandated by law from registration of births
and deaths, PNDT act and notifiable diseases
• Provides the basis for most of the biomedical research in hospital
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 MRD can be divided into three district areas/divisions
• Reception and enquiry office/counter
Reception –cum- registration area
• Admission and registration counter
• Medical record office which also includes the storage space

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 Admission and Enquiry Office

• Deals with reception, registration, initiation of the "face sheet“ which

includes all demographic parameters, ward allotment and bed number
to the admitted patient
• Notification of communicable/notifiable diseases to medical record
office whenever required
• In most public sector hospitals there is a separate registration counter
for OPD patients, which is also part of medical record department

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 Indoor Wards/Nursing Units

• The major part of the medical records are initiated by the healthcare providers
• This area holds the key for establishing proper documentation in the hospital as
history taking, physical examination, investigations, plan of treatment,
consultations, treatment and progress notes, blood pressure, temperature,
pulse, respiration charts, input/output charts, consent form, anesthesia and
operation notes (wherever applicable), discharge/death reporting, including
patients leaving hospital against medical advice (LAMA) is generated here

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 Medical Records Office

• This is responsible for collection of records of discharged patients/deaths

in the wards, assembly, deficiency checking, incomplete record control,
coding and indexing, analysis and statistical reporting, filing, numbering,
storage and retrieval
• Receipt of summons from courts of law and submission of
records/documents as desired
• Maintaining correspondence with insurance agencies for reimbursement
purposes

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Medical Records Office contd…

• Standardization of forms and other documents used in hospital

• Custodian of patients records taken for medical audit/ death
review /peer review
• Notification of communicable/notifiable disease cases to
appropriate authorities
• Co-ordinate issue of medical certificates, estimates for treatment,
reimbursement certificates and other documents used by patients
Location

Generally the location of the three main divisions of MRD are

different in relation to the hospital

• The admission and enquiry office should be near the main entrance to
the hospital, OPD and accident and emergency department, so that
patients requiring admission do not have to travel long distances
• The OPD registration counters should be at the entrance/ outside OPD
premises for orderly flow of patients to consultation rooms
• The nursing station/indoor wards should be located in the
hospital building in a proper sequence

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Location contd….

• Medical record office should be within the hospital building, near to business
office/administration and not very far from the entrance
• General tendency to locate the MRD in the basement is fraught with risk of
fire/water logging/seepage and should be avoided
• Storage wing of the office used for inactive records can be located relatively
distantly from the hospital building

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Physical Layout

• Admission and enquiry office should be of adequate size, with

counters and space for patients/ attendants
• Unidirectional flow of patients and attendants is recommended to
avoid criss crossing
• In most private sector hospitals this is also known as the front office
and should have convenient workflow, good placement of work areas
and excellent communication systems
 Physical Layout contd….

• Office of medical record officer

• Office of asst. medical record officer
• Waiting space/lounge
• Modular workstations for different functions with scope for expansion
• Room for doctors-incomplete record control
• Issue desk/ counter with photocopying equipment
• Storage room/ area for active records
• Storage area/room for inactive records in a contiguous area or remote
area with proper communication
 Key Planning and Design Parameters
• Admission and enquiry office (front office) should be spacious well
ventilated and lighted
• In overcrowded public hospitals air cooling and optimal ventilation
should be provided
• Provision of health education posters, CCTV displaying related themes
will be an added advantage
• Medical record office should be spacious, well ventilated, and have
adequate protection from pests and rodents
• It may be prudent to have air-conditioning so as to control humidity
and improve comfort levels
• The walls floors and ceiling should be leak and seepage proof
especially in the storage portion

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Key Planning and Design Parameters contd….

• Adequate light (200-300 lux) should be provided for office works

• Work stations should be modular with independent space for computer
• Access control to storage area is essential hence entry gate should be strategically
located
• Fire sprinklers and smoke detector systems must be installed as a safeguard
against fire
• Sewage systems from toilets should be away from storage areas, so as to present
accidental seepage in walls

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Space Requirement

The space requirements depend upon the level of hospital

(secondary/tertiary) and status of computerization
• Admission and enquiry office should be 15-20 m2 with waiting
areas 0.5 m2/bed for smooth flow of patients/attendants at the
counter
• Thumb rule for OPD registration space is 1.0 m2/bed
• Medical record office should be 1.0 m/bed, but would also depend
upon status of computerization of the hospital
• Storage should be 15-50 m2 with compactors to store more
number of files in same space
• Filing space should be provided adequately and can be calculated

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 Unit record system

Other systems :
• Chronological / source oriented medical record
• Problem – oriented medical record

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 Filing systems

1. Numerical filing
2. Terminal digit filing
3. Terminal digit filing with color coding

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Medical record storing methods

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 Summary

• This is responsible for collection of records of discharged patients/deaths in the

wards, assembly, deficiency checking, incomplete record control, coding and
indexing, analysis and statistical reporting, filing, numbering, storage and
retrieval
• The admission and enquiry office should be near the main entrance to the
hospital, OPD and accident and emergency department, so that patients
requiring admission do not have to travel long distances
• An effective and efficient medical records department is an important variable
for a hospital as a quality parameter especially in light of Consumer Protection
Act 1986 and the recent Right to Information Act 2005
• It is also a mandatory requirement for accreditation of hospitals and
computerization can go a long way in ensuring optimal functioning
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References

• Kant Sunil, Gupta Shakti and Chandrashekar S. (2009) - Modern

Trends in hospital planning and designing, Jaypee Brothers, New Delhi
• Kunders, G.D. (2004)-Facilities Planning and Arrangement in
Healthcare, Prism Books Pvt Ltd. Bangalore

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