Implementing the Unique and Claim Clinical File in the Insure System in Mexico, can Decrease Medical Demands or Lawsuits

Aim: In the last decade in Mexico we have had an increase in medical demands in all health
subsystems, we have studied twelve years (2004-2016) about the alarming increase in demands in
the Mexican Institute of Health, due to the disorganization in the clinical records, the absence of an
interconnected electronic record, in addition to the lack of an original record of the claims in the
insurer that carries the institution's liability policy, not forgetting the non-compliance with NOM 168,
NOM 004 and NOM-024 of the clinical record.
Objective: Reduce accidents at the institute for medical negligence claims, avoid duplication of fees
the insurance reserves expressed in cost to the health system in Mexico with the presence of a single
clinical record.
Materials and Method: In the observational, descriptive, cross-sectional and retrospective study
carried out on a Mexican Institute of Social Security (MISS) claims, the Integrated Clinical Record and
Quality Model (MECIC) established in 2013 was applied, which showed that no reports could be
established due to the absence of the record. Original or copy. The instrument created ECUS was
applied to the files with a claim through which it was evaluated with 0 if it did not meet the stipulated
requirements, 1 if it had content in each of the contexts and NA or Not Applicable when the terms did
not refer to the service correspondent. This reported duplicate cases, patients in open and closed
reserves at the same time and lack of integration of the record with lack of compliance with NOM 004.
Results: 172 files with demands on patients of different ages registered by the insure from 2004 to
October 2016 corresponding to the Medical Professional Civil Liability policy were analyzed; in order
to project the causes of the demands, the services involved and make recommendations for the
reduction of these.
Conclusion: The single clinical claim file (ECUS), as part of the universal health record for Mexico,
when implemented, will allow physical, digital or claims medical records to be automatically evaluated,
issuing reports, an effective suggestion to the institution, avoiding harm to patients, in addition to
reducing expenses in the health system due to repeated cases or fraud in the insurance system.