IM&T DES E-audit The process, the queries and the clinical issues

Dougal Darvill

PRIMIS+ Clinical Adviser

The purpose of the IMT DESaccreditation

“The accreditation of practices is required by NHS Connecting for Health before patients electronic summaries are uploaded to the spine”

To make sure that data is fit to share

What links a geologist and a PRIMIS+ facilitator?

Occupation recording

Practice list size 7750

Out of 643 with occupation recorded:

• Paperworkers 67

• Health Visitors 28

.03FJ Health Visitor

contacted me to discuss the extreme stress

which this family are suffering.

.0D4. Paperworkers

Court report prepared-returned to solicitor

Occupation recording

• Doctor happy with data• Patient happy with data

• BUT it’s wrong –poor data quality • Misleading data in remote extraction • Only identified by data extraction and

comparison with the expected• Only preventable through training

Occupation recording data quality

E-Audit role

• The e-audit is only one part of the assessment & accreditation process.

• It does NOT test all aspects of Data Quality.

IMT DESassessment and accreditation

• Be part of PRIMIS+ facilitated network

• Demonstrate compliance with Good Practice Guidelines– E-audit– Submission– Practice visit

Data quality sample

• IMT DES specifies different aspects of recording to be examined

• PRIMIS+ tool under testing– Pilot – Agreement of DH, Joint GP IT Committee,

CfH and RCGP on clinical validity

Need to examine data in context

• Remote extraction can highlight variation from expected but it can’t explain it

• Explanation needs context

• Not a pass/fail test

• Traffic lights to highlight variation from peers

• Caution with small numbers

Need to examine data in context

• 7750 patients >2 million Read codes• Can’t check them all• Can’t check reason for choice of code remotely• Need to look at the processes for coding in the

practice• Variation from norm to provoke discussion

Use of e-audit tool in practice 1

• Practice applies for approval

• First run of e-audit tool, web submission

• Feedback, reflection, and discussion

• Comparison with benchmarks

• Practice examination of individual records

Use of e-audit tool in practice 2

• Identify areas for improvement

• Training

• Subsequent runs of e-audit tool

• Meeting with assessor

What’s to stop practices just ‘playing the game’?

• Seeing the bigger picture

• Facilitator involvement

• Too big a job

• Some sample areas impossible to ‘cheat’