Management Essentials

Storage Wars: Maintaining Required Records

By Farrell “Toby” Tyson, MD, FACS

Who says regulations don't create jobs? When I started practicing ophthalmology, an exam note was just a blank piece of paper for writing down pertinent positives and negatives. Now, through regulations and requirements to document the appropriate level of coding, an exam consists of several pre-populated pages of checkboxes and forms. Over the years, our charts have swollen in size and number. Even as we migrate to electronic medical records, it has become too expensive to scan in all the old charts and files. This leaves practices with the burden of document retention.

One of the problems with document retention is determining how long, legally and administratively, to maintain documents. Meeting minimal legal requirements is necessary, but if the space is available or a specific need makes it prudent, it may be wise to exceed those requirements. In our practice, we looked to our malpractice carrier for initial guidance and then to the University of Florida Health and Safety Record policy. In addition, we reviewed the Florida Administrative code and the Florida statute of limitations to develop a practice-wide records retention policy.

Medical Records

Patient medical records are maintained for 10 years after the last date of service: no exceptions. Medical records for patients who have died are only maintained for five years from the date of death. These charts are stored separately and it is important for the staff to maintain a list of deceased patients. In addition, charts of minors need to be stored for 10 years after the last date of service or four years after the patient turns 18, whichever is longer. Post-refractive surgery patients' charts should also be considered, but that would be up to the individual practice to decide.

Employee Records

Human resources records must also be maintained. A good rule of thumb is to retain all job advertisements and employee applications for a year.

Employee personnel files should be stored for up to seven years following termination of employment. Payroll records, such as tax returns, W-2s, payroll check records, and employee withholding records, should be kept for seven years and time sheets should be kept for five years.

The federal government really asks a lot when it comes to maintaining Occupational Safety and Health Administration (OSHA) records. A practice is required to keep exposure records for the duration of employment plus 30 years! OSHA Forms 101, 300 Log, and 300A must be maintained for five years from the end of the year to which the record relates. Corporate tax returns (federal tax, state tax, sales tax, county tangible tax, etc.) along with bank statements to back them up should be held for 10 years. The practice's pension records require seven years after the termination of the plan.

Clear Guidelines

Maintaining all this can be a daunting task as well as a time-consuming expense. To make sure it is done properly and in a timely manner, a record-retention policy needs to be adopted and written up in the employee manual. All it takes is one “enthusiastic” employee to shred years of information that can never be retrieved. To prevent such a tragedy, a practice timeline clearly stating when document purges are to occur (usually once to twice a year) can be beneficial.

One would think, upon retirement, we could just take down our shingle. If only it were that easy. Even then, physicians are required to maintain and be responsible for patient records. That explains why many are trying to sell their patient charts when they retire. They understand the burden they still carry unless they can find someone to relieve them of it. Usually, it is in the retiring physician's best interest to make this transition over time so both parties feel benefited.

Over time, as we migrate to a fully electronic environment, many storage and time issues will disappear. The only remaining question will be whether it is beneficial or detrimental to maintain electronic files even longer than required. OM

Farrell C. Tyson, MD, FACS, is a refractive cataract/glaucoma eye surgeon at the Cape Coral Eye Center in Florida. He may be reached at tysonfc@hotmail.com.