While there may be some differentiation state to state about who ultimately “owns” a medical record, the one constant nationwide is that to remain HIPAA compliant, every physical medical record must be stored, accessed, and moved throughout its life cycle in compliance with specific privacy regulations. These rules were significantly tightened under the American Recovery and Reinvestment Act of 2009 (ARRA) and include provisions that every hospital, practice and third-party provider must be compliant with all current HIPAA regulations. (Source)
Keeping track of every record throughout its life cycle and ensuring its protection can be a formidable challenge. Plus, the government has amplified its enforcement and penalties related to protected health information (PHI) of up to $1.5 million annually per type of violation.
So, how can your healthcare IT team ensure the electronic medical records in your care are secure and compliant? Let’s take a look at Chain of Custody (COC).
What defines Custody of a Medical Document?
In general, custody refers to when a person has physical possession of a document or has visual sight of the document.
Similarly, Chain of Custody refers to how any time someone touches, looks at or stores a document, the company must keep a record of the activity. The Chain of Custody can be stored in a system that keeps track of a document’s location and who has accessed it.
It is important for your healthcare organization to have a plan to maintain accurate Chain of Custody of your electronic health records. The plan should include details about:
- Security – Who has access to each type of electronic health record (from PHI to HR data to other operational records)
- Storage & Retrieval – How the documents are accessed and stored. One long-term secure storage option is an archive, such as Harmony Healthcare IT’s HealthData Archiver®. This solution should offer the ability to audit the chain of custody. Benefits include easily seeing who has accessed the record via audit logs in the archive and ensuring the ability to migrate the COC from the source application if it exists.
- Custody Log – A process to identify each time a record is stored or received. This includes a log that notes who accessed the document, where/when it was accessed and a description of the document being accessed.
How to avoid a chain of custody failure
Step 1: Understand the Risk of EDMS Failure
If something goes wrong with your electronic document management system, the consequences can be severe—ranging from lost records to large‑scale security breaches. Beyond reputational damage, breaches are extremely costly. Recent incidents at major healthcare organizations like Community Health Systems and Anthem exceeded $100 million in total impact, including remediation, legal exposure, and compliance mandates. Breached entities also face class‑action lawsuits and multi‑year compliance oversight. Most critically, patient trust—the foundation of provider and payer relationships—can be permanently damaged.
Step 2: Eliminate Legacy Data Sprawl
A common challenge healthcare organizations face is storing legacy data across too many locations. While many organizations work toward a single go‑forward EHR or ERP, they often overlook the importance of a single, unified archive. When records live in dozens of disconnected systems, complexity increases instead of decreasing.
It’s not uncommon for healthcare organizations to maintain 30 or more legacy systems simultaneously—each one increasing operational burden and security risk.
Step 3: Centralize Archival Data
Preserving historical medical and employee records in one secure archive simplifies:
- Record access
- Requests for information
- Reporting and audit readiness
Reducing the number of places data exists directly lowers exposure and improves governance.
Step 4: Partner with Trusted Experts
Decommissioning legacy systems requires careful planning, prioritization, and execution. Trusted industry experts can help you:
- Identify risk across systems
- Safely sequence decommissioning
- Ensure regulatory compliance
- Maintain access to historical records
This isn’t just a technical exercise—it’s a risk‑management initiative.
Step 5: Don’t Go It Alone
Time and resources are limited, and compliance requirements continue to evolve. With the volume of EHRs, applications, and regulations under your responsibility, working with a record retention and data lifecycle expert helps ensure your organization has a sustainable, compliant strategy for long‑term storage and retrieval.
Bottom line: Keep the Chain of Custody secure.
For more information about tracking chain of custody for your historical medical records, contact Harmony Healthcare IT, the makers of HealthData Archiver®.
Editor’s Note: This blog contains content from an earlier blog posted on May 17th, 2016.
