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3
Record Keeping
"Information, not data, is critical to the survival of a health care organization."
Diedling and Welfeld (1995)
Information management is fast becoming the key to effective action in animal care. As wildlife habitat for
many threatened and endangered species continues to shrink, a greater responsibility is placed on zoos to function in
part as the last refuges for more rather than fewer species (Teare, 1998). Long-term survival of small populations of
captive wildlife requires intense management that encompasses information derived from numerous scientific
disciplines, including genetics, nutrition, ethology, and veterinary medicine (Teare, 1998). When faced with
questions regarding the care and management of wildlife species, literature surveys and reviews of individual
medical records are labor intensive and time consuming. Thus, the more information that can be accurately collected
and maintained and later effectively retrieved and used, the more successful captive animal management will
become (Earnhardt et al., 1995). As with any facility responsible for the care of its residents, modern zoos require
effective systems for gathering relevant information from the field, processing it in ways that provide maximum
value, and presenting it in a form that is easy for staff to use in implementing appropriate actions to achieve effective
animal management and disease control programs (Morris, 1991). Responsibilities of the chief information officer
and managers of those systems are equally important in ensuring effectiveness (Greer, 1998).
Several published reviews describe objectives for information management systems and criteria for
information-gathering activities in animal health that should be met to ensure effectiveness (Morris, 1991; Harris,
1991). Information management systems are the functional coordination of data (records) from input (the data that
goes into the system) through processing (what is done with the data) to output (the information that is produced).
Ten characteristics are important in any information management system (R. Whitehouse, Associate Hospitals
Administrator and Director, Medical Information Services-University of Michigan Hospital and Health Centers,
"Clinical Information Systems" presentation to committee, October 2, 2003):
1. Accessibility,
2. Accuracy,
3. Appropriateness,
4. Comprehensibility,
5. Comprehensiveness,
6. Consistency,
7. Relevance,
8. Reliability,
9. Timeliness
10. Usefulness
These characteristics apply to systems ranging from simple (paper record) to complex (decision support
software) (see Figure 3-1). Two critical aspects of paper systems are tracking and accessibility of the records.
47
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48 ANIMAL CARE AND MANAGEMENT AT THE NATIONAL ZOO: INTERIM REPORT
Records should provide an accurate account of situations and practices relating directly to animal management and
health. They should permit reconstruction of events in the recent and distant past and provide a rational basis for
decision making.
Decision support resources applied
Provides for multimedia information management
Data is digitized, permitting review of data elements
across cases
Prompts for information
Interactive capture of information and work flow processes
All information entered into a data repository
from which one can select information
Paper record available from computer
Basic paper record
FIGURE 3-1 Range of complexity in information management systems (R. Whitehouse, Associate Hospitals Administrator and
Director, Medical Information Services-University of Michigan Hospital and Health Centers, "Clinical Information Systems"
presentation to committee, October 2, 2003).
ELECTRONIC DATA MANAGEMENT IN ZOOLOGICAL INSTITUTIONS
Many software programs used for zoo and aquarium animal information management have been developed
by the International Species Information System (ISIS), a small nonprofit membership organization that maintains a
data depository for its institutional members. It has, however, not kept pace with advances in information
technology, and it does not have the resources to ensure the accuracy of member records. In an effort to supplement
animal collection records, several institutions and some zoo and aquarium associations have developed additional
software. For example, the Australasian Regional Association of Zoological Parks and Aquaria (ARAZPA)
developed REGASP, software for managing institutional and regional collection planning data. REGASP is now
used by several regional associations. The Zoological Society of London supported the development of software to
manage invertebrate populations. Several individual institutions have developed in-house inventory systems that
meet their individual needs but still export data to a central ISIS database (Dubois, et al., 2003). In addition,
veterinarians have been searching to find a replacement for the DOS-based Medical Animal Record Keeping System
(MedARKS) software program, which has been adopted as the "de facto" standard for computerized medical
records in zoos. It was developed in 1986 and later supported by ISIS. MedARKS is the single largest computerized
database of medical information on captive wildlife (Teare, 1998); approximately 200 institutions in over a dozen
countries maintain health records in these systems.
A new Zoological Information Management System (ZIMS) is being developed by the American Zoo and
Aquarium Association (AZA) and a consortium of zoological and professional organizations (Cook and DuBois,
2003) and is being coordinated by ISIS. This new system is being designed to create a global animal information
system for zoos and aquariums. It will include modules for animal inventory, veterinary care, nutrition, husbandry,
environmental monitoring, collection planning, and research, and will be designed to accommodate expansion
(ZIMS, 2003). ZIMS will support all of the information that is in the current ISIS software (ARKS, MedARKS) and
additional information as determined by planners.
The recognition that well-designed, standardized electronic medical record-keeping systems are essential to
proper animal care is not limited to the zoological community. The U.S. Department of Agriculture's (USDA)
Animal and Plant Health Inspection Service (APHIS) recently announced a proposed regulation of medical record
keeping for research facilities, dealers, and exhibitors (Docket No. 97-033-1), which includes zoological institutions.
Maintenance of medical records is implied in the Animal Welfare Act, but the regulations do not specifically
stipulate the maintenance of medical records as one of the elements in a program of adequate veterinary care. The
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RECORD KEEPING 49
proposed rule would amend the Animal Welfare Act (7 U.S.C. 2131 et seq.; 9 CFR 2) to require these entities to
maintain medical records as part of adequate veterinary care. The proposed maintenance of medical records "would
serve as a basis for reviewing the medical history and planning veterinary care, and provide a mechanism of
communication for matters of animal health, behavior, and well-being. Medical records document the animal's
illness, veterinary care, and treatment and serve as a basis for review, study, and evaluation of veterinary care
rendered by the facility."
The lack of a standardized information technology strategy for regulatory veterinary medicine resulted in
state and federal information systems evolving separately (Miller et al., 1994). Animal managers ultimately pay the
price for deficiencies in regulatory coordination of U.S. animal health and disease information. As seen in the recent
identification of the first U.S. case of "mad cow disease," our national system for tracking and coordinating
information on animal health and management needs to be improved, and the USDA has expedited its current efforts
(USDA, 2004c). The longer the development of information technology strategies is delayed, the more costly it will
be to correct the deficiency (Miller et al., 1994).
In another example of moving toward record standardization, the Department of Health and Human
Services (DHHS) recently announced the development of a new Systematized Nomenclature of Medicine
(SNOMED) for veterinarians and physicians, which was originally created for human medicine, but has been
expanded to include veterinary terms; SNOMED will allow institutions throughout the country to share information
electronically (AVMA, 2003). In addition, the National Academies' Institute of Medicine has been asked by DHHS
to design a standardized electronic health record.
Information Managers
Information managers, or chief information officers, have become increasingly important in recent years,
especially in the human and veterinary medicine fields (Greer, 1998). These people typically occupy positions at the
executive management level in the human medical field and administrative or management positions in the
veterinary medical (zoo) field (Greer, 1998; Zoo Registrars Association, 2003).
There are only two formally established regional groups of animal records keepers: the Australasian
Animal Records Keeping Specialist Advisory Group and the North American Zoo Registrars Association. The
membership of these organizations consists of people with primary responsibility for animal record keeping in
zoological institutions, aquariums, and similar organizations (i.e., registrars). A zoo registrar's responsibilities are
varied and complex (see Table 3-1). Two AZA scientific advisory groups (the Institutional Data Management
Advisory Group and the Small Population Management Advisory Group) have produced official standards for data
management in AZA-accredited zoos. The AZA offers professional training in record keeping.
TABLE 3-1 General Responsibilities and Qualifications of a Zoo Registrara
Responsibilities: Serves as a member of the Animal Management Team, assists in the development and
implementation of the zoo's Collection Management Policy, and its resulting collection plans. Monitors all
transactions for adherence to policies. Manages animal records and ensures the maintenance and quality of
animal records for use in the management and development of husbandry and breeding programs,
preparation of scientific publications, and provision of data for cooperative ventures at both the regional
and international level. Serves as liaison and information source to other departments and organizations.
Provides a complete inventory and record of all animal transactions. Monitors legislation for compliance
with wildlife laws. Collaborates with curators. Works under the supervision of the Zoo director. (Specific
responsibilities detailed in Appendix E).
Qualifications: Four-year college degree in biology or related field plus two years of experience.
Knowledge of concepts, principles, and practices of professional museum and zoo registration methods and
collection management standards. Knowledge of inventory accession and record-keeping practices;
zoological nomenclature; laws regulating animal acquisition, disposition, exhibition, husbandry standards,
and transportation within the United States and abroad; and statistics and population management.
Experience with computers, animal records, and word processing software. Ability to collect and collate
information from a variety of sources into concise and accurate reports. Good communication and
organizational skills, and attention to detail.
aAdapted from Zoo Registrars Association (2003).
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50 ANIMAL CARE AND MANAGEMENT AT THE NATIONAL ZOO: INTERIM REPORT
RECORD KEEPING PRACTICES AT THE NATIONAL ZOO
Within the National Zoo, animals are assigned a "local ID" in the form of an accession number. This accession
number uniquely identifies each animal in the National Zoo and is used in each type of record generated at the
National Zoo. The National Zoo generates many types of animal management and husbandry records, including
Keeper logs generated by the zoo keepers to document daily observations of each animal.
Curator reports generated by the curator, usually weekly, to highlight significant events noted in the
daily keeper logs of that week.
Specimen reports generated by the records keeper within the registrar's office. It is the official history of
the animal and documents major events such as birth, death, origin of specimen, medical history,
behavioral and husbandry concerns, and location of a specimen (Earnhardt et al., 1998). These reports are
generated from information in the curator reports.
Nutritionist records generated by the nutritionist to document diet management.
Veterinary medical records generated by the veterinary staff to document the medical care received by an
animal, including clinical notes, laboratory results, anesthesia records, and parasitology records.
Pathology records generated by the Pathology Department to document the examination of tissue or fluid
samples as well as the findings of necropsies.
The veterinary medical records are generated on MedARKS (ISIS, 2004; AAZV, 1999). The specimen
reports are generated using the Animal Record Keeping System (ARKs) software package developed by ISIS. The
keeper logs, curatorial reports, and nutritionist records are generated in a variety of ways detailed below.
Keeper Logs
The keeper log is the only record of normal daily observations of individual animals. In the past these
records were generated through the use of a carbon paper form called the zookeeper's daily report. Over the past
five years a prototype electronic keeper record system called the Daily Animal Records System (DARS) was
developed and implemented. DARS was implemented in only one unit to test the system; that unit still uses the
system. A second electronic system is being developed and implemented, using a Web-based form found on the
National Zoo's intranet. This initiative was started approximately a year ago. It uses a form similar to the
zookeeper's daily report on paper, and currently two units are using the system, though not every keeper within the
unit uses it (NZP, Animal Records Procedures: Statement of Practice, 2003; J. Block, Registrar, National Zoo,
personal communication). Both the DARS and the new intranet-based system allow for electronic entry of data onto
the form; however, there is no electronic archiving of the information. The forms are printed out and the paper
copies are to be archived (J. Block, Registrar, National Zoo, personal communication).
Curator Reports
Curator reports are generated by the curator, usually weekly, and contain the most salient animal
management and husbandry information gleaned from the keeper reports. For one unit this report is generated
through the DARS system; for all other units it is generated by a version of a curator report form. Paper copies of
these reports are forwarded to the registrar's office, where they are archived, and salient information from the
curator reports is included in the specimen report (NZP, Animal Records Procedures: Statement of Practice, 2003).
Nutritionist Records
In the past and currently the development, implementation, recording, and archiving of nutritionist records
has been at the discretion of the National Zoo nutritionist. Nutrition files were kept on hard copy, though it was
evident that there was a lack of standard documentation on the current diet of each animal and any changes made to
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RECORD KEEPING 51
the diet (e.g., see Box 2-1). The acting head of the clinical nutrition program, appointed for a two-year term, has
begun organizing the nutrition records, and is developing and implementing a new electronic record-keeping system
for nutrition records.
STRENGTHS AND WEAKNESSES IN RECORD KEEPING AT THE NATIONAL ZOO
Failure to Adequately Document Animal Management, Husbandry, and Medical Care
With the exception of the Pathology Department, the adequacy of the record keeping varied greatly within
the different units and departments of the National Zoo, and often was deficient, as in the case of the Grevy's zebra
"Buumba" (see Box 2-1). This resulted in part from a lack of standardized practices for reporting and archiving
records. Patterns of inconsistent record keeping and archiving were found in keeper logs, curator reports, nutritionist
records, and medical records. The National Zoo has acknowledged errors in record keeping for a number of animals
(African lion [Accession # 108413], bobcat [Accession # 103175], East African bush elephant [Accession # 26223],
eastern bongo antelope [Accession # 110565], Geoffrey's marmoset [Accession # 113220], Masai giraffe
[Accession # 104081], Sumatran orangutan [Accession #100797], tree kangaroo [Accession # 110974], Vietnamese
pot-bellied pig [Accession # 109080], zebra [Accession # 113393]; NZP, Letter to Committee, December 31, 2003).
Keeper Logs
The keeper log is a particularly important record as it is a primary sources for information used for animal
management decisions (Earnhardt et al., 1998). There were numerous instances of keeper logs not reflecting
important changes in an animal's behavior or management (e.g., see Box 2-1). This may occur for a variety of
reasons, including a failure to appropriately train keepers regarding the information that should be recorded in a
keeper log and a failure of the curator to provide appropriate quality control. Another keeper log issue that arose was
a failure to archive these records (see Boxes 2-1 and 2-2). Currently each unit is responsible for archiving the daily
keeper logs, though there is no stated expectation of how long to archive the materials. There is a lack of
appreciation at all levels of the importance of these records, and that in various situations it may be essential to be
able to review weeks, months, or even years of keeper logs on a particular animal or group of animals. Not only
were there numerous failures to archive these records but there was also a failure to manage these records as a
whole. In essence, no individual within the National Zoo has responsibility for documenting where the records are
archived and how they are organized. This leaves each unit's records vulnerable when staff turnover occurs. When
staff leave the National Zoo (particularly curators, who are responsible for overseeing the quality and archiving of
keeper logs), knowledge as to where the records are kept and how they are organized is lost. With the large amount
of staff turnover resulting from the buyouts, it is particularly important to standardize practices relating to keeper
logs, so that these records are accessible regardless of the current staffing situation.
Curator Reports
Curator reports also failed to provide complete information regarding animal management (e.g., see Box 2-
1). This is partially because curator reports are compiled from keeper logs (which were deficient in many cases) but
also because of a failure to appropriately train curators regarding their responsibilities in generating complete and
accurate curator reports, and also their responsibilities in overseeing the quality and completeness of the keeper logs.
There is no formal training process; rather, the registrar, on a case-by-case-basis, informally discusses record
keeping with a curator. In addition, few curators have received training on record keeping through the AZA (2003a).
The National Zoological Park Animal Records Procedures, which outline the responsibilities of the curator and the
information for which they are responsible, was developed in July 2003, and there has been no organized effort to
educate curators of the contents of the document, ensure they are properly trained to carry out its policies, or provide
oversight to ensure they are adhering with the policies.
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52 ANIMAL CARE AND MANAGEMENT AT THE NATIONAL ZOO: INTERIM REPORT
Nutritionist Records
In the past there has been a failure to maintain accurate, up-to-date records on the diets and nutritional
management of animals at the National Zoo. This situation arose due to several factors, including: a failure on the
part of nutritionists to fulfill their responsibility to maintain adequate records, the lack of written expectations as to
what would be contained within nutritionist records and how they were to be managed and archived, and the failure
of senior management to provide appropriate oversight to ensure that the nutrition department was fulfilling its
responsibilities.
An acting head of clinical nutrition has been hired for a two-year appointment and the process of organizing
the few records that do exist, developing an electronic system to document diet management, and creating a diet
management record for each animal in the collection has begun. The original intent was to have a diet management
record created for each animal in the collection, and to have these records accessible via the Intranet. However, due
to the retirement of the commissary manager, the acting head of clinical program temporarily assumed the
responsibilities of the commissary manager, which has delayed completion of the nutrition records. A new
commissary manager has been hired. Those nutrition records that have already been created are slated to be
assessable via the Intranet in early 2004.
Veterinary Medical Records
In general the medical records kept by the veterinary staff at the National Zoo were acceptable, however
there were multiple instances of medical records being altered weeks and even years later (see Box 2-1). The
National Zoo, like many other zoos, uses the MedARKS system as a teaching tool, by allowing veterinary students
and residents to create the initial clinical note in an animal's record and then, at a later point, editing these records
when errors are made. The MedARKS system documents the initials of the person who creates the clinical note,
though the system does not automatically identify the user when edits are made to a record. Recently the veterinary
department established a variety of policies regarding the identification of persons who enter or edit a record,
including having students use the initials of the case veterinarian and most recently, having students use their own
initials as was done previously. When edits are made, case veterinarians should manually enter their own initials.
Though editing of clinical notes is a standard practice at the National Zoo, it is an unacceptable practice as currently
implemented.
The American Animal Hospital Association has established clear standards for medical records, including
"the author of medical record entries is permanently and uniquely identified (by a code numbers/letters, initials, or
signatures) in a manner that is understood by anyone examining such records." The National Zoo's practice of
editing medical records without identifying the changes made or the individual making the changes casts doubt on
the credibility of their records, especially when the quality of the veterinary care is called into question. If erroneous
entries are made, they should be corrected by addenda, not by altering the original entry. If the National Zoo
continues to allow students to make medical record entries, the students need to be carefully supervised to limit
inconsistencies and errors that would require the supervising veterinarian to create an addendum; these addendums
should be made in a timely fashion.
Lack of Records Accessibility
There are two main issues regarding accessibility of records. The first was discussed above and involves a
failure to consistently and appropriately archive keeper logs and curator records. Each unit and the nutrition
department is responsible for archiving the unit's/department's generated records, with no apparent oversight. This
has resulted in records being lost or misplaced. When records are not retrievable in a reasonable manner, their value
is lost.
Second, all pertinent animal information is not archived in one location (be it paper or electronically).
Currently at the National Zoo the information management infrastructure is set up so that daily information about an
animal is included in the keeper log; the curator summarizes this information into a weekly curator report; medical
information is contained within the MedARKS medical records; and nutritional information is contained within the
nutritionist records, which are still being developed. Many units within the National Zoo submit all of their keeper
logs to the veterinary medical department daily. Some do this by faxing the forms, while others send it by e-mail.
Other units submit only their weekly curator reports to the veterinary medical department by fax, while at least one
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RECORD KEEPING 53
unit does not submit any reports to the veterinary medical department (J. Block, Registrar, National Zoo, personal
communication). In addition, there is no expectation, nor should there be, that the veterinarians archive these
materials for future use. In an emergency, if veterinarians needed access to these records (for example, to determine
if medications were administered or behaviors were altered.), they would have to rely on locating a member of the
unit staff to find the paper copies of these records and transmit them to the veterinary staff in a timely fashion.
According to National Zoo policy (NZP, Animal Records Procedures, July 2003), the registrar is
responsible for setting the standards and overseeing the animal records systems, maintaining the transaction files and
the core data in the specimen records, and reporting on collection holdings and changes. In reviewing keeper logs,
curator records, medical records, pathology records, and specimen records over the last six months, the committee
found that the type of information being documented in the keeper and curator records was inconsistent and the
keeper and curator records were inappropriately archived if they were retained at all. These deviations from stated
policy directly affected the quality of care some animals received (see Box 2-1) and hampered the investigation of
the circumstances contributing to animal deaths at the National Zoo. It is clear that there was not adequate oversight
of keeper and curator record keeping and archiving by the registrar. It is not apparent whether adequate policies on
record keeping and archiving were in place prior to July 2003. The committee was unable to determine whether the
registrar had a clear mandate and appropriate authority to ensure adequate record keeping and archiving by the
keeper and curatorial staff.
Findings and Immediate Needs
As with any zoological park it has often been necessary at the National Zoo to review the history of an
animal in the collection to help determine a future medical treatment, a change in diet, or to help identify a cause of
illness or death. The National Zoo has been handicapped in its efforts to provide adequate animal care by a
nonfunctional information management system (see Box 2-1).
Finding 5: The National Zoological Park lacks a comprehensive information management system for animal
husbandry and management records, which results in inconsistent record keeping and practices of alteration in
medical records weeks or years after events. While some issues are being addressed (e.g., an electronic keeper log
system is in development) these are stop-gap measures often having no concrete timeframe for completion or
implementation.
Immediate Needs: The National Zoo should implement an information management system that ensures complete
documentation of animal husbandry and management and reasonable accessibility to the records by all units and
departments. This does not necessarily mean that the entire system needs to be computerized immediately but rather
that consistent practices be put in place, that a system be developed to make the records reasonably accessible and
that an appropriately experienced individual be given responsibility for system oversight.
It is essential that the problems outlined within this section be addressed immediately, either through better
use of the ARKs system already in place at the National Zoo or through efforts to standardize record keeping and
archiving and to make records accessible. Based on the deficiencies in record keeping observed by the committee,
when developing and implementing a system, the following performance standards should be established:
There should be standardized practices for recording and archiving animal husbandry and management
information. These practices should outline the information to be contained in each type of record and
how and where these records are to be archived.
Employees should be appropriately trained and prove their competence regarding recording and
archiving standards.
There should be oversight to ensure compliance with recording and archiving standards.
A communication system should be developed to ensure that all appropriate individuals are notified
about significant changes in animal husbandry or management.
A protocol should be developed to allow for pertinent information related to a specific animal or group
of animals to be reasonably accessed by an employee, even if that employee is attached to a different
department.
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54 ANIMAL CARE AND MANAGEMENT AT THE NATIONAL ZOO: INTERIM REPORT
The information management system should be implemented in such a way that record keeping,
archiving, and accessing records is unaffected by staff illness, absence, or turnover.
Records should provide an accurate account of situations and practices relating directly to animal
management and health. They should permit reconstruction of events in the recent and distant past and should
provide a rational basis for decision making in the present. Records should indicate
who generated them
which animals were involved
when the observation was made or procedure done
what practices were carried out or problems were encountered
where events took place
why actions were taken
There are several ways these performance standards can be achieved. Ideally, a single, comprehensive
electronic record-keeping system should be implemented. The National Zoo already uses such a system (the ARKS
and MedARKS systems), though it currently uses it only to generate specimen reports for communication with
institutions outside the National Zoo. The ARKS system was developed as an electronic information management
system to provide a way to organize all information about an animal and make it electronically accessible to keepers,
curators, and veterinarians, nutritionists. In addition to the ARKS software, an entire system was developed around
this software to describe how a zoo could standardize record keeping and use the ARKS system most efficiently and
to the fullest extent. This information is contained in the document "Standards for Data Entry and Maintenance of
North American Zoo and Aquarium Animal Records Databases: (Earnhardt et al., 1998).
If the National Zoo were to choose the ARKS system to address the most pressing issues relating to
information management, the system would have to be accessible to all appropriate staff within the zoo, including
keepers. Data entry would have to occur daily, and be derived directly from keeper reports that are quality checked
by the curator. To control the security of the system the data entry and data changes should be limited to the
registrar's office (Earnhardt et al., 1998).
The current staffing level of the registrar's office (a recently retired registrar who has not yet been replaced
and an assistant registrar) and the lack of appropriate computer equipment and training might preclude these
improvements. The National Zoo would also need to devise a system in which pertinent information originating in
the veterinary hospital or nutrition department is sent to the registrar's office for daily data entry. The ZIMS system
currently being developed by AZA could be an ideal solution for the National Zoo; however, it will be at least two
years before this system is available. It is unacceptable for failures in the current information management system to
remain unresolved for two or more years; therefore, the National Zoo may choose to make improvements to its
current system (mixed paper and electronic). Resolving the failures in the current mixed paper and electronic
information management system will require a quick and thorough evaluation of the current system under the
direction of an individual versed in implementing and overseeing a successful information management system.
It is essential that a qualified individual be clearly designated to oversee the evaluation of the current
system, development and implementation of new practices and standards, and adherence with these new practices
and standards. This individual should have the authority and responsibility for achieving these goals. With the recent
retirement of the National Zoo's registrar after decades of service to the zoo and significant contributions to the field
of animal record keeping (Miller and Block, 1992), the zoo should quickly identify and hire an individual to head
the record-keeping functions of the zoo. This person should be qualified in implementing and overseeing a
comprehensive information management system.
Representative terms from entire chapter:
record keeping
