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Data retention defines the policies of persistent data and records management for meeting legal and business data archival requirements. Although sometimes interchangeable, it is not to be confused with the Data Protection Act 1998 .
The patient health record is the primary legal record documenting the health care services provided to a person in any aspect of the health care system. The term includes routine clinical or office records, records of care in any health related setting, preventive care, lifestyle evaluation, research protocols and various clinical databases.
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Many systems, especially for electronic records, require documents to be formally declared as a record so they can be managed. Once declared, a record cannot be changed and can only be disposed of within the rules of the system. Records may be covered by access controls to regulate who can access them and under what circumstances. Physical ...
Handwritten paper medical records may be poorly legible, which can contribute to medical errors. [14] Pre-printed forms, standardization of abbreviations and standards for penmanship were encouraged to improve the reliability of paper medical records. An example of possible medical errors is the administration of medication.
XDS uses structured EHR standards such as Continuity of Care Record (CCR) and Clinical Data Architecture (CDA) to facilitate data exchange. [2] The registry stores metadata about each document stored in a repository, including its source or location. [3] There may be multiple repositories of documents indexed, [4] but only one registry per ...
Federal and state governments, insurance companies and other large medical institutions are heavily promoting the adoption of electronic health records.The US Congress included a formula of both incentives (up to $44,000 per physician under Medicare, or up to $65,000 over six years under Medicaid) and penalties (i.e. decreased Medicare and Medicaid reimbursements to doctors who fail to use ...
A retention schedule is a listing of organizational information types, or series of information in a manner which facilitates the understanding and application of the identified and approved retention period, and other information retention aspects.