Filing Documents and the Folder Structure

I've been speaking with folks from HIM who are concerned about the filing of a variety of inpatient documents, including those of your service. To give you some background, the so-called folder hierarchy was designed, tested and retested over about 2 ½ years before it was put into the live environment a number of months ago. While it might seem confusing to some, there is an overarching logic to its build that accounts for the filing of documents of all types and from all sources. This is to say that, implicit in its design is consideration of the type of document (dictation, PowerForm, PowerNote), the author of the document (physician, nursing, social work, ancillary service), the document's associated department/division, and, most importantly, the venue of origin. This last determinant is the crucial one to keep in mind.

So, if a patient is seen in the hospital, there are a limited number of folders to place a document. In the case of a consultation, the initial document, whether dictated or done by PowerNote, must be placed in the Consult Notes folder. Those notes created on follow-up visits in the hospital are Progress Notes and so should be filed in that folder. The easiest way to think about this is to consider the design of the paper hospital chart: the initial consult note is placed under the Consultation tab and all subsequent notes are placed along with all others under the Progress Notes tab. Other hospital-based folders include Admission/History and Physical and Discharge/Transfer Notes.



Other folders designed for physician use, i.e. those that are labeled by specialty, are for the ambulatory world. So if a patient comes in to your office for a pre-operative evaluation, this note should be filed in the Medical Consultation Program folder. Were you to see that same patient for a follow-up visit, that document should also be filed into the same folder. That folder is essentially the office chart for the program/division.



Additionally, operative and procedure reports will be filed in the Operative Notes and Procedure Notes folders, respectively, and without consideration of whether the event occurred during a hospital, daystay or ambulatory encounter. Associated consult, progress and follow-up notes, though, are filed in folders as described above (Consult & Progress Notes folders for inpatients and Specialty Office Notes folder for ambulatory patients).



We are working to educate folks about the proper filing of documents, particularly in the inpatient setting. When notes get placed in specialty folders designed for the ambulatory environment, there is a great risk of those notes not being found on review by colleagues, consultants, ancillary services and administration, e.g. HIM coders.



I hope this clarifies a murky subject.