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MICROFILM STORAGE OF MEDICAL RECORDS IN GENERAL PRACTICE
1084
Special Articles MICROFILM STORAGE OF MEDICAL RECORDS IN GENERAL PRACTICE M.B.
CHARLES HODES Glasg., M.R.C.G.P., D.Obst.
GENERAL PRACTITIONER, BOREHAM WOOD, HERTFORDSHIRE
J. S. WILLIAMS
BERNARD
A.L.A. OF THE NATIONAL REPROGRAPHIC CENTRE FOR HATFIELD COLLEGE OF
DOCUMENTATION, TECHNOLOGY, HERTFORDSHIRE
WITH the start of the National Health Service in 1948, general practitioners were presented with a new problem of record keeping and storage. No method for the record has been introduced other than the envelope (E.c.5) and continuation sheets (E.c.7, and E.c.8). In 1968 the filing systems of general practice are bulging-thick record envelopes containing continuation cards, copies of letters to hospitals, hospital reports, discharge letters, and other correspondence. Each time a patient registers with a new general practitioner under a different executive council the movement of his medical record involves six postal transactions; and throughout the U.K. there may be five million new registrations each year, thus posing a considerable postal problem. We have carried out a small pilot study of the use of microfilm to improve storage, retrieval, and handling of medical records in a group practice. The standard microfilm format used in business is 16 mm. unperforated roll film, but this would clearly be unsuitable for patients’ records since additional material could be inserted into, or extracted from, the roll-film file only by a series of time-consuming splicing or cutting operations. We used 6 x 4 in. plastic jackets containing five channels to take strips of the 16 mm. film which together form a miniature of the complete full-sized file. Each jacket has an opaque strip along the top onto which the patient’s name can be typed. METHOD
Four operations are involved in setting up the unitised microtext file: (1) file bursting; (2) microrecording; (3) refiling; and (4) jacket filling. We used a sheet-fed microfilm recorder (see below), so the first task was to break down individual patient’s records into single sheets and to remove all clips and pins. Of two types of camera available for 16 mm. microfilm, the planetary camera, though it produces high-quality records, is slow in operation and not portable, since the column on which the camera head moves may be more than 8 ft. in height. The rotary type of camera used in the project is extremely portableit is similar in dimensions and weight to a medium-sized suitcase. Single sheets are fed into the camera over a system of rollers, and recorded on a synchronously moving film. Insertion of a sheet into the device automatically activates both the film movement and the internal illumination system. The recording speed is limited only by the operator’s ability to feed successive documents-effectively about 750 items per hour. The maximum length of document capable of being recorded in the model used is 12 in.; this allows the recording of the great majority of documents likely to be found among patients’ records, excluding only foolscap which need trimming prior to insertion. Larger documents can be photographed sideways on
the width does not exceed 12 in. The most onerous operation is the refiling of the original record. The jackets were filled on a " reader filler " device. The operator winds the film through until the enlarged image of the first document, normally the front cover of the record envelope, appears on the screen; from this identification details are written or typed on the opaque title strip of a jacket. The jacket is then placed on the platen of the machine (two holes in the jacket are mated with two pins on the platen to ensure positive location), and the film wound into the jacket. At the end of each row the operator presses a button which causes the film to be guillotined and pushed home into the channel of the jacket, at the same time the platen automatically moves on one stage to present the next row ready for filling. Each jacket could hold approximately 100 pages-the average contents of each record is only 15. We suggest that each patient has one page of written record which is filmed, together with any documents which may have accumulated, only when it is completed. A relatively wide range of simple reading devices is available at prices ranging upwards from E60. With microfiche readers the image is projected, approximately full size, on to the back of a translucent screen. Some of the more expensive models have an indicator to show the row being viewed. Some readers can operate off car electrical systems. Pocket viewers, or indeed any simple lens with a x 18 or more magnification, can be used for reference to the records.
provided
COSTS
The labour cost for 1000 records in the pilot study would work out at: on-site processing (breaking down the files, and recording and refiling them) at 3 minutes per record, and jacket filling at 1 minute per record, E33 (66 hours at 10s. per hour). Materials cost E40 consisting of six 100-ft. rolls of process-paid 16 mm. film at 30s. a roll and 1000 ’Mylar ’ jackets costing E31. The equipment cost El 380-E500 for a rotary camera, E780 for a reader filler, and E100 for the reader. In most microfilm applications the original files are destroyed. We could not do this since the conventional files had to be retained to fit in with the national system. This meant foregoing the 95% space saving usually obtainable from microfilm systems, and incurring a considerable penalty in reassembling the files after microrecording (which alone accounted for 40% of the 21/2 minutes which, on average, it took to break down, record, and refile a record). Thus, neglecting the initial outlay for equipment and allowing a reduction of 25% in labour not needed in refiling, 1000 records would cost E65. The conventional cost is for lateral filing systems approximately E20 per 1000 records, for drawer systems approximately El 6 per 1000 records. The advantages of microfilm are, of course, the small amount of storage space required (5% of conventional storage systems), and that copies of any record can be easily made. In addition, mechanised systems are available which would aid sorting and selection and so considerably reduce labour costs and time. Cameras and reader fillers could be shared on a regional basis. The handling and postal problems of medical records would also be very much less of a burden. The main disadvantage is the high capital cost of setting up such a system, but more research information is required from surveys. We thank Dr. J. H. Marks, Dr. S. E. Nathan, Dr. G. D. Ripley, Dr. H. A. Collins, the staff of the group practice, the members of national reprographic centre for documentation who took part in the study, and Bell & Howell Ltd, and the Recordak Division of Kodak Ltd. who lent us the equipment.
Special Articles MICROFILM STORAGE OF MEDICAL RECORDS IN GENERAL PRACTICE M.B.
CHARLES HODES Glasg., M.R.C.G.P., D.Obst.
GENERAL PRACTITIONER, BOREHAM WOOD, HERTFORDSHIRE
J. S. WILLIAMS
BERNARD
A.L.A. OF THE NATIONAL REPROGRAPHIC CENTRE FOR HATFIELD COLLEGE OF
DOCUMENTATION, TECHNOLOGY, HERTFORDSHIRE
WITH the start of the National Health Service in 1948, general practitioners were presented with a new problem of record keeping and storage. No method for the record has been introduced other than the envelope (E.c.5) and continuation sheets (E.c.7, and E.c.8). In 1968 the filing systems of general practice are bulging-thick record envelopes containing continuation cards, copies of letters to hospitals, hospital reports, discharge letters, and other correspondence. Each time a patient registers with a new general practitioner under a different executive council the movement of his medical record involves six postal transactions; and throughout the U.K. there may be five million new registrations each year, thus posing a considerable postal problem. We have carried out a small pilot study of the use of microfilm to improve storage, retrieval, and handling of medical records in a group practice. The standard microfilm format used in business is 16 mm. unperforated roll film, but this would clearly be unsuitable for patients’ records since additional material could be inserted into, or extracted from, the roll-film file only by a series of time-consuming splicing or cutting operations. We used 6 x 4 in. plastic jackets containing five channels to take strips of the 16 mm. film which together form a miniature of the complete full-sized file. Each jacket has an opaque strip along the top onto which the patient’s name can be typed. METHOD
Four operations are involved in setting up the unitised microtext file: (1) file bursting; (2) microrecording; (3) refiling; and (4) jacket filling. We used a sheet-fed microfilm recorder (see below), so the first task was to break down individual patient’s records into single sheets and to remove all clips and pins. Of two types of camera available for 16 mm. microfilm, the planetary camera, though it produces high-quality records, is slow in operation and not portable, since the column on which the camera head moves may be more than 8 ft. in height. The rotary type of camera used in the project is extremely portableit is similar in dimensions and weight to a medium-sized suitcase. Single sheets are fed into the camera over a system of rollers, and recorded on a synchronously moving film. Insertion of a sheet into the device automatically activates both the film movement and the internal illumination system. The recording speed is limited only by the operator’s ability to feed successive documents-effectively about 750 items per hour. The maximum length of document capable of being recorded in the model used is 12 in.; this allows the recording of the great majority of documents likely to be found among patients’ records, excluding only foolscap which need trimming prior to insertion. Larger documents can be photographed sideways on
the width does not exceed 12 in. The most onerous operation is the refiling of the original record. The jackets were filled on a " reader filler " device. The operator winds the film through until the enlarged image of the first document, normally the front cover of the record envelope, appears on the screen; from this identification details are written or typed on the opaque title strip of a jacket. The jacket is then placed on the platen of the machine (two holes in the jacket are mated with two pins on the platen to ensure positive location), and the film wound into the jacket. At the end of each row the operator presses a button which causes the film to be guillotined and pushed home into the channel of the jacket, at the same time the platen automatically moves on one stage to present the next row ready for filling. Each jacket could hold approximately 100 pages-the average contents of each record is only 15. We suggest that each patient has one page of written record which is filmed, together with any documents which may have accumulated, only when it is completed. A relatively wide range of simple reading devices is available at prices ranging upwards from E60. With microfiche readers the image is projected, approximately full size, on to the back of a translucent screen. Some of the more expensive models have an indicator to show the row being viewed. Some readers can operate off car electrical systems. Pocket viewers, or indeed any simple lens with a x 18 or more magnification, can be used for reference to the records.
provided
COSTS
The labour cost for 1000 records in the pilot study would work out at: on-site processing (breaking down the files, and recording and refiling them) at 3 minutes per record, and jacket filling at 1 minute per record, E33 (66 hours at 10s. per hour). Materials cost E40 consisting of six 100-ft. rolls of process-paid 16 mm. film at 30s. a roll and 1000 ’Mylar ’ jackets costing E31. The equipment cost El 380-E500 for a rotary camera, E780 for a reader filler, and E100 for the reader. In most microfilm applications the original files are destroyed. We could not do this since the conventional files had to be retained to fit in with the national system. This meant foregoing the 95% space saving usually obtainable from microfilm systems, and incurring a considerable penalty in reassembling the files after microrecording (which alone accounted for 40% of the 21/2 minutes which, on average, it took to break down, record, and refile a record). Thus, neglecting the initial outlay for equipment and allowing a reduction of 25% in labour not needed in refiling, 1000 records would cost E65. The conventional cost is for lateral filing systems approximately E20 per 1000 records, for drawer systems approximately El 6 per 1000 records. The advantages of microfilm are, of course, the small amount of storage space required (5% of conventional storage systems), and that copies of any record can be easily made. In addition, mechanised systems are available which would aid sorting and selection and so considerably reduce labour costs and time. Cameras and reader fillers could be shared on a regional basis. The handling and postal problems of medical records would also be very much less of a burden. The main disadvantage is the high capital cost of setting up such a system, but more research information is required from surveys. We thank Dr. J. H. Marks, Dr. S. E. Nathan, Dr. G. D. Ripley, Dr. H. A. Collins, the staff of the group practice, the members of national reprographic centre for documentation who took part in the study, and Bell & Howell Ltd, and the Recordak Division of Kodak Ltd. who lent us the equipment.