​A risk manager recently wrote to ECRI Institute asking for guidance in handling patient records received from previous treating providers. In some situations, providers may seek to retain only the portion of the record that they perceive as being relevant to the patient's current concerns, and may wish to discard the remaining records, viewing them as extraneous or fearing that they will add too much to the medical record and render it difficult to follow or navigate.

In our response, ECRI Institute notes that complete and accurate medical record documentation fosters quality and continuity of care. Therefore, we recommend that the entire record remain on file. The record documents the patient's medical history regardless of the current problem list. To retain records selectively based on the perception of current problems raises the risk that information that could be useful in managing future problems could be discarded.

That said, the organization should retain records in accordance with its organizational policy regardless of the records' provenance. The risk manager or medical staff leaders should begin by directing providers' attention to a relevant policy regarding record retention—and if the organization does not have such a policy, this might prompt it to develop one.

If providers are resistant in general to participating in evaluation of the records, the organization should consider it a warning sign of deeper concerns about the workplace culture. We recommend that the risk manager and other leaders investigate the origin of such conflicts. Understanding the source of providers' frustrations can help in developing a lasting answer to their concerns. Questions to ask include the following:

• Is the practice receiving reams of nonclinical or "front office" records from other providers (i.e., billing, benefits)?
• Does the practice have a policy that clearly defines the "legal medical record" that guides decisions on what to retain?
• Does the process used to incorporate outside records into the electronic health record make it burdensome for providers to find the information they need?
• Is the issue limited to a single outside provider who seems to be sending unnecessary documents, and if so, can the problem be addressed by direct communication or clarification with that provider?

The recommendations contained in Ask ECRI do not constitute legal advice. Facilities should consult legal counsel for specific guidance and develop clinical guidance in consultation with their clinical staff.