NY records department hit with two floods during major clean-up project
HIM staff with contract help persevered
Imagine daring to take a look at your hospital’s dungeon where a decade or more of medical records are stored and then deciding to clean up the mess as efficiently and cost-effectively as possible.
Now imagine that a couple of weeks into the clean-up, when boxes still are blanketing the storage room floor, your hospital is flooded and already-sorted records are soaked. Then, picture the scene a month later when it happens again, only this time the records were sorted and stored in a temporary location.
Does it seem like a plot from an HIM horror flick? Well, this scenario actually occurred last year to the State University of New York’s (SUNY) Downstate Medical Center in Brooklyn.
Shoshana Milstein, RHIA, CCS, was new to the job of director of medical records when she decided in the summer of 2001 to take on the hospital’s backlog of 15 years’ worth of stacked medical files.
"We had a very old filing system with shelves in front of shelves," says Milstein, who now is the hospital’s privacy director.
"Each one of those shelves was stuffed, so we couldn’t move one shelf to get to the one behind it," Milstein adds. "Boxes were piled high on the floor, in aisles, and blocking shelves."
The apparent strategy had been to archive records in that basement office and to not keep track of what was down there and when it needed to be purged.
Plus, the 50-employee department was short 11 people, and Milstein was pregnant, expecting a baby in December.
"I had just begun the job and wanted to do my best, but it seemed like an impossible task," Milstein says. "None of the administrators knew what was going on in the basement, so I showed them the area, and they knew a Joint Commission [on Accreditation of Healthcare Organizations] survey was coming up."
The hospital’s administration gave Milstein the go-ahead to seek bids from medical records contractors who could take care of the reorganization and clean-up.
One bid came back at $500,000 just to handle the emergency department records. Another bid was based on an estimated number of man-hours the project would take to complete. Milstein presented the second bid to administration, and it was sent through a lengthy bureaucratic process before finally receiving approval.
The Joint Commission survey was scheduled for October, and that time was fast approaching, but when terrorism struck New York City in September 2001, the survey was postponed until early 2003, Milstein says.
Even so, it was late October before the contracting company, Precyse Solutions of King of Prussia, PA, was able to begin the work.
"We were on site a couple of weeks when the first flood occurred," says David Wright, director of HIM services for Precyse Solutions.
"A couple of weeks into the process, we were just beginning to make a dent in the file area, just getting into the process of discovering that the age of documents was considerably greater than we anticipated," Wright recalls. "Unfortunately, because of the overflowing shelves, the most recent charts, which were the ones we were trying to prepare for scanning, were greatly affected by the flood."
Milstein was overwhelmed by the disaster. "I remember walking in there, and I just felt like I was going to cry," she says.
By law, the hospital needed to maintain those charts, so Milstein and Wright figured the best solution was to find a vendor to freeze-dry the records and reproduce them through copying to generate a new original record.
The flooding disaster also meant that the total cost of the project would rise by at least $20,000 for the freeze-drying process, Milstein says.
Plans were to scan onto a CD-ROM all records from 1998 and 1999 and keep the records dating from 2000 forward in the storage department for fast retrieval. Anything dating before 1998 would be sent to an off-site storage location, Wright explains.
"The normal process is to continually purge records to make room for new charts, and that process had been neglected for years," Wright adds. "When talking about the volumes of charts this facility was dealing with, the cost of backlog scanning is astronomical."
To expedite the process of making the basement records room cleaner, the Precyse crew moved the records being prepared for scanning to a second location on the first floor near the cafeteria. This occurred as the crew was making fast progress in sending older records to off-site storage.
"It was a holding area so it wouldn’t impede the process in the main medical department, and so it would look like something was getting done there," Milstein says.
During this second phase of the project, the medical records department began to look clean and organized, which was the image Milstein wanted to present to the Joint Commission surveyor, whom she figured might or might not take a look at the area.
In the temporary storage space, boxes were stacked high for scanning, and then the unthinkable happened in December 2001: There was a second flood, and this time it soaked the bottom boxes in the temporary storage area, Milstein says.
"At that point, we realized we were way over the amount of man-hours we should have had for that point," Milstein says.
This presented a major problem because the project was given a budget cap that could not, even under these circumstances, be exceeded, she says.
Wright outlined several options and alternatives to their original plan, and they decided to reduce the number of files scanned and simply store the remainder. One of the most important goals, making the records storage area neat and accessible before the Joint Commission survey, was being met.
"When the Joint Commission walked through the door, it was orderly, and everything was off the floor and onto the shelves," Wright says. "We purged 70% of that department."
The second batch of wet files was handled similarly to the first, and the project continued.
"When we did this project, there were 65,000 inpatient charts purged and 86,000 ED records, and it was such an insurmountable task," Milstein says. "It’s much easier to do this on an ongoing basis and have the staff scan older records regularly."
Although this project was unusual because of the amount of the backlog of files and the two floods, it does serve as a learning lesson for other HIM departments, Wright notes.
"Give yourself enough time to clean up old files," Wright recommends.
As it turns out, Milstein’s planning and preparation paid off. The Joint Commission surveyor had decided to visit the records storage area and made the trip in the evening when Milstein was off work.
"I was so thrilled," Milstein recalls. "I walked in the next morning and didn’t even know they had come in the evening before, and then the surveyor said at the 9 a.m. meeting that the medical records department had been visited."
The surveyor had no negative comments about the department, and the hospital received a 98 rating on the survey, Milstein adds.
Milstein then called Wright, who was at a meeting in Atlanta, and thanked him for the successful job and survey.
"I had known the Joint Commission typically didn’t do walk-throughs of medical records storage areas, so neither of us was anticipating they’d do a walk-through," Wright says. "But of course if it wasn’t prepared, we knew they’d walk through it."