Outside Medical Records are essential for accurate continuity of care when patients are transferred from one healthcare system to another. Despite their importance, obtaining records in a timely manner is a notoriously difficult process. At Stanford Hospital, the medicine teams were burdened with 5 pages of paperwork per record request for a single patient. The request form contained overly complicated language and required redundant signatures on multiple pages. On average, residents estimated they spent 40 minutes to find the request form, fill it out, discuss with the patient, and fax it to the outside hospital. Residents also noted they would have to follow up on this process for a second or even third request.
Our team developed a novel electronic request form that was incorporated into a new process work flow, helping to improve the efficiency of the medicine teams.
We first surveyed medicine residents about the current process of obtaining medical records and found that, on average, records are not obtained for up to 17 hours and 30 minutes. We then developed a new, simplified request form with clear language and HIPAA compliance to streamline the process. This was next transitioned to an entirely electronic version with automated information of local hospitals to expedite the process even more. Lastly, a new work flow was taught to the medicine residents and unit clerks over the course of 2 weeks, with daily check-ins. Our post intervention results demonstrated that, on average, residents now only waited 5 hours for outside records to arrive via fax.
Although obtaining medical records is integral to transitions of care, the process is often inefficient and cumbersome. By creating a simplified request form with a streamlined process, we were able to reduce the average delay from 17.5 hours to 5.2 hours. This improvement likely translates to earlier diagnosis, earlier treatment, and reduces redundant inpatient testing. The most frequent difficulty with our intervention was unit clerk education on the new work flow. We resolved this issue with one on one training for each new unit clerk.