The patient health record contains important information regarding clinical quality and care. The health record is also undergoing a radical evolution as more imaging becomes available and digital record keeping becomes the norm. The HIM professional needs to have a clear understanding of how to manage increasingly complex sources of health information. In this paper, we will discuss how the HIM professional should manage the use of paper forms in a hybrid environment in order to maintain the integrity of the health record. We will also compare the strengths and weaknesses of using hybrid records and discuss legal issues that may arise when using hybrid records. Additionally, we will evaluate the “Willow Bend Record Policy” to determine if it protects health information for record storage and destruction of paper and electronic health records based on Kansas state regulations, Medicare Conditions of Participation, and Health Insurance Portability and Accountability Act (HIPAA). The term hybrid health record is used in today’s healthcare environment to describe a format that has both paper based and electronic information. Given that this type of health record is complex in content, it comes with additional requirements in regard to management. This is particularly true when comes to managing patient information into a concise, presentable formation. As HIM professionals, we should also be seeking ways to improve access to information and balancing that access with security. For example, the longitudinal health record is significant as it allows for access to patient information from multiple locations. This is incredibly valuable to physician’s looking at long term treatment plans. It saves time, money and prevents mistakes. As such it should be the objective to convert the hybrid record into a longitudinal format. This is currently very difficult as hybrid health records are often just lines of text and cannot be easily utilized by every health system. Goals for management should be to increase accessibility and security. This currently can be done most effectively by ensuring that paper content meets current regulations and accreditation standards. This will be an ongoing challenge for the HIM professional. Next, we will compare the strengths and weaknesses of using hybrid records. First, the primary benefit of a hybrid record is that it maintains the same format even after the patient has been discharged. Some facilities have integrated scanning documents into the patient record in order to take advantage of electronic recording keeping. In these instances, the advantages include faster access and less labor in filing and retrieving paper sources. Hybrid records also allow for remote access in some cases. This also allows for fewer delinquent health records as physicians can more easily complete documentation. Some of the drawbacks of hybrid records include a decreased ability to gather certain data elements. The paper documents scanned into a hybrid record can contain essential data elements that are difficult to search. Next, we will discuss legal issues that may arise when using hybrid records. The information that is contained within the legal healthcare record serves to protect legal considerations for both the provider and the patient. There is a long-standing saying that in a synopsis states if an action was not documented it was not actually performed. This is an obviously exaggerated statement, however, it serves as a reminder that in the modern world good clinical care can only be as good as that care’s documentation. When defining the legal health record in a hybrid setting, some issues need to be taken into consideration. One obvious difficulty is that the healthcare industry has not created a clear definition of the legal medical record. For instance, is metadata truly part of the legal health record? Should we also include all date and time stamps into the legal health record? These are issues that have been left unanswered by legislation at this current time. However, the HIM professional must work to set the standards within his or her facility and draw the line in the sand to include all elements which could be pertinent. Next, we will evaluate the “Willow Bend Record Policy” to determine if it protects health information for record storage and destruction of paper and electronic health records based on Kansas state regulations. Kansas state regulations on clinical records protection states, “the facility shall safeguard clinical record information against loss, destruction, fire, theft, and unauthorized use” (Kansas, 2011, p. 27). Regulations go on to specify reasons for when records need to be transferred. There is, however, very little regulation that addresses electronic records. What can be perceived is that the Willow Bend policy goes into much greater detail about the level of protection and retention than the State of Kansas. So, in accordance with the previously mentioned protection regulation the Willow Bend Record policy is consistent when it reports that “All paper records converted to electronic format will be maintained in a safe and secure area… Safeguards to prevent loss, destruction, and tampering will be maintained as appropriate” (WBRP). The state of Kansas does not put forth any regulation regarding how long paper records must be kept after being converted to electronic format. So, again, the Willow Bend policy holds to a higher standard and is therefore consistent. However, the organization should consider what type of electronic storage method is implemented. In the case of diagnostic images for occupational health that must be retained for thirty years, converting to microfilm storage would be advantageous. We will now evaluate the “Willow Bend Record Policy” (WBRP) to see if it protects health information for record storage and destruction of paper and electronic health records based on Medicare Conditions of Participation. The conditions of participation state that a hospital must maintain medical records for each outpatient and inpatient. These records have to be accurate and written promptly. In addition, a hospital must ensure the integrity of authorship and securely protect all entries. Also included in the conditions is a regulation on how long records must be held in retention; “medical records must be retained in their original or legally reproduced form for a period of at least 5 years” (CMS, 2015). The WBRP goes beyond this standard in regard to most patient paper documents. The WBRP holds that the Disease Index, Fetal heart monitor records, Master Patient Index, and Adult medical records all be kept for ten years. It is only the diagnostic imaging which only has to be held for five years. In this way, the WBRP is consistent with the conditions for participation in Medicare. Of course, as the paper records are destroyed they remain in retention via electronic storage. This could fit the description of ‘legally reproduced form’ as the paper documentations are being scanned and stored. However, the WBRP it is doubly secured in regards to the previously mentioned documents. In the case of six month retention of all other paper documents, the WBRP meets the standard in its retention and proper storage of electronic data. Lastly, we will examine and evaluate whether the WBRP protects health information adequately in accordance with HIPAA. In HIPAA’s administrative simplification rules, there is a requirement that an entity, such as a physician, retains all required clinical documentation on a patient for up to six years from the date of its origin. With this in mind, we see that the diagnostic imaging retention standard of the WBRP may be inadequate. However, as will be explained, this is not the case. But, this is an important consideration for hybrid health records. Because the content is varied, some of the documents within each record may have been selected for destruction when it is not necessary and vice versa. Early destruction of records given an organization the appearance of hiding or covering up wrong-doing. However, the WBRP is only referring to the destruction of paper records and that the electronic health record will be maintained in retention. In this way, we see that the WBRP is consistent and following HIPAA. Additionally, we see that HIPAA has the equivalent requirements previously mentioned state regulations and CMS conditions in that all information must be kept safeguarded. This standard is given added incentive by HIPAA. This is due to the fact that as we become more technologically based, the potential for information hacking increases. The WBRP addresses this by implementing destruction of the hard-drives of decommissioned computers. However, one area of concern still remains in that there is no mention of cryptographic securing of data to help prevent loss. This is an area the WBRP could improve upon in its storage and protection of patient data. In conclusion, we have looked at and examined various aspects of hybrid health record and its relation to law and policy. We discussed how to manage the use of paper forms in a hybrid environment in order to preserve the integrity of the health record. We also compared the strengths and weaknesses of using hybrid records and discuss legal issues that may arise when using hybrid records. Finally, we evaluated the WBRP to determine if it protects health information for record storage and destruction of paper and electronic health records based on Kansas state regulations, Medicare Conditions of Participation, and HIPAA. As electronic records continue to expand these hybrid health record issues are currently pressing. Therefore, the HIM professional must understand and help to establish policies and practices that are in accordance with all requirements.

Works Cited

CMS (2015). 42 CFR 482.24 - Condition of participation: Medical record services. (n.d.). Retrieved April 18, 2015, from https://www.law.cornell.edu/cfr/text/42/482.24

Kansas, A. (2011). Administration. In Understanding Nursing Home Regulations. Topeka, KS.