Aspirational but Realistic: Reimagining Accessioning Workflows in a Medical Archives
The Medical Center Archives of NewYork-Presbyterian/Weill Cornell Medicine (MCA) was established in 1972 as the repository for what is now NewYork-Presbyterian Hospital and Cornell University's medical college. Since its inception, MCA has stewarded the records and personal papers of a large medical center through the labor of a small staff and limited resources, leading to accessioning policies and procedures that merited modernization and clarity. MCA staff have spent the last several years evaluating accessioning practices throughout the archival lifecycle, identifying key areas for improvement, and implementing clear workflows and documentation to improve efficiency and establish transparency. This case study discusses tools, resources, and methodologies utilized at MCA to implement accessioning best practices, scaled to the realities of our repository. Through incremental yet strategic changes, MCA clarified staff roles and labor, refined collection development practices, and created new internal workflows that incorporate born-digital and digitized material. A new accessioning manual serves as a tool for ongoing evaluation of our evolving practices and challenges within our medical archives context, particularly when serving as ethical stewards of historical medical records while still aiming for an access-driven approach. Strategies and methodologies are described to promote emulation in other repositories with a smaller staff or limited resources.ABSTRACT
Accessioning has come to be recognized as a critical component of archival work, affecting all aspects of the archival lifecycle from ingest to access. Yet, limited resources and competing priorities take away from critical time needed for accessioning labor, much of which is invisible to administrators and users. When accessioning work does occur, archivists often contend with legacy practices that lack transparency and consistent documentation and have failed to keep pace with our modern context, which includes the emergence of born-digital materials and a critical reckoning with problematic collecting practices and structures. Refocusing accessioning as a priority can present an opportunity to positively shape future collection development, processing, preservation, outreach, and reference activities.
This case study confronts the challenges associated with accessioning in a repository with historically limited resources—the Medical Center Archives of NewYork-Presbyterian/Weill Cornell Medicine (MCA). We discuss tools, resources, and methodologies used as part of our multi-year initiative to implement accessioning best practices, scaled to the realities of our repository. Our project resituated accessioning as an intentional step that will make other aspects of our work more efficient, create transparency for future staff, and ultimately, make our collections more representative and accessible. Although situated within the context of a medical archives, where laws and institutional policies protecting the privacy of patients affect all areas of our work, many of the challenges we confronted and adjustments we implemented will resonate in different institutional contexts. Significantly, we approached accessioning holistically—from carefully considering what we bring in and why, to examining who implements this labor, to discussing how and when that process works in practice, clearly articulating what is often the invisible labor behind our work. Although our iterative accessioning workflows are still in progress, we share our decisions, rationales, and observations in the hopes that others—including archivists implementing accessioning with minimal staffing and/or resources, archivists contending with challenging access restrictions, archivists adapting or replacing legacy practices, and archivists seeking to improve their practical born-digital accessioning workflows—may find them applicable and useful in their own repositories.
Institutional Context
MCA was established in 1972 as the repository for what is now the NewYork-Presbyterian/Weill Cornell Medical Center. In addition to serving as an institutional repository for the records of NewYork-Presbyterian Hospital and Cornell University's medical college, MCA also collects, organizes, and preserves the records of affiliated and predecessor institutions and papers of noted associates, making these materials available for use by students, faculty, staff, and the general public. MCA successfully served as a model for the establishment of other healthcare archives across the country after its founding.1 Former archivists established collecting policies and procedures, bringing centuries-old materials under the stewardship of MCA, which now preserves and creates accessibility to more than 10,000 linear feet of records representing a continuous chronicle of health care, scientific research, and medical education dating to 1771.
In the decades since its founding, however, the staff and resources of MCA were not matched to the growing demands and volume of records connected to a large medical center. These challenges were further exacerbated by inadequate storage space and shifting regulations around privacy and health, which necessitated more detailed approaches to processing and access to ensure compliance with the Health Information Portability and Accountability Act (HIPAA) and institutional policies related to Protected Health Information (PHI).2 MCA necessarily began to prioritize certain activities over others as time became increasingly limited, often focusing on projects that could meet the immediate needs of stakeholders (such as digitizing and rehousing thousands of photographs for reference) or that became a priority out of necessity (such as responding to leaks and other environmental issues threatening the collections).
As a result, key internal processes related to accessioning suffered. Workflows were not sufficiently updated to reflect the emergence of born-digital records, and documentation such as deeds of gift were not consistently created or saved. Temporary measures were sometimes employed when new materials were brought in, including writing a donor's name and/or donation date on boxes, which at times served as the only notation of ingest.3 When documentation did exist, it was not always saved in a unified place, sometimes being filed within collections (leading to an “ah-ha!” moment for future staff, when discovered). As databases came into use, handwritten information from documentation was not always entirely transcribed, nor were accruals consistently noted. Furthermore, the new collection record was often written over the corresponding accession record in the database when a collection was processed, blurring the line between information acquired during acquisition versus processing. The impact of inconsistent documentation efforts relating to the basic details of an acquisition is large—it can complicate issues related to the use of the material, such as determining copyright ownership when a user needs an item for publication; it can affect donor relations if the original terms or restrictions of the agreement were not maintained, potentially discouraging future donations by others; and it can even bring custodianship into question, risking loss of the collection if the original accession was not sufficiently documented. All of these issues have the potential to reflect poorly on the repository and make the work of future archivists more challenging, while negatively affecting the user and donor experience at the same time.
In addition to documentation challenges, collections were separated by format and organized into discrete databases until 2018, often divorcing them from their original provenance. Staff who were not present during the initial acquisition needed to check multiple databases and lists to attempt to identify the full extent of a collection when responding to reference requests or gathering materials for processing, often without satisfactory results. After several encounters with unprocessed boxes containing vague labels related to processed collections, we quickly realized we would also need to physically search the storage areas for related materials—often accruals, ongoing institutional records such as publications, or artifacts—that were never documented or sufficiently linked in any of the databases or lists.4 The additional labor needed to identify collections was incredibly time consuming for staff, who already felt pressed for time, while also affecting the quality and speed of user services.
All of these activities demonstrate the negative effects of insufficient accessioning practices, which were multiple and felt across the archives. To complicate matters further, MCA experienced a full staff turnover between 2018 and 2022, which brought many of the challenges associated with legacy accessioning practices and the loss of institutional knowledge to the forefront. At the same time, however, the arrival of new staff presented an opportunity to begin to modernize archival policies and procedures, particularly those related to accessioning. MCA staff embarked on a new project to identify key areas for improvement within the realities of our institution and situated within the best practices of our profession.
Selected Literature Review
Evolving Accessioning Practices
Two excellent summaries on evolving accessioning practices that have had a direct influence within our specific context are Rachel Searcy's case study “Beyond Control: Accessioning Practices for Extensible Archival Management” and Audra Eagle Yun's “Principles and History of Archival Accessioning” chapter from Archival Accessioning. Searcy summarizes critical discussions related to creating a modern accessioning program. Albeit at a larger repository, her discussion of the day-to-day realities highlights the importance of consolidating legacy workflows and implementing an access-driven approach to accessioning.5 Yun expands on this discussion, illustrating the evolution of accessioning within US American archival practice. Her chapter describes the shift from a basic checklist-type activity to an essential, thoughtful activity as part of the archival lifecycle, one that acknowledges the white supremacist history of the archival profession and the impact this has had on accessioning practices (among others) over time.6
Doing More with Less
While it tends to be prevalent in smaller archives or archives with a small staff, working with limited resources is a reality all too common in our industry.7 In her “Retrospective Accessioning” chapter of Archival Accessioning, Chela Scott Weber writes that “for many institutions, accessioning is a function that has been managed variably over time, and such examination, analysis, and documentation of knowledge has not regularly occurred upon arrival of collections.”8 This inconsistent approach resonates with archivists tasked with stewarding large quantities of material with insufficient resources. Eira Tansey applied the phrase “the cycle of poverty” within an archival context in the article “Archives without Archivists” to describe the downstream dwindling of resources and invisible labor that archives inherit from their chronically underfunded parent institutions.9
The dwindling resources have become even more evident as funding is needed for the preservation of both analog and digital materials, as well as adequate staffing levels to avoid burnout, especially as the emergence of born-digital content has necessitated new skillsets and technologies.10 Limited resources inevitably affect our stewardship work when we must prioritize certain activities over others due to a lack of time or personnel. Activities that are appealing to key stakeholders, such as the acquisition of exciting collections, may receive more attention than the time-consuming labor required for a robust accessioning program. However, when the critical work on the “back end” is incomplete or managed inconsistently over time, this can snowball into larger issues in the future.11
Compounding these challenges is the accumulation of problematic legacy practices archivists have inherited from their predecessors. Jillian Cueller, Audra Eagle Yun, Jennifer Meehan, and Jessica Tai directly address problematic legacy practices as archival debt (a term coined by Cuellar) in a panel discussion at the 2022 Society of American Archivists conference.12 Based on the premise that our profession is rooted in patriarchal white supremacist culture and that archival debt resulted from prioritization of “the protection and validation of institutions over democratic access and responsible stewardship,” their discussion goes on to describe how it can manifest as backlogs, insufficient documentation, problematic descriptions, and demoralization, among many other issues.13 The ongoing accumulation of archival debt will require vast amounts of time and resources to remediate in the future, a problem that can seem (and likely is) insurmountable.14 The effort to do more with less, coupled with increased workloads and problematic legacy practices, is an ongoing source of frustration, discussion, and even departure from the profession.15
Digital Accessioning
In addition to contending with limited resources, archivists have had to alter processes at all stages of the archival lifecycle due to the emergence of digital records. Terry Cook described the early responses as “paper minds trying to cope with electronic realities,” as technology changed the way records were produced and archivists attempted to adapt their practice.16 Efforts seemed to go largely unheeded as repositories, already burdened with large backlogs of analog materials in their stewardship, began “the active acquisition of born-digital material without formal plans for the ongoing management and preservation of these materials.”17
Archival literature attempted to contend with backlogs in the twenty-first century, challenging archival theory to reimagine workflows to increase accessibility of collections.18 This literature eventually included digital records, with case studies aimed at creating best practices for standardized accessioning, processing, and preservation of these records. Initially, the guidance came from larger institutions that had funding, resources, and expertise often out of reach for medium and smaller repositories, though there has been movement toward creating more approachable guidance.19
Privacy Concerns
The Society of American Archivists’ “Code of Ethics for Archivists” articulates the significance of privacy in our records, noting that archivists must “establish procedures and policies to protect the interests of the donors, individuals, groups, and organizations whose public and private lives and activities are documented in archival holdings.”20 This is particularly true in archives with medical or student records, where archivists must comply with the Family Educational Rights and Privacy Act (FERPA), HIPAA, and other institutional policies regulating access.21
Balancing privacy with access to historical records (what has been previously termed as access anxiety22) is an ongoing challenge and point of discussion for many archivists, especially those working in archives with medical collections. As part of a recent virtual educational session provided by the Education Committee of the Librarian, Archivists, and Museum Professionals in the History of the Health Sciences group, several panelists described their efforts to streamline the process of managing and creating accessibility to these types of records. Hanna Pennington and J. E. Molly Seegers shared their experience creating a workflow for identifying restricted analog materials during processing and providing onsite access to researchers at the Arthur H. Aufses, Jr. MD Archives in the Icahn School of Medicine at Mount Sinai.23 Lucy Brooks Waldrop and Rebecca Williams from the Duke University Medical Center Archives discussed how they strategically reprocessed a collection containing PHI to facilitate access while balancing their institution's internal privacy practices. The discussion included navigating privacy concerns and the resulting benefits when fielding reference inquiries.24 The impetus of this virtual session demonstrates that even those accustomed to working with privacy restrictions on a regular basis can experience challenges and confusion when it comes to processing and providing access to records containing PHI.
Not only does the absence of universal criteria for the acquisition and appraisal of health records create challenges for staff,25 but the varying access policies to those records, often specific to each institution, also cause confusion for researchers. Identifying the best approach (or approaches) to providing access to records containing PHI while still serving as ethical stewards of our material is an ongoing conversation.26 In the absence of universal guidance, it is critical for archivists to stay up to date with national laws (and any legal challenges) related to privacy; to continue sharing knowledge, best practices, and lessons learned among archival colleagues; and—critically—to rely on institutional partners (such as privacy officers, lawyers, or your organization's Institutional Review Board) who have the needed expertise to contend with the legal implications at an even larger scale.27
Improved accessioning practices can also mitigate challenges related to privacy in the future. Identifying the donor and dates of donation and whether the collection is flagged for restrictions, discussing the benefit (or downsides) of collecting material that may need to be restricted for a significant amount of time, and gleaning context can all provide insight for later processing and access, in addition to determining the collection's appropriateness for your repository.
Toward a Holistic Archival Accessioning Program
Set within a larger effort to modernize all our stewardship policies and procedures, and situated within professional best practices, the MCA team took steps to identify and implement achievable goals to improve accessioning and create the most impact with available resources and staff. MCA prioritized accessioning despite competing priorities as we understood the importance of setting a strong foundation for materials at the beginning stages of the archival lifecycle.28 Prioritizing accessioning is a deliberate resource allocation decision; that this decision was made in an institution with historically limited resources demonstrates the centrality of accessioning work to archival practice.
With this goal in mind, MCA made compelling adjustments to the accessioning process in several areas: we set the stage for success by identifying the labor needed and refining collection development practices; we then created new workflows and documentation to improve efficiency and create transparency as part of our more holistic process; we also focused on the practical challenges that born-digital accessioning presents; and finally, we sought to reconcile our ethical, legal, and institutional responsibilities around sensitive and restricted materials with our professional imperative to make materials accessible. Throughout the process we contended with legacy practices while simultaneously building on them to avoid reinventing the wheel. In addition to making our process more streamlined and efficient for donors and staff, these steps aimed to shorten the interval between acquisition and access for both our internal and external users.
Clarifying Staff Roles (Or, People Need Time to Do This Work)
Given the significant amount of time a holistic and thoughtful accessioning process would take, we first clarified responsibilities for the three MCA staff members.29 By assigning everyone's role, it ensures that all tasks are completed, ownership is clarified, and critically, adequate time is allocated as part of each person's yearly work plans. Minimizing any confusion of responsibilities also provides continuity for every accession, keeps each person accountable, and prevents gaps or breaks in the chain of custody.
Staff turnover in 2020 led to the creation of a new technical services archivist role, focusing on all aspects of collection management in line with the modernization efforts we'd already set in motion. In 2022, MCA advocated for and hired the repository's first-ever digital archivist, responsible for establishing an infrastructure for born-digital and digitized archival materials and expanding our team to three full-time staff for the first time.30 With revised staff roles in place, discrete accessioning responsibilities could be articulated more clearly:
The head of the Medical Center Archives is responsible for establishing new relationships with prospective donors within and outside the institution, coordinating with institutional partners on critical issues related to donations (including the privacy officers regarding HIPAA and PHI), signing deeds of gift and related documentation, and maintaining ongoing donor relationships.
The technical services archivist solicits recurring institutional donations, coordinates physical transfers and shipments, creates accession records, manages all documentation for the collection files, conducts the initial survey and stabilization of analog materials, and determines processing recommendations.
The digital archivist establishes and implements the workflows connected to digital or hybrid collections, including the ingest, stabilization, normalization (if necessary), preservation, description, documentation, and initial survey of digital records and external media.
What's the Big Picture? Refining Collection Development Practices and Goals
MCA receives donations through offers of papers, institutional record transfers, and solicitations. Potential accessions are discussed in a new weekly collections meeting attended by all three archivists, which provides intentional time to pause, discuss, and evaluate in light of our Collection Development Policy and ongoing collecting practices.31 To facilitate these discussions, we created an “Accessions in Progress” spreadsheet, which tracks potential, recurring, and completed donations in discrete tabs. By highlighting actionable items and assigning an archivist responsible for shepherding each donation, the spreadsheet helps MCA stay on top of donor management and granular tasks during the process. A big challenge in our pre-custodial work was the inability to understand the status of donations that were offered or solicited prior to the arrival of our current staff. Consequently, our spreadsheet includes a tab documenting potential donations, even if they do not materialize, chronicling and tracking our effort to follow up with donations that we wish to pursue. Because we are an institutional archives without a formal records manager, the spreadsheet also has a tab for recurring departmental transfers that we must track and solicit on a regular basis, such as annual reports.32 Having all relevant information, including departmental contact information and frequency of donations, helps streamline our approach to collecting these institutional records.
Critically, our weekly meetings and the “Accessions in Progress” spreadsheet have enabled us to discuss gaps in the collections and how we can seek out new material to more accurately represent the history of our large (and growing) institution. By approaching accessioning as a proactive, thoughtful activity within the archival lifecycle, as described by Yun, MCA staff framed the emphasis on accessioning within these larger collection development goals. Recognizing that historical archival practices in the United States have tended to prioritize collecting certain narratives over others,33 MCA has focused recent collecting efforts and related projects on better reflecting more diverse voices from our institutions.34
Back to (Accessioning) Basics
Now that specific collection development goals and staff roles were defined with a clear division and acknowledgment of labor, MCA established new tracking systems and workflows for all stages of the accessioning process, including getting back to the basics.35 An easy way to organize accessions is with accession numbers and accession files—now common archival practices that had not yet been implemented in our repository but are achievable using basic tools available to most archivists. Entries for new accessions historically received the next available identifier automatically generated by a former database used in our repository. Critically, the identifier did not distinguish between accession and collection records, and consequently it fell on the archivist to spend a considerable amount of time examining each record to determine the type.36
To overcome this, we created an “Accession Numbers” spreadsheet to not only track a running list of all new accession numbers and those assigned to retroactive accessions,37 but also manage the status of documentation, entries to our new collection management system, and temporary locations.38 The spreadsheet effectively serves as a checklist for our process, ensuring the completion of tasks and accountability for all stages in the acquisition process, while also enabling a number of benefits in the process. Being able to pull up all accession records, which was not possible with the previous database, has been critical in identifying processing needs, relationships between records, and accruals. A secondary benefit is the quantitative data for what we've acquired on an annual basis, which can be used for internal advocacy and resource allocation purposes, as needed. The accession numbers are also used to organize the new accession file system we established, which maintains all documentation created during the accessioning process.
Demystifying the Process for Donors
When MCA staff reviewed existing donation procedures and forms intended for our donors, we recognized two things: first, that there were areas for potential confusion that merited improvements, particularly for new donors unfamiliar with the process; and second, that we could save time later in the archival lifecycle (such as during processing) by taking steps to clarify these areas of confusion. Identifying simple solutions that do not require specialized tools and can remediate two issues at the same time is always beneficial for under-resourced staff.
To help demystify the process for internal record transfers, a core component of our work as an institutional archives, we created a branded, one-page document framed in conversational text without professional archival jargon. Sent at the initial point of contact with departmental constituents, the document poses questions as basic as “Why should we send anything to the Archives?” and “What counts as a ‘record’?” While very simple (and free) to create and execute, this document simultaneously makes MCA more approachable and increases our visibility, serving as a conversation starter for departments that may not have transferred records before or are unaware that an institutional repository exists (or why). The document also directly addresses sensitive or restricted materials protected by HIPAA, FERPA, or other institutional policies, ultimately helping donors better help us. All questions and issues are those which we would typically spend time on in emails, conversations, and phone calls later in the process but now can directly be addressed in a one-page overview at the start.
We also updated resources and workflows for personal papers. These donors already receive a “deed of gift explanation” document that clarifies confusing sections, such as copyright interest and conveyance, to ensure they fully understand the donation process and legal paperwork.39 We added simple one-page packing instructions, as we often received questions on the shipping process and can now ensure it is clear and straightforward for all our donors. The instructions outline the best way to pack materials in order to preserve the original order and keep the materials safe during transit. The document also prompts donors to check for hazardous materials (such as artifacts containing mercury or other chemicals commonly found with medical materials) or preservation considerations (such as inspecting for mold) before shipping, which helps prevent dangerous and often time-consuming situations for our staff or other collections upon arrival of the collection at our repository.
In addition to providing further information on transferring institutional records, the deed of gift, and shipping process, all donors are now also encouraged to provide inventories and short descriptions at whatever level they are able. Although some donors simply provide contextual information in paragraph form, we also made the process easy for those who want to add additional details by sharing an Excel template for metadata such as dates and known restrictions. While not all donors participate in this part of the process, any metadata or summaries we receive are repurposed for collection description at various levels, helping MCA staff in both early (accessioning) and later stages (processing) of the archival lifecycle. In addition to helping donors better understand where the information will ultimately go (giving the archives another chance to introduce them to the ubiquitous and mysterious “finding aid”40), it also facilitates more authentic description of both creators and their work.41
Digital Accessions (Within Reach!)
MCA lacked the time and resources to fully contend with digital records as they began appearing in collections in the form of legacy media and born-digital files, a common reality for many archives. This resulted in the continuation of legacy practices that did not fit the reality of digital records, including intellectually and physically separating materials by format and tracking them in multiple, discrete databases. The workflow that was created in the past to address digital accessioning needed to be adjusted to meet current protocols (which no longer includes creating an artificial collection of digital materials) and expanded due to advancements in digital accessioning best practices.42 The legacy workflow only partially contended with the needs of digital records, leading to inconsistent documentation about their acquisition and leaving current staff in the dark about the full extent of digital materials residing in the collections,43 their long- and short-term preservation needs, and—in some cases—their original provenance. To overcome these challenges during our new accessioning process, MCA prioritized establishing a baseline accessioning practice that would be “good enough” to address immediate needs and protect the integrity of digital records as part of our new holistic approach.44 Specifically, the goal was to address major pain points such as failing to collect essential intellectual information (sometimes leading to orphaned records), inconsistent donor documentation and loss of provenance, and a lack of digital preservation activities.
Our revised process included purchasing basic but necessary hardware (such as a write blocker), establishing a new preservation storage environment that utilizes a combination of cloud storage and external hard drives to protect against loss, and testing and employing a variety of open-source tools, including the following:
DROID—a free format characterization software created by the United Kingdom National Archives that we use to capture technical information, assign checksums, and create a file manifest for the initial survey of the digital records and to establish baseline intellectual control;45
ClamAV—an open-source virus and malware checker that we use to avoid introducing corrupted and problematic files and programs into our repository;46 and
BagIt and the graphical user interface version Bagger—tools produced by the Library of Congress that we use to package files (including documentation) to support validation and transfer to our preservation storage environment, ensuring files will be available later for processing and reference.47
The next step in our process is to track all legacy and new digital accessions in a “Digital Asset Register,” a spreadsheet that serves as an interim management tool until our new collection management system is implemented.48 In addition, a “Media Inventory” spreadsheet we now utilize at the beginning of our process captures any visible descriptive and technical information from external media accompanying new accessions. This ensures that no intellectual or provenance information is lost, even if the media is physically (but not intellectually) separated from other collection materials for preservation purposes (for example, a bulky hard drive stored apart from manuscript materials).
Our staff have embraced that “each new accession of materials and iteration of policies and procedures will lead to insights and higher skill levels” as we continue to adapt and grow our digital accessioning work.49 Soon, we plan to set up a BitCurator station to automate ingest steps, gather more robust metadata, and employ software to screen for sensitive information, such as PHI identifiers.50 Although the current workflow is slim compared to those at larger or more well-resourced institutions, it is sufficient and leaves the program open for incremental improvements.51
From Accessioning to Access
Maintaining better intellectual and physical control during the accessioning process ensures that facilitating access to collections will be easier for both current and future staff in many archives. Yet, “facilitating access” is not always all encompassing—while ideally striving for complete, immediate, and open access to all members of the general public, this is not always possible.52 Archives holding restricted or sensitive material can still aim for an access-driven approach, however, adapted to the needs of their own users and repository.53
The unique needs found within our own context as a medical archives makes the prospect of access-driven accessioning more complicated, albeit not impossible. Additionally, as a repository with a small staff and large backlog, we recognize that many collections will not be traditionally processed immediately upon acquisition (which is often seen as the ultimate access goal for archives) and have adapted our accessioning process accordingly. Our new approach prioritizes systematic, baseline accessioning activities of description and stabilization to assist us in our efforts to increase accessibility: we now survey new accessions within four weeks of acquisition to gather descriptive information needed for the creation of an accession record, immediate preservation interventions (such as addressing mold or media obsolescence), future processing, and interim accessibility for staff and researchers (both internal and external).54
The survey is a critical opportunity to identify the presence (or likelihood) of PHI at a collection, series, or box level. As the repository for a covered entity, the historical records in MCA are protected by HIPAA and internal institutional policies that require protection and confidential handling of PHI, whether or not they are still covered by HIPAA (which is a framework that expires 50 years after an individual's death date—a detail we may or may not be able to glean from the historical record). The internal policies provide important added layers of protection to ensure the privacy of our institution's historical patients, though at the same time they can also make access to historical documents somewhat more challenging from a research perspective. To overcome this hurdle, after HIPAA was enacted, MCA consulted with institutional privacy officers, who address privacy issues for the entire institution, to establish policies that can enable mediated access to records containing historical PHI. This is an ongoing relationship, and we consult regularly with the privacy officers regarding both internal and external requests for access to historical PHI and to discuss revisions and changes as needed.55
Although we are able to facilitate mediated access to many of our records thanks to the policies created in conjunction with the institutional privacy officers, many of our collections still require time-consuming, detailed processing prior to full-level access. This is partially due to the fact that PHI can be found in any type of document beyond material that is traditionally considered a medical record. An example might be a passing mention of a patient in a letter found in a physician's personal papers. This letter could contain several elements of PHI, including the patient's name and treatment, even though the remainder of the letter may have no relevance to their health. The level of familiarity with PHI of the archivist conducting the review can also affect the processing timeline—familiarizing oneself with the eighteen identifiers that constitute PHI in a way that enables an efficient (and relatively speedy) review of a large amount of historical documents takes time and practice (similar to the processing of any archival collection containing new ethical challenges, unfamiliar legal restrictions, or other gray areas). Consequently, contemporary approaches that suggest making collections more fully available upon accessioning do not fit neatly within our context.56 Even so, the work of accessioning adds value even when it does not result in immediate, open access to the general public: in addition to facilitating internal use of records for the departments of creation, the high-level PHI review and baseline description created during the initial collection survey following accessioning can be used by staff to make informed decisions on the level of intervention required within our mediated access policies, giving the materials a higher possibility for increased (as opposed to no) access by others.
The Evolution Continues
In order to lay a strong foundation for responsible stewardship, our revised accessioning program addressed multiple issues that are found in all types of repositories: inconsistent or incomplete legacy practices, limited bandwidth, expanding digital needs, and restricted material. While the work and progress are ongoing, we are now better situated and committed to be responsible stewards of our records and meet the needs of our stakeholders, thanks to the changes made to our accessioning process. It is imperative to continue to honestly reflect on past and current practices while striving for incremental improvements in the years to come.57
Taking Stock of Our Project
We confronted many challenges that may feel familiar to other archivists, particularly those in smaller institutions and/or with limited resources. Despite the challenges of having a small staff and limited bandwidth, we found that deliberately setting aside time to reimagine our roles helped clearly outline responsibilities and eliminate confusion, ensuring continuity throughout the accessioning process. We recognized that dedicating more time to accessioning naturally meant taking time away from our other activities, but we determined that this new resource allocation benefited staff and collections to a greater extent in the long run by setting up the remaining tasks in the archival lifecycle (and consequently current and future staff) for greater success.
Allocating and articulating the labor needed to responsibly and thoughtfully accession new materials emphasized our commitment to responsible stewardship at the start of the archival lifecycle and led to thinking about accessioning more holistically. This enabled us to dedicate more time to clearly articulate overall collecting goals and address collecting gaps and hopefully prevent major new ones from occurring. Our new weekly meetings specifically to bring these issues to the forefront involve an assessment of the collections as a whole and a more thoughtful approach to not just how we collect, but also what and why we collect.
We found that using basic tools and creating simple workflows that were easy to implement made our accessioning process easier for staff and donors. By implementing new tracking systems for potential and incoming donations and accessioning tasks—with something as simple as a spreadsheet—we were able to combat inconsistent legacy practices and set a strong foundation for future accessions. These systems also provide a framework for retroactive accessioning as we continue to work toward gaining better intellectual control over our collections. We also addressed ways to help demystify what is often a confusing donation process for both internal and external donors, ultimately (and significantly) saving time for staff while also serving as an advocacy and donor relations tool.
Our new approach to digital records required an entire overhaul of the archival lifecycle from accessioning to preservation to access. This is a large project, and focusing on building a “good enough” workflow at the start of our digital stewardship was a crucial first step. We focused on pressing needs like tracking incoming digital records and separating materials (such as bulky hard drives) for preservation purposes while still maintaining provenance—actions that are critical for later processing efforts and demonstrate that there is strong value in responsible accessioning even when it cannot result in immediate, open access. Our new workflow focused on using open-source software and tackled only the essential steps, with a plan to continue improving with each new accession as staff expertise necessarily advances with practice over time.
Contending with the sensitive nature of our records is an ongoing challenge, particularly when considering access as an ultimate goal while accessioning new collections. We confronted our institutional realities as a result—as a medical archives, we recognize that we may never feasibly implement “accessioning as processing” for all our incoming collections, but we were able to modify our accessioning practices that allow for increased access within our mediated access policies. Our new processes also make access and discoverability easier for both current and future staff.
After implementing the new accessioning project, MCA drafted an accessioning manual in 2023 to codify the allocation of labor, workflows, and documentation efforts, with the understanding that this will be iterative as internal systems and professional standards evolve. Our new accessioning practice has already evolved since its initial creation, and we address the evolution regularly in our weekly collections meetings. Discussions address particular pain points and how they can be improved. For example, do we need to revise our “survey in four weeks” goal or shuffle other responsibilities to dedicate sufficient time to actualize that four-week timeline? Are we creating too many spreadsheets with our new systems, and if so, what can we migrate or combine to streamline our efforts? We understand that some of the quicker solutions we adopted, like the new tracking spreadsheet, will be reevaluated as our overall processes improve. It is also imperative to be aware of the dangers of adding too many steps without understanding the value they contribute, potentially spiraling into a disjointed and cumbersome workflow. As our team reflects on these questions and learns from our work, we adapt the accessioning manual accordingly. The manual is a reminder that we not only need to reevaluate legacy practices as we move forward, but we also must reevaluate and adapt our own.
Accessioning: A Work in Progress for All?
Technologies, laws, and the world around us are constantly changing, and our archival processes must consequently respond and adapt to fit the changing needs of our collections, users, donors, and institutions. Regardless of the type of archives or staff size, it can be easy to feel overwhelmed when trying to accomplish everything in order to be responsible stewards of our collections. Our case study on archival accessioning in a small repository with historically limited resources is just one example of how best practices can be thoughtfully yet practically adjusted to fit specific institutional contexts and goals. As a result of our project, we encountered a few critical, overarching issues that affect archivists who are trying to accession holistically, thoughtfully, and responsibly as part of their work, and that the profession should continue to assess as a whole.
First, problematic or incomplete legacy practices can be found at every institution due in part to advancements in archival theory and practice. Although it is simply not feasible (even if desirable) to correct all the past “wrongs,” reevaluating rote activities and procedures on a regular basis can help avoid the “we've always done it this way” mindset and allows archivists to think critically about how their workflows can benefit from minor (or major) improvements. Reflecting on both legacy and more recent practices (including one's own) can also encourage staff to step back from the practicalities of their work and consider the greater impact our choices have on the written legacy of our society.
Second, contemporary approaches that suggest making collections more fully available upon accessioning do not fit neatly within all archival contexts. Published professional literature, case studies, and best practices are largely written by those who work in academic institutions, sometimes causing a lack of nuance for the realities and needs of nonacademic archives. “Accessioning as processing” approaches do not always address the considerations that may better fit the context of some nontraditional repositories, such as tiered approaches to access when contending with a large amount of sensitive or restricted collections. There is a strong need to broaden discussions and share practices on the varying access-driven approaches of repositories outside of academia that may not always contribute to the professional literature but are still actively engaged with it.
Third, responsible digital stewardship can seem daunting to many archivists who see innovative projects from well-resourced institutions that are not immediately replicable.58 However there are basic steps that are the digital equivalent to “getting boxes off of the floor” (which prevents baseline problems for analog materials) to mitigate against loss.59 Archives that do not have the budgets or staff expertise for complicated software can still employ familiar and easy to use tools (such as spreadsheets) to track their accessions and capture relevant metadata for digital records. As expertise grows—especially through practice—accessioning and preservation workflows can expand to include new tools and more sophisticated concepts. Small, incremental steps are still valuable to strengthen digital accessioning, especially if coupled with an iterative plan to continue to improve and revisit the process at the speed their resources allow. Continuing the conversation and sharing documentation and workflows from lower-resourced repositories are critical to lowering the barrier of entry and making digital stewardship more approachable for all.
Finally, most archivists simply cannot do it all, despite our best efforts. Our decisions need to come from a resource allocation perspective—what is it that we need to do, and which activities will we necessarily dedicate more or less time to as a result? How can we make the most impact, given the resources we have available? Addressing every best practice is not always feasible, and decisions need to be made about where our labor is best spent. By acknowledging the limitations we have, we are better able to identify the opportunities, confront next steps, and confidently scale practices to the realities of our institutions.
Conclusion
The MCA project to improve accessioning practices within the context of our resources and repository was a conscious resource allocation decision meant to make a significant impact on all areas of our work. As discussions and practices around accessioning progress, we hope to continue expanding and building on the project. This includes addressing retroactive accessioning, streamlining deaccessioning, expanding digital workflows, and improving ways to identify and provide access to collections with restricted materials. Ultimately, we hope to more thoroughly assess the impact of our revised accessioning work, make changes as we gain insights, and lighten the load of archival debt for our successors. While we recognize the positive and immediate influence it has had on our time—making us more efficient and our processes more streamlined—we hope to better quantify and evaluate this new process and understand the impact it has on users and donors.
Accessioning is only one part of the large workload we encounter, and the clear articulation of responsibilities and steps outlined in our new process reminds us that we must sometimes accept when processes are sufficient (if not perfect) because we may need to prioritize our labor elsewhere. Looking at our entire process more holistically and iteratively has allowed us to evaluate whether our work is meeting our goals—documenting actions that are scaled to the realities of our institution while not losing sight of our aspirations.
Contributor Notes
The authors contributed equally to this article and are listed in alphabetical order.