Records Management Journal

Filing systems
HEATHER WALKER

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HEATHER WALKER, (1996),"Filing systems", Records Management Journal, Vol. 6 Iss 1 pp. 51 - 58
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Study Guide

Filing systems
HEATHER WALKER
ABSTRACT
This study guide should start with an explanation of what I mean by filing systems. Whether one is referring to the filing of records on a shelf or the filing
order of papers within a record, both are filing systems and both are organised
differently. To cover filing systems in a comprehensive way, therefore, we not
only have to discuss both of these systems but also the numbering and organisation of records or papers that allow them to be filed and retrieved.
Drawing on examples from the health service, this study guide will cover
the following topics:

numbering systems
filing within a record
methods of filing

filing of a record within a filing system

tracing records within the filing system

It is important to emphasise the importance of a well organised and maintained filing systems without which many businesses and organisations
could not function efficiently.

Records Management Journal, vol. 6, no. 1, April 1996, pp. 51-58

Records Management

Journal

vol. 6 no. 1

1. NUMBERING SYSTEMS
Within the health service there are at least four different numbering systems with several variations on these. The number is issued as a unique
identifier to all patients attending a hospital. This number is kept on both
the computer and the manual record. The different types of systems used
include:

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a.

alphabetical
straight numerical
date of birth
numerical with year or alpha prefix

Alphabetical

This is the most commonly used system and most readily understood. It
is still used in the health service in small departments particularly Accident and Emergency and Maternity as it easily understood and easy to
maintain for a small number of records. It may also be important to allow
easy access to non-records staff out of office hours and an alphabetic
system requires the retriever to know only the patient's name.
b.

Straight Numerical

This system starts with the issue of a unique number, usually number 1,
for each patient registered and is used up to the issue of 999 999. After
six digits the number becomes difficult to remember when filing. This type
of system relies on an index to enable retrieval of records and is usually
used for the main hospital filing system.
c.

Date of Birth

This numbering system uses the patient's date of birth as the six digit
number with alpha characters from the surname used to differentiate
records within the same date of birth. This method can be used either in
a simple sequential or a terminal digit filing system (see section 4).
d.

Numerical With Prefix

This system is similar to straight numerical but with a prefix added either
when the number would become larger than six digits or to indicate the
date of the registration year. This system allows the records to be sorted
by year of registration, so the number of new records added to the system
can be monitored. For records that are no longer current, the year of registration can be used to identify those records that can be destroyed or
microfilmed once the agreed retention period is passed.

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Filing systems

2. FILING WITHIN A RECORD

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The medical record contains a large variety of papers that may or may
not be standard documents and vary considerably between hospitals. An
attempt to standardise these documents in the health service was made by
the Tunbridge Committee1 in 1961 which recommended:

the classification of records according to their likely period of relevance.

retention periods for documents.

the use of international paper sizes.

the unit system of record-keeping - one patient one record.

the use of shelves for filing as an alternative to cabinets.

the formation of a permanent body to act as a point of
reference for changes in medical record-keeping.
the use of standard forms.
guidance on paper quality.

The report from this committee was finally published in 1965 as The
Standardisation of Hospital Medical Records2. Some of its recommendations were introduced, although no permanent body was ever formed. The
next influential report on medical records keeping did not come until 30
years later when the Audit Commission chose medical records as a subject for one of its national studies. The recommendations of the
report3 regarding record-keeping were as follows:

a single main filing area or library

improved content within a single set of notes

culling of contents
a clear medical record architecture
colour coding of records

a closed filing area or library

The record used in the health service is an A4 manila folder for hospitals
or trusts and an A5 (Lloyd George) envelope for GP records.
3. METHODS OF FILING DOCUMENTS WITHIN A FILE OR
RECORD
There are two main methods of filing documents within a file or medical
record:

loose filing of papers in a pocket or cover

fixed papers with a clip or a tag

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Journal

vol. 6 no. 1

Within these two methods there are a variety of ways in which the documents or papers can be organised:

chronological

by medical/surgical speciality
by type of document

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Many health records are organised into sections to allow similar documents
to be kept together. The four main sections are:

identification and administration section

clinical notes

investigation and test results

correspondence

Other types of documents are filed within the record although their place
may not be clear. An alternative system would be to use coloured dividers to create many more sections and allow the classification to become
much wider.
4. FILING O F RECORDS
There are several ways to file records. Some of the more common ones
used to file medical records are:

a.

simple sequential
terminal digit

alphabetical
mixed sequential/terminal digit

Simple

Sequential

Records are filed in ascending numerical order with the growth of the file
at one end of the system. This system is suitable for straight numerical
numbering, numerical with a prefix, and date of birth systems.
The disadvantages of this system are that the growth of records is at one
end of the system which means that records have to be culled and moved
back every year. It also means that all new records are at one end of the
system which, in a medical records filing system, may cause congestion
as the activity in a medical records filing system is generally with new
records as these belong to new patients.
b.

Terminal Digit

The filing area is divided into 100 equal sections or filing bays/shelves
numbered from 00 to 99. The last two digits of a record number are the
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Filing systems

terminal digits and indicate into which section the record should be filed
so, for example, record number 123456 would file in bay/shelf 56. Within
each of these sections the remaining digits, 1234 in this example, are used
for filing sequentially. In very large systems the shelves or bays may be
further subdivided into another 100 sections or into 10 sections and the
middle digits filed accordingly.

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The advantages of this method are that it allows for filing equally within
the system, with new records spread throughout the area. So, 100 new
records issued consecutively would each have a different terminal digit
and would therefore be filed within a different filing bay.
This method is suitable for straight numerical and date of birth numbering systems; it is particularly useful for large filing systems in hospitals
as new records are spread throughout the system and access is easier to
maintain.
Terminal digit filing is not, however, suitable for use with mobile shelving as simultaneous access to shelves in different rows would be very
difficult.
c.

Alphabetical

Alphabetical filing is the most commonly used system and most readily
understood. It is still used in small departments in the health service,
particularly Accident and Emergency and Maternity. Rules have to be clear
as different spellings of names and hyphenated names can lead to filing
difficulties.
The advantage of this method is that only the patient's name is needed to
access the system although this may be, therefore, unsuitable for highly
confidential records e.g. genito-urinary medicine clinics.
d.

Mixed Sequential/Terminal Digit

This system usually results from two filing areas being available, one
known as secondary storage. Records are filed in a terminal digit order
within the main system but, when culled to the secondary storage, are filed
in sequential order usually due to the more limited space or the use of
mobile shelving.
Within all of these systems the use of colour coding may assist in the filing
of records. A colour is allocated to each number from 0 - 9 using coloured tape. The different coloured tape is then used to represent the terminal digit or year of registration and attached to the spine or edge of the
record. This means that all the records with the same terminal digit will
have the same coloured tape on the cover making it easier to file and to
identify misfiles.
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vol. 6 no. 1

5. TRACING OF RECORDS
Within any filing system there needs to be some method of retrieving the
records. In the health service this would be known as a Master Patient
Index and is now usually held on a computer. Likewise, the records
removed from a file have to be traceable. This can also be done by computer, using a tracking system, or alternatively using a manual system
relying on tracer cards. There are four types of tracing systems:

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a.

personal tracers
common/temporary tracers
library tickets
bar coding/medical record tracking

Personal Tracers

Created with the record a personal tracer contains the unique identification number and the patients name. The movement of the record is added
to the tracer card and this is retained within the filing system when the
record is removed. Once the record is returned to the file the tracer is
replaced within the record. This type of tracer contains the history of a
record's movements.
b.

Common or Temporary Tracer

This tracer is used only when the record is removed from the filing system. Details of the record's destination are added to the tracer and once
the record is returned to the file, the tracer card is removed and the entry
deleted.
c.

Library Ticket

The record contains a small card containing the record number and name
of the patient. When the record is removed from the file the details of the
borrower are added to the card and the card is filed in an alphabetical
index. The difficulty with this type of tracer is that as there is no record
within the filing system itself and two places have to be searched by
anyone wishing to borrow the record. Once the record is returned the card
is reinserted in the front of the record.
d.

Bar Coding/ Record Tracking

The unique record number can be bar-coded and this can be scanned when
the record is removed from the filing system and the details of the transaction recorded on the computer system. The advantage of this method
of tracing is that a list can be produced from the computer system giving
information on the location of records and, therefore, preventing
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Filing systems

unnecessary searching in the filing system for a record that has already
been removed. A study of this system at a large teaching hospital proved
that enough clerical staff time could be saved to pay for the introduction
the bar coding system.
6. CONCLUSION

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This study guide has described the essential elements of records filing
systems with reference to currently used manual filing systems within the
health service. The future of filing systems within the health service though
may be very different with the introduction of patient-held records,
including smart cards, document image processing and the electronic
patient record.
Patient held records have already been tried for small groups of patients
such as diabetic and obstetric patients. This allows patients to carry a small
amount of medical information with them, although a duplicate of this
record will be maintained at the hospital or clinic.
Document image processing involves archiving paper records onto optical disks and can, with the use of word processing facilities in clinics and
wards linked to the central record database, create a paper free environment. However, before hospitals move to the paperless office the manual
systems have to be well organised and efficient as the electronic record
will not solve efficiency and organisation problems. The hospital record
may in the future be transformed into a computerised record but before
this can happen the difficulties with legality and cost of this type of system have to be overcome. It is unlikely this will happen within the next
ten years so we should continue to maintain and improve the present
systems because without them the hospital, as indeed any other business,
could not function.
References
1.

Great Britain. Ministry of Health Central Health Services Council.

Standing Medical Advisory Committee. The standardisation of
hospital medical records: report of the sub-committee. Chairman Professor RE Tunbridge. HMSO, 1965. p. 36-37.

2.

Ibid.

3.

Great Britain. Audit Commission. Setting the records straight: a study

of hospital medical records. HMSO, 1995

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vol. 6 no. 1

Bibliography
1.

Technicians Handbook. IHRIM, 1995.

2.

Great Britain. Ministry of Health Central Health Services Council.

Standing Medical Advisory Committee. The standardisation of
hospital medical records: report of the sub-committee. Chairman Professor RE Tunbridge. HMSO, 1965.

3.

Great Britain. Audit Commission. Setting the records straight: a study

of hospital medical records. HMSO, 1995.

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Author
Heather Walker is a Senior Consultant with CHKS Ltd, providers of a national
comparative database service of health service information. She originally joined
the health service as a management trainee and worked for seven years in medical records management posts in the north west of England. She then moved to
the Health Services Management Unit, Centre for Health Informatics at the University of Manchester where she was Fellow in Health Records and in 1994 joined
CHKS Ltd.
Heather Walker, 29 Hatchery Close, Appleton Thorn, Warrington, Cheshire. WA4
4TF.

58