For medical records reviews to be acceptable according to industry standards they must be conducted by an independent review organization.
Medical records reviews can be conducted for quality analysis and for the improvement of service. There is an increasing need for health care companies, insurance plans, providers, and government regulatory bodies to determine the quality levels of health care. A medical records review can help to analyze, measure and report on data sets to help improve the quality of services offered. A medical records review can be a part of a totally new quality initiative or used to determine compliance with previously set standards of care. The goal is to generate more effective results with less time and resources wasted or under-utilized. Quality improvement goes hand in hand with strategic planning for the organization.
A good medical record review starts with organized methods of data collection and uses calibrated data minim methods to get an adequate sample size to be representative of the organization's efforts. This abstract of the data from the full data set must be done in such a way so as not to introduce bias in the results. While it is possible to do a 100% record by record medical review. This is usually not necessary as long as the proper sampling techniques are used to gather a representative sample in order to make an analysis that is statistically significant. The study of the records sets is done by analysts and epidemiologists who are highly skilled in finding ways to utilize the date sources by combining date sources for example or using methods of process control to identify system anomalies. Often the medical record review uncovers situations that can be addressed for quality improvement. The methodologies can be used to train staff in new procedures for overall quality control improvement.
Millions of medical records can be managed through databases that summarize the process functions. The idea is that the analysis of database information produces summary information of high quality that can be used to design actions steps for improvement. The data is scrubbed, processed, and summarized in a meaningful way that leads to conclusions and recommendations about improvement in quality, lowering cost, increasing utilization, and patient access to services.
Independent review organizations provide the quality data and analysis necessary to give significance to the medical records review process and allow professional reliance on the results.