Except for the OSHA provisions regarding x-rays, there are no laws limiting the microfilming or storing of medical records in a reduced format. However, it is very important that photographically reduced records and any copies subsequently made from the reductions are completely legible. Ensuring the legibility of photographically reduced records is not a trivial process. It demands that the photoreduction process be carefully controlled and that the reduced records be constantly monitored to make sure that each one is legible. The most difficult problem in ensuring legible photoreduction is in controlling the color of ink used to make entries in the medical record. Photoreduction materials are able to record only certain colors of ink accurately. If the medical record is in several different colors of ink, it may be impossible to record all entries legibly. It is very important to keep exotically colored ink from the medical record. Ideally, all entries in the medical record should be made in black ink. This would make it simple to produce a photoreproduction and ensure that the subsequent copies would be legible. While it may not be possible to require that all entires be in black ink, it should be possible to require that all entires be in either black or regulate blue ink, thus excluding such colors as peacock blue. Under no circumstances should entries be made in pencil. While a penciled entry may reproduce satisfactorily, it is easily altered an produces a legally questionable record.
Once photoreductions have been made of the medical record, it is permissible to destroy the original record by shredding or burning. Special precautions are needed when storing the photoreductions. The original paper records can stand quite a bit of abuse and still maintain their legibility. This is not true of photoreductions. Humid conditions of storage can lead to the destruction of the emulsion by mildew, and even a minor scratch can eliminate major portions of a medical record. Access to the photoreductions thus should be limited to members of the medical records department. This will prevent unskilled person from damaging the reduced records in the process of trying to read them. The facility may even want to make duplicate reduced records and store them separately. Once the record has been reduced, copying the reduction is simple and inexpensive.
Original paper records should be retained for as long as is economically feasible after photoreductions are made. The original paper record is still the most effective documentation of the health care that was rendered to the patient. It is imperative that the paper record not be destroyed if litigation is in progress. If the record is microfilmed and the original destroyed, the plaintiff's counsel may be able to throw the entire record into question over the issue of whether the copying was done to cover up alterations in the original record. Conversely, a properly reduced and stored medical record is the best guarantee against both future alterations in the record and the complete disappearance of the record.
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