Virtual Site Visit Best Practices: Chart And Document Sharing

This post provides best practices for sharing the required patient charts and trauma center documents. This article will describe the sharing services that are available and the pros and cons of each one.

Sharing Services

In the old days, the trauma program manager was (usually) tasked with putting together all of the program documents required by your verification or designation authority. And it took a considerable amount of time to do this, approaching a month in many cases. In the COVID era, things are a bit different. Yes, you still have to assemble every bit of documentation that you did before. Instead of putting it all in a dozen or more three-ring binders, you will now need to upload it to some type of file sharing service.

As you may suspect, there are quite a few services available for this. All are so-called “cloud” services, meaning that the files are stored on a secure server located somewhere else. Most services have a network of cloud servers located around the world. Some allow your hospital or hospital system to host those files on-site for added security.

The truth is, all commercial file sharing services are extremely secure. They offer encrypted transmission of the files to their servers. And once there, the files remain encrypted. This means that some nosy employee is not able to look at your data. Only users that have been given login credentials for the account can see anything.

Unfortunately, hospital information technology (IT) and corporate compliance (CC) teams have their own ideas about what is secure. Thus, there is a great degree of variability in what various hospitals find as an acceptable service. You will need to meet with your hospital’s IT and CC teams to find out what service(s) they approve of, and to ensure that people outside the hospital (your reviewers) can be granted access to it. I highly recommend that you schedule these meetings at least six months in advance of your site visit to ensure that their choices will support your site visit. The reality is that, since most hospitals are now undergoing virtual Joint Commission visits, they probably have already worked through most of these details.

Now, let’s dig in to the various cloud storage and file sharing services.

Commercial / Personal Services

There are a number of well-known cloud file sharing services:

  • DropBox
  • Box
  • Microsoft OneDrive
  • Google Drive
  • iCloud Drive

Most of these services were initially created for public users. Security and ease of use were excellent. But with businesses clamoring for the same service with added security, all of them have implemented business versions. The good news is that they are operating system agnostic. By this I mean that every one of them can be used on either a Mac or a Windows system.

All of the listed services provide access to a main file directory. You are free to fill it up with files and subfolders to your heart’s content, until you run out of the amount of file space you paid for. Hopefully your hospital has a license for plenty of space. All services can all be accessed by signing in to the provider’s website. Some of them (DropBox, Box, OneDrive) can also be installed on your computer if corporate security policies allow. This saves you the extra step of accessing your files via the website. You can work directly with your files as if they were in directories and subdirectories on your own computer.

Pros: These services are easy to use and many of you are already familiar with them. If it is permissible to install on your own computer, it is very easy to access your files.

Cons: Many hospital IT departments do not allow unfettered access to these services, and some prohibit them entirely.

  • Citrix ShareFile
  • Microsoft SharePoint

These two services are more robust and provide extra layers of security. However, they can only be accessed via a website. Microsoft SharePoint can be run on your organization’s servers, so you can sign in on the hospital intranet. They do not interact with your computer’s file system. This is a security feature, not a flaw.

Pros: These are very robust and secure storage and sharing systems.

Cons: Every file needs to be uploaded via the site’s web interface. This can take some time, especially for large files like patient records.

Really bad: ShareFile and SharePoint have their own pdf file viewers. Unfortunately, they are not very full-featured and cannot understand the concept of bookmarks. As you will see in the next installment, this feature is very important to the reviewers. It allows them to move up and down patient charts and other documents with ease. For this reason, your administrator will need to enable downloads for the site. The reviewers must be able to download the files to their computers and open them with a better pdf viewer.

  • Microsoft Teams

What, you say? Isn’t Teams just a teleconferencing tool? Yes it is. But when your administrator creates a new Teams channel, a SharePoint site and a OneNote notebook can be automatically added. This provides your cloud storage and sharing, as well as a way to organize all of your charts and docs without any other applications!

Pros: It’s one-stop shopping! It has everything you need for organizing everything and giving your reviewers access.

Cons: If your hospital doesn’t use teams you are out of luck. And if they do, but don’t have a license for OneNote, you’ll have to resort to good old PDF files. Important note: OneNote cannot be used on Mac computers. Check with your reviewers to make sure they can use this software if you are planning to organize your records with it.

Physical File Sharing

The alternative to cloud file sharing is the good old USB flash drive. These are dirt cheap, even when they are hundreds of gigabytes in size. Many are available with high quality encryption so they can’t be accessed if stolen. But there are several downsides. First, when they are being loaded by your trauma program, only one person can access the device at a time. If it’s plugged into your computer, you can store data on it but no one else can. With the cloud services, multiple people can be uploading to different directories at the same time.

Next, they must be physically shipped to each of your reviewers. This takes (wastes) a few days that they could use to review your documents. And finally, as of May 2020, the American College of Surgeons discourages their use for security reasons.

Pros: None.

Cons: Just don’t use them, please.

The Bottom Line

In my opinion, any of the file storage and sharing services will work fine. Just make sure that the reviewers can have file download privileges if you will be using PDF documents.

I believe the most convenient system is a Microsoft Teams channel using the included secure storage and OneNote notebook. This is truly one-stop shopping. If your organization is using Teams, it has already been vetted for security by your IT department. All of the tools are built-in, and you can move documents (relatively) effortlessly to OneNote.

Meet with your hospital IT and CC departments several months in advance of your site visit to inform them of your needs. They will help you figure out how to meet those needs using their existing software licenses and installed software and hardware. The sharing service needs to be accessible to users inside the hospital, as well as those on the outside (your reviewers).

And as with the hospital walkthrough preparations, testing is extremely important. Once your sharing service is set up, log on and learn how to upload files. And of course, always check with your verifying or designating agency to see if they have provided any additional instructions or guidelines for chart preparation and storage. Their preferences will always supersede these.

Then read the next article in this series that shows you how to set up your file system organization.

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