Bar-coding programs outdo manual record tracking
UIHC retrieves nearly 100% of 1.2 million records
If your organization is still years away from electronic medical records (EMR), bar coding could be your interim solution to an unreliable check-in, checkout system. For the University of Iowa Hospitals and Clinics (UIHC) in Iowa City, bar-code tracking retrieves 99.9% of the daily checkouts from a store of 1,230,135 active records. Compare that to 65% to 75% retrieval from the old 3 x 5 card system, which received an honorable discharge 10 years ago.
Tammi Craft, senior associate director of UIHC’s health information management department, is quick to note that bar-coded record tracking is not unique in health care, but its near-perfect retrieval rate — "that’s something we’re very proud of." As a whole, the clinics see 600,000 patients a year. Orthopedics alone sees approximately 180 appointments a day, and the university clinics, as a whole, have 2,400 appointments a day. Typically, a department’s chart-control employees make three to four record retrieval runs a day to medical records, compared to the card system era when it took one person an entire day to do the job.
While near-perfect retrieval can be attributed partially to a sophisticated tracking system, Craft notes, "we couldn’t do it without full commitment from the staff. And we continually remind people to scan the charts in and out when they use them." To drive the message home, medical records and chart control staff ask people to consider how they would feel if their child came into the emergency room and nobody could find his or her records.
As it stands, retrieval for the emergency room averages 30 minutes during the day. At night, it’s 20 minutes, thanks to the three- to five-person crew who staff the health information management department outside of regular business hours.
The detail-rich paper trail, built into the bar-code software, boosts the retrieval rate. It begins at the central appointment desk where all inpatients and outpatients register. The hospitals and clinics use a unit record so all documents pertaining to an individual are in one folder. New patients receive a registration number, which is associated with a bar code.
Each time a record is scanned in or out of a department, this information is recorded:
• time;
• date;
• location;
• operator (usually the department’s chart control staff) and operator’s phone number;
• list of the patient’s appointments, automatically posted from the institution’s on-line appointment scheduling process.
The institutional rule is that the last person to handle the record is responsible for its location. Fred Fevold, supervisor of the orthopedic chart control office, explains how the rule works: "Even if the recipient does not scan in a chart, the system still shows that I scanned it out of my office at 8:45 a.m. And it names the recipient. Then I’m responsible for calling the recipient and asking where the chart is." Since chart control staff handle most records, mixups like the ones Fevold describes aren’t a big deal.
More troublesome, and time-consuming, are the occasional incidents in which a physician carries off a record for an off-site project. Even then, the electronic paper trail helps resolve the problem. Any new documents for temporarily or permanently lost charts go into a temporary chart identified with the patient’s bar code. "The next person who scans the patient’s primary record sees a warning flag that a partial record exists. Its location is recorded so it can be combined with the primary record," he says.
Craft credits the success of the bar-code record tracking to three factors:
1. detail of tracking system;
2. links between on-line appointment scheduling and record tracking;
3. commitment of all staff to scanning records.
Rather than strive for 100% retrieval rates, Craft says they are putting their resources into the EMR development. According to James R. Wagner, the health center’s director of information systems, institutionwide rollout of Phase 2 is planned for this year. Components will include on-line order entry, diagnoses, and problem list, procedure capture, structured dictation, coding, automated visit follow-up, and billing. Wagner anticipates the full EMR to go live within five years.
In orthopedic surgery, however, administrator Paul Etre hopes to have full EMR implementation by July 2000. His department has been a primary test site for the EMR. Currently, touch- screen computers in the orthopedics’ waiting rooms enable patients to complete their histories. From there, the system generates a narrative summary for the physician. Terminals at the nursing stations allow clinicians to enter vital signs and update medication lists. Residents enter details about the patient’s reports of their current progress, and the physician completes clinical notes during the patient’s appointment.
The system prints a hard copy of notes from the visit to be faxed to the patient’s next appointment or handed directly to the patient. (See story on UIHC’s department of orthopedic surgery, chosen as a "Better Performer," QI/TQM, March 1999, p. 37.)
Need More Information?
For information on bar-code records tracking and development of an electronic medical record, contact:
- Tammi Craft, Health Information Management Department, University of Iowa Hospitals and Clinics, Iowa City, IA. E-mail: tamra-craft@ uiowa.edu.
- Fred Fevold, Orthopedic Chart Control Office, University of Iowa Hospitals and Clinics, Iowa City, IA. E-mail: [email protected].
- Paul Etre, Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA. E-mail: [email protected].
For information on developing bar-code tracking systems and electronic medical records, contact:
- James R. Wagner, Director of Information Systems, University of Iowa Hospitals and Clinics, Iowa City, IA. Telephone: (319) 356-4445.
(Wagner says he is available for inquiries concerning possible acquisition of UIHC's medical record tracking software. But he cautions that there may be transportability issues because the system was created in-house to meet UIHC's specific requirements. You'll find additional products described in "More Bar-coding Resources," p. 6.)
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