Nuts and Bolts of Conducting Diabetes Audits - … and Bolts of Conducting Diabetes Audits ... Education documentation RPMS specific coding Systemdependent ... All or sample of

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