Rural vs. City Medical Record Perspective

While at the ACP conference in San Diego (yes, it’s fun for a tech person to attend a medical conference), I had a really interesting conversation with a medical records lady from Cardone EHR Solutions. In our discussion she highlighted an interesting difference between the rural and city perspectives on a medical record.

In essence…

Rural clinics want to keep the medical record forever. City clinics want to get rid of as soon as possible.

When she said this idea, it really rang true to me. Of course, the real issue has to do with liability. The real issue is how litigious our society has become and I think it’s fair to say that those in the urban environment are more litigious than those in the rural setting. That’s why clinics in a city generally want to dispose of the record as soon as is legally possible. They don’t want to be held liable for a record that’s 20 years old. However, the rural community would be aghast at the idea that a clinic wouldn’t keep their clinical record forever. Of course, it’s quite likely that many of those in the rural community will be going to that doctor or hospital for their entire life.

I’ll admit that I’m far from an expert on the differences in these environments, but I found this perspective quite interesting. Has some interesting impacts as clinics and EHR vendors start to discuss the idea of records retention in a digital world.

Another side benefit to talking with Cardone EHR Solutions at ACP was that I got a chance to meet Dr. J. I guess it’s fitting to have Dr. J at a conference for doctors.

About the author

John Lynn

John Lynn

John Lynn is the Founder of, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • dhenderson,
    I’m not sure that the above discussion changes who owns the record. It’s more of a question of how long the provider should be required to maintain the record for the patient. The patient can still request their record at any time and maintain their record however they please.

  • When I was in training as a fellow and later a junior faculty at Hopkins, we had an electronic record that went back to the early 1990s. That’s one of my favorite things about an EHR. You literally can keep it all forever without taking up any physical space. And now with cloud storage, it’s all the better.

  • I think most academic medical centers also want to keep the records (and everything) forever. In my experience the possibility of research trumps any concern about possible liability.

  • Rural EHR requirements absolutely require a “special” kind of EHR. Bandwidth in “underserved” rural areas makes cloud based SAAS solutions slow or un-usable. Technical services and training requirements demand very simple and extremely stable and robust systems capable of functioning in isolation. Storing Medical Records “forever” means that documents and images must be stored in an open and permanently available electronic format such as .TXT, .ADB, .DCM, .DOC, .XML and .XLS and not databases because when inevitable changers to the database Vendor, Schema, Security, Versions, Upgrades change you have two choices, dump and re-load into the new Database or experience an unacceptable situation where you have an unsupported or unavailable database but you just can’t access its content any longer. Size is a HUGE concern; imagine how large and unmanageable a database would grow in the “forever” time frame…

  • John,

    If PHR/EHR is on a voluntary, that is OPT-IN, basis; and its the patient/individuals’ sole discretion to decide what info will s/he enters so it be included in their record;
    then you could overcome two major obstacles;
    Plus you actually empower the patient/individual, as s/he needs to make those decisions concerning his/her own health and how it may be handled in case of a need.
    To my humble opinion that was a basic true in the past, is in the present and may well be also in the future.

  • With the federal incentive coming around the corner, are implementation of EMR systems not enticing to rural facilities?

  • As an Internist and MD IT liason in our smallish rural hospital, I am very involved in the selection of our EMR. Have you made comments / had thoughts re the difference in empire systems between different size facilities? For ~100 bed centres the number of systems available and the issues re IT support are a major issue.

  • Robert,
    I’ve been writing more and more about those subjects (mostly on ) and will try to do so more in the future. The high end market is well served. I see a real battle from EHR vendors trying to serve the small rural hospital. It sounds like you’re talking about a hospital in the middle of those two extremes which is what makes it most difficult I imagine. You have many of the capability and support issues that a rural hospital has, but withe some of the needs and demands of the large hospital. Is this a fair assessment of where your hospital is at?

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