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2017DiabetesinIndianCountryConference
NutsandBoltsofConductingDiabetesAudits
KarenSheffIHSDivisionofDiabetesTreatmentandPrevention
9/19/2017
Objectives
1. LocateresourcesnecessaryforconductinganAudit.2. PerformamanualorelectronicAudit.3. SubmitAuditdataintotheWebAudit.4. ReviewDataQualityChecksintheWebAudit.
WhatistheAuditandwhydoit?
What:AprocessforassessingdiabetescareandhealthoutcomesforAmericanIndianandAlaskaNativepeoplewithdiagnoseddiabetes.
Why:1. Toworktowardsthegoalofprovidingalldiabetespatientswiththe
highestqualityofcare,asoutlinedintheIHSStandardsofCare2. Toassessthediabetescareprovidedatafacility,includingstrengthsand
areasforimprovement3. TofulfillrequirementsofSpecialDiabetesProgramforIndians(SDPI)
grants(participationinAnnualAudit)4. TocontributetoAreaandIHSoutcomemeasuresandreports
DiabetesStandardsofCare&ClinicalPracticeResources
https://www.ihs.gov/diabetes/clinician-resources/soc/
WhenareAuditsdone?
1. AnnualAudit:Onceperyear,datasubmittedtoandprocessedbytheIHSDivisionofDiabetesa. Periodofcare:Jan1-Dec31b. Duedate:Marchofthefollowingyear
2. InterimAudits*:Canbemanytimesperyear,forSDPI,Area,orlocaluse– checkwithyourAreaDiabetesConsultant(ADC)a. Periodofcare:LocallyorAreadeterminedb. Duedate:LocallyorAreadetermined
*UseoftheIHSDiabetesCareandOutcomesAudittoolsforanypurposeotherthantheAnnualDiabetesAudit.
WhoconductsAudit?
I/T/Uhealthcarefacilities
• ParticipationintheAnnualAuditisrequired forSDPIgrantees.• OthersarewelcomeandencouragedtoparticipateintheAnnualAudit.• AllparticipatingfacilitieshaveaccesstoallAuditresources,regardless
ofwhethertheyhaveanSDPIgrant.
WhatoutcomesdoestheAuditmeasure?
• Bloodpressure• Heightandweight• Tobaccouse• Exams• Education• Medications• Immunizations• Labresults• Comorbidities:depression,CVD,TB• More…
Therearechangeseveryyear!
DifferentTimePeriodsforDifferentItems
• Most Audititemsarereviewedforthepast12months,including:-Tobacco/ENDSscreening -Weight-Bloodpressure -Education-Medications -Labs
• Exceptions include:-Tobacco/ENDSuse -Height-TBtest/results/tx -Immunizations(exceptflu)-Healthconditions(e.g.,HTN,CVD)
• Lookforkeywords:“Auditperiod”,“ever”
EncountertoWebAudit
Throughouttheyear:1. Patientencounterstakeplace– Visitswithproviders,medicationpickup
orrefills,labtestsdone,immunizationsgiven,others2. InformationaboutencountersisdocumentedinpaperchartorEHR3. Other(historical)informationcanalsobeaddedtoEHR
Audittime:1. Patientisonregistryoraddedtodiabetespatientlist2. Auditis“run”onregistry/patientlist3. SelectedinformationispulledfromtheEHRaccordingtothedetailedlogic
(rules)foreachitemandusedinreportsorAuditdatafile4. AuditdatafileisuploadedintotheWebAudit
AuditMethods
ToconductanAudit,dataforpatientswithdiabetesarecollectedataclinicorhospitalbyoneoftwomethods:
1. ElectronicAudit:Dataareextractedfromanelectronicmedicalrecordsystemintoadatafile.
2. ManualAudit: PaperchartsarereviewedanddataarewrittenontoapaperAuditformforeachpatient.
SeetheAudit2017Instructions foradditionalinformation.
ElectronicAudits– RPMSvs.OthersTheprocessandrequirementsforconductinganelectronicAuditdependsonthehealthrecordsystemusedatyourfacility.
RPMS OtherSoftware programmingdoneby IHSforall Yoursoftwarecompany
orvendor
Preparation Install patchUpdatetaxonomies
Software dependent
Needseparatereportingsoftware No Usually
Healthfactors &examcodesused Yes Notusually(mayuseCPTcodes)
Educationdocumentation RPMSspecificcoding System dependentDiabetesregister/patientlisttools Yes Notusually
(createlist‘onthefly’basedonICDcodes)
ElectronicAuditProcess(Part1)
1. Updateelectronicdiabetesregistry/patientlistorconfirmthatit’scurrent.
2. PrepareelectronicmedicalrecordsystemforcurrentAuditsoftware(2017).ForRPMS/DMS:a. Verifythatpatch10hasbeeninstalledorrequestinstallationby
RPMSsitemanager.
b. Reviewandupdatelocal taxonomiesasneeded.
3. CreateAuditdataexportfilefor12-monthtimeperiodofinterest.
4. Retrieve Auditdatafile– mayrequireassistancefromOIT.
5. UploaddatafiletoWebAudit.
ManualAuditProcess(Part1)
1. SelectchartstoreviewaccordingtoAuditInstructions (allorasample).
2. Revieweachselectedmedicalchart.
3. CompleteoneAuditformforeachchart.
4. EnterdatamanuallyintoWebAudit.
Electronic&ManualAuditProcess(Part2)
Step WebAudit Tool(s)1 Enterfacilityinformation EnterFacilityInfo2 Submitdata(choose one)
ElectronicAuditManualAudit
UploadDataDataEntry
3 Checkdataforpotentialerrors→revisedataasneeded
DataQualityCheckView/EditData
4 Reviewreportsandgraphsofresults→ revisedataasneeded
AuditReports&TrendsGraphsView/EditData
5 “Lock”data LockFacilityData6 Completeusersurvey linkonscreenandinemail
AftergatheringAuditdata,intheWebAudit:
AuditDataSecurity
ManualAudits:Paperformscontainpatientdataandshouldbehandledaccordingtofacility’spolicies.
ElectronicAudits
• RPMS/DMSAuditfilescontainpatientdataandshouldbehandledaccordingtofacility’spolicies.
• SaveDMSAuditfilesinasecurelocation,asinstructedbyyourfacility.
AuditDataSecurity
WebAudit
• Donotgiveyourusername/passwordtoanyone.Morethanonepersonfromafacilitycanhaveaccess.
• Lockyourworkstationorlogoutifyouneedtodosomethingelse.
• Protectfilesanddocumentswithpatientdata(fromView/DownloadDataorDataQualityChecktool)accordingtolocalpolicies.
WebAudit Tips
1. Loggingin- Inyourbrowser,addtheWebAudit loginpageortheAuditmainwebpagetoyour‘favorites’.
2. DataEntry– Usethetabandnumberkeys.
3. WebAudit help– Emaillinkinlefthand menu.
4. InterimElectronicAudits – BesuretoselecttheAudityearthatmatchestheDMSAuditversionyouused(e.g.,2017forDM17).
Audits:Annualvs.Interimvs.SDPIRKMDataAnnualAudit InterimAudit SDPIRKMData
Frequency Once peryear Asmanyasneeded Asmanyasneeded
WebAudit Audit Type Annual Interim Interim
WebAudit VersionsAvailable
Currentyearonly Current+previous year
Current+previous year
ConductedWhen Feb-Marc Allyear Allyear
PeriodCovered Jan-Dec Locallydetermined Locallydetermined
DueDate 2018:3/15/2018 DeterminedbyAreaorprogram
2017Baseline:2/28/172017Final:1/31/18
Who isincluded Electronic:AlleligibleDMpatientsManual: AllorsampleofeligibleDMpatients
DeterminedbyAreaorprogram
SDPITargetGroup
DatareviewedbyDDTP Yes No No
Dataused fornationalreports
Yes No Yes(baseline&finalonly)
AuditResources
Website– Accessinformationandresourcesbelow– https://www.ihs.gov/diabetes– ClickontheIHSDiabetesAuditlinkinthelefthandmenu.
1. Materials:Form,Instructions,Checklists,RPMS/DMSAddendum
2. Training: Live,recorded,OIT/DMS,other3. SupportfromAuditteam(WebAudit andgeneral?):
[email protected]. OITServiceDesk(RPMSelectronicAudits):
https://www.ihs.gov/Helpdesk/5. AreaDiabetesConsultants/AreaAuditSupport
DiabetesAuditTeam
AnnBullock KarenSchellenbergerDirector,IHSDivisionofDiabetes WebAudit Developer
LoriButcher KarenSheffRPMSDeveloper Biostatistician,Support,Training
CeciliaButler MarkWilliamsWebAudit Support VisualDMSDeveloper
ChrisLamerRPMSSupport,ClinicalExpert
IntroductiontoAuditWebsite&WebAudit
Questions?
Thankyou!
WantmoreAudittraining?• AuditPowerTools:UnderstandingandUsingReportsandGraphs
Wednesdayat1:15p- FiestaI-II(sameroom)
• MakingtheCase:SharingDiabetesDatawithTribalLeadersandOtherStakeholdersWednesdayat2:20p- PavilionVI
• Don’tFilethatAuditReportAwayYet!UseYourDiabetesAuditforImprovementActivitiesThursdayat9:05a- FiestaI-II(sameroom)
• OutsidetheRPMSBox:Usingnon-RPMSSystemsforDiabetesDataWednesdayat3:35p- FiestaIII-IV
