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WASHINGTON, April 25, 2000 – WASHINGTON, April 25, 2000 -- Military medical experts are facing a new kind of epidemic, one that doesn’t involve a disease but can affect patients’ health nonetheless -- missing medical records.
“We have a very different culture in the military as far as the custody and control of medical records goes,” said Army Col. Susan McMarlin, director of program analysis with the TRICARE Management Activity here. "I don’t know how it all got started, but we’ve really gotten ourselves into an extremely relaxed atmosphere as far as maintaining the records.
“It has become the rule rather than the exception in some places for patients to maintain their records,” she said. “In the civilian sector, such a situation, where a patient maintains a legal medical document, is not even comprehensible.”
McMarlin said that individuals are welcome to make copies of any documents in their medical records. The records themselves are federal property, however, and it's the servicing medical treatment facility's responsibility to maintain them. Besides the fact that’s the law, she said, there are several reasons it’s important for medical treatment facilities to maintain patients' records.
The most basic reason is that having medical records on hand helps physicians assure the quality and continuity of care they give patients, said Army Lt. Col. Michael Montgomery, TRICARE’s senior health program analyst for patient administration. An example: "If you had an accident and came into the emergency room, it might matter what medications you're taking or if you have any drug allergies,” he said.
Another reason is accreditation. “There are standards for all hospitals to be accredited,” Montgomery said. “One of those standards is keeping good records.” The General Accounting Office and DoD inspector general also review records to verify facilities’ workloads. “If we say we have a certain workload but we can’t document it through medical records, we can’t truly substantiate our patient load,” he explained.
There are also financial reasons for facilities to maintain good records. The military is required to bill third-party insurance companies for care their patients received in military medical treatment facilities. Medical records are important to substantiate those bills, Montgomery said.
It’s no secret that medical records belong to the government and members aren't supposed to hold them. The rules about returning them, however, aren't uniformly enforced across the services or even medical treatment facilities, he said.
Montgomery said DoD needs to get closer to the civilian sector’s way of doing things. “Private-sector physicians are a lot more restrictive of their records. The patient never touches the records,” he said. This isn’t true in the military, where people move often and receive care at more than one facility, Montgomery acknowledged. “But we need to get away from the attitude that it’s OK for the patient to keep the record,” he said.
McMarlin said the problem really came to prominent focus during a recent DoD IG inspection during which the facilities were given a preselected list of Social Security numbers of people who had recently received care. Some facilities were only able to come up with 25 percent of the requested records, she said.
The situation definitely has officials' attention. The assistant secretary of defense for health affairs, Dr. Sue Bailey, advised the services’ surgeons general in a January memo that she would “appreciate [their] assistance in assuring our MTFs implement improved custody and control procedures for outpatient medical records.”
Even though DoD is upgrading to a computerized patient record system that should be completed within three years, the department will still be responsible for maintaining these records. McMarlin said DoD is required to maintain active-duty members' medical records for 50 years.
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