Case Study: Great Bay Oral Surgery


A few years ago a federal mandate forced medical facilities to digitize all patient records. This allowed for easier access to medical information and less reliance on paper files. The Dental industry was not immediately affected by this mandate and so there was more time to plan for conversion as well as to let more physical files accumulate in spaces that were susceptible to damage and destruction in storage facilities or more often basements and attics. While the mandate still lingers as a possible requirement, waiting for the mandate can lead to trouble.


This was the case for a New Hampshire based oral surgery office. They are a thriving practice with two sites that had serviced thousands of patients over decades of practice. Over the years they had accumulated their patient records in a basement that was recently starting to leak. This meant that decades of records would be vulnerable to possible damage, mold and/or mildew. Not to mention the filing system over the years had become a bit hard to manage due to multiple record keeping techniques employed at different times of the practice’s history. Not all the files were necessary to keep; only a few people knew how to navigate through the filing system in the basement, and key office personnel were ready to retire. Things were coming to a critical head and action needed to be taken.


The office manager contacted Recordsforce in hopes of finding a solution to their complex and suddenly urgent records management situation. After visiting their offices, inspecting the record system in their basement and having conversations with the office manager and practice manager, Recordsforce created a set of recommendations and a proposal to solve their problems. Within a couple weeks of realizing they had a problem that needed solving, heir prayers were answered. Recordsforce had a comprehensive and customized solution that addressed all of their needs. 


Prior to any work being done Recordsforce offered consultative services to the office team to help build the most convenient and legally soluble solution to their problems. Since Recordsforce is well versed in the laws pertaining to dental and medical records the company was able to provide an accurate and detailed plan on how to identify which records needed to be retained, which could be purged and what would benefit most from being digitized. 


Before removing the records from the customer site RF first worked with office personnel to organize files by type and age. The next step was to carefully pack and remove all records from the leaking basement and move the files to Recordsforce’s secure production and storage facility. While in process, the customer could at any point request files being scanned and delivered digitally on demand, or, since they worked in the area, could come to our facility and have access to their records directly. 


Once the patient files were secured onsite they were then inventoried, sorted and some files were able to immediately be purged. The files were sorted into the following categories:


  1. Keep permanently- In the oral surgery world, unlike traditional dentistry, oral surgeons performs implant surgery. Implants fall under the FDA’s requirements for document retention, which puts an additional burden on oral surgery centers when considering their records retention management strategies. Patients that have received implants have to have their patient records kept for the life of the patient plus 9 years, since the lifespan of a dental implant could be the life of the patient. For oral surgeons who have spent a career in the industry, this can add up to a lot of records that have to kept and managed virtually forever.
  2. Sort by destruction date - If the patient did not receive an implant, there is still a lot of complexity in record retention and file destruction management. NH law states that all records must be kept for 7 years after the last date of service and for children 7 years after the child has reached 18. This means that records can’t simply be sorted by the date of service, there also needs to be consideration of the patient’s age at the date of service.
  3. Immediately shred - These were any files that met the criteria of inactive files without implants were either the adult patient had not been seen in 7 years or the child patient had reached the age of maturation plus 7 years.

    Next, the remaining records were sorted by destruction year in alphabetical order. Finally, all files that were designated as ‘keep indefinitely’ were indexed at the patient level by the box. Recordsforce then met with the customer to discuss options. They could scan the remaining files and keep them digitally in their practice management system, they could have them returned to the leaky basement for storage or they could continue to store them with Recordsforce and request files as needed to be digitized and delivered securely to the practice. The oral surgery office opted for the ‘scan on demand’ option, allowing them to be free of the need to store the files themselves without losing the ability to gain access to files quickly and conveniently.

    Since the files are indexed and recorded in a database by patient name, date of birth and box, the customer is able to request files through Recordsforce’s unique to the industry customer portal within their PACE management software. Once the request is received by Recordsforce’s production team they are able to utilize the database to locate the box that the customer file is in. Because of RF’s warehouse organization feature within PACE they can search for the exact location of the box which contains the needed files quickly. Once the file contents are scanned they are securely delivered to the customer with ease via the same HIPAA compliant secure portal the customer used to make the request.. 


The purge process resulted in an immediate 47% reduction in unnecessary file storage. Before we move on, consider this statement. Nearly half of the records that GBOS was storing were past their destruction date. What did this mean for the practice? First, it means they were exerting energy, using office storage space, building filing shelves and buying filing cabinets, managing the entire collection of charts, all for files that were no longer required to be kept. That’s a lot of expense and effort for no valid business reason. 


While saving money and reducing efforts are great reasons to stay on top of your records management program, There’s a second more insidious issue. The practice was voluntarily keeping itself open to lawsuit and was storing evidence that could only harm the practice. In the U.S. judicial system, you are innocent until proven guilty.  What this means is, even though the practice could have destroyed files sooner, thus eliminating the threat of self incrimination through evidence stored in a dental chart, by keeping them, they would have been compelled in court to provide those records in the case of someone suing them for malpractice. They were weaving the noose by which they could have been hung. Fortunately for our customer, that never happened. Recordsforce eliminated the threat through their solution.