By Ankur Malik, Chief Executive Officer, Excel Solutions, Inc.
LinkedIn: Ankur Malik
LinkedIn: Excel Solutions, Inc.
On paper, medical record indexing sounds simple. A clinical document comes in. Someone identifies the patient, figures out what kind of document it is, and sends it to the right place in the chart. The rules can be written down. The team can be trained. The work should be repeatable. And for straightforward documents, it usually is.
The problem is that health systems are built out of departments, exceptions, provider preferences, old workflows, new workflows, and rules that have changed over time. The document may tell you the patient and the document type. It may not tell you which department specific rule determines where it should go next.
Rules Vary from Department to Department
Inside one organization, the same type of document may be handled several different ways. One department may send it to the ordering provider. Another may route it to a clinical review pool. A third may send it to an administrative pool. The document can look exactly the same in all three cases. The difference is not always on the page. It lives in the department’s workflow.
That is why the rulebook matters, but so does the process for keeping it current. If department level exceptions are not updated, the written rules slowly drift away from the work people are actually doing.
Rules Also Drift over Time
Even clear rules do not stay fixed forever. Departments reorganize. Service lines open. Providers leave. A go live process may still be written down long after the real workflow has changed. Often, those changes are communicated to the people working with the department every day: a call, an email, a note on a document. It’s not always captured in a revised master document.
That is how a vendor can perform well early in the relationship and begin to slip later. The issue may be that the vendor’s process was built around the original rulebook, while the health system kept moving.
The Staffing Model Matters
This is where staffing starts to matter. Some knowledge can be written down. But a meaningful share of medical record indexing is learned through repeated exposure: which departments use which queues, which exceptions come up often, and which documents need a second look. A stable team has more chances to build that familiarity. Over time, they are more likely to notice patterns that are specific to the account, not just the document type. A rotating staffing model can still work, but only if the vendor can capture and transfer account specific knowledge. Without that, the same questions get relearned by different people.
That is one reason two medical record indexing vendors with similar tools, training, and quality programs can produce different results. The difference is how well the operating model preserves what the team learns.
Mistakes Are Often Quiet
A misrouted document usually does not disappear. It is filed somewhere. It may even be searchable. The problem is that it is not where the next person expects to find it. That mistake may not surface until a provider needs the document, a procedure is being prepared, or an audit uncovers a pattern. By then, the fix may be more disruptive than getting the indexing right the first time.
What to Ask a Vendor
Most medical records indexing vendors will say they can provide a dedicated team. That answer, by itself, does not tell you much.
- Will the same people be working on our documents next quarter?
- What is your turnover rate on dedicated accounts?
- When one of our departments changes a routing rule, how is your team updated?
- How long does it take for a rule change to take effect?
- Are the people doing the work your employees or project based contractors?
- How do you document account specific rules and exceptions?
- What happens to that knowledge when someone leaves?
- What does your team do when a document does not match any rule we have provided?
That last question is the one I would listen to most closely. The real test is what happens when something does not fit neatly into the rules.
Be Careful with Accuracy Rates
Accuracy numbers are useful, but they need context. One vendor may count a document as accurate if it is matched to the right patient. Another may require the right patient, encounter, document type, and routing destination. Both may report the same accuracy rate while measuring very different things. Before comparing accuracy numbers, ask exactly what the number includes.
The Point
Medical record indexing is rules based, but the rules are not static. They vary by department, change over time, and often live partly in institutional memory.
When you choose an indexing vendor, you are not just buying a process. You are buying the vendor’s ability to understand your documents, your departments, and your rules, including the ones that have changed since the rulebook was first written.