The back room
The clinic moved to Cliniko or similar a few years ago. Everything before that is on paper: record cards and case notes in labelled boxes, stacked in a cupboard, a loft or a storage unit. When a returning patient from ten years ago books, someone climbs up to find their notes. When a records request arrives, it can take an afternoon. When the previous owner retired, their patients' notes came too.
Nobody is quite sure how many boxes there are, which patients they cover, or when each set of records can be reviewed for destruction under the clinic's retention policy.
Why the boxes never get dealt with
Scanning everything at once feels enormous and expensive, so it never starts. Doing it gradually has no plan, so it stops after a few weeks. The alternative, simply keeping the paper, has no immediate cost until a records request, a move of premises or a flood in the storeroom forces the issue.
Underneath it is a missing index. If the clinic knew which patients were in which box and when each record's retention period ended, the problem would already be half solved.
What the paper costs you
| Issue | Effect |
|---|---|
| Finding one patient's notes | Time, and sometimes failure |
| Records requests | Slow responses that your own obligations may require to be prompt |
| Retention | Records kept too long, or destroyed without a clear record |
| Storage | Space in the clinic, or rent for a unit |
| Risk | Fire, flood or loss with no copy |
The clinic's retention policy, and how long records must be kept, are for the clinic and its advisers to decide under the guidance that applies to your profession. What a workflow can do is make sure the policy you decide is actually applied.
The workflow we set up
- First, a quick index: each box is opened and the patient names and date ranges are recorded, so the clinic knows what it holds. This alone makes retrieval faster.
- Scanning is prioritised: patients who have returned recently or are likely to, then records nearest a requested date, then the rest.
- Scans are done in-house on a document scanner or by a scanning bureau you choose; our software handles naming and matching regardless.
- Each scanned file is matched to the patient's digital record in your clinic software by name and date of birth, with uncertain matches queued for a person.
- The scan is attached to the record, so a clinician sees it alongside current notes.
- Each record carries a review date calculated from your policy, and a monthly list shows records due for review, for a person to decide on.
- Any destruction is logged with date, method and who authorised it.
Optical character recognition can make typed parts searchable, and handwriting recognition is sometimes useful, but we treat it as an aid, not a replacement for the image. The image is the record.
The clinic afterwards
Returning patients' old notes appear in their record with no trip to the loft. Records requests are answered from the screen. The clinic knows what it holds and when each record falls due for review. Paper that no longer needs keeping, once your policy allows, can be securely disposed of with a clear log. And the storeroom can finally be used for something else.
The work can also be paced to suit the clinic. A few boxes a week, scanned during quiet sessions, is a perfectly reasonable plan once the index exists, because the index is what makes retrieval quick even for records that have not been scanned yet.
Is this your back room?
- Pre-digital notes are stored in boxes, cupboards or off site.
- Nobody has a list of which patients are in which box.
- Finding old notes for a returning patient is a trip, not a click.
- You are unsure which records are due for review under your retention policy.
- Notes from a previous owner came with the clinic and have not been sorted.