IM&T DES e-Audit

Dr Dai Evans

Clinical Advisor, PRIMIS+

Context 1

• IM&T DES part 1Prepare plan, TNA, training, N3, smart cards (40p/pt)

• IM&T DES part 2Accreditation for paper-light practices (44p/pt)

• IM&T DES part 3Demographic validation & EPS (27p/pt)

• IM&T DES part 4Moving to a hosted system (22p/pt)

Context 2: IM&T DES Part 2

• Practice Data is “fit for sharing” **

• Standards as in “Good Practice Guidelines”

• Mixture of practice submission, e-audit and practice visit by assessor

• Occurs after “preparation” (formative) phase

• Outline details in the DES specification

facilitator works with practice on

plan for PCT and draft submission

prepare plan for PCT

dummy run with facilitator

PASS

FAIL

assessor visit

PASS

FAIL

PRIMIS+ trains facilitator

PRIMIS+ trains assessor

e-audit

organisa-tional

IG Toolkit

Component 1submit plan to

PCT

revise plan

PASS

40p per patient

44p per patient

Component 3address validation

and EPS use

27p per patient

Component 4migration to NHS

CfH hosted system

22p per patient

Component 2data accreditation

e-audit

organisa-tional

IG Toolkit

FAIL

PRIMIS+ provides e-audit toolkit

upload summary to

Spine

Pre-Requisite for DQA

• Practice must be “paperlight”.

• Entering consultations contemporaneously where appropriate

e-Audit

• Drug to Disease Audits (MIQUEST)• Presence of some Disease codes (MIQUEST)• Presence of other expected codes (MIQUEST)• Event Date inconsistencies (MIQUEST)

• Other audit sources (QoF/QMAS) to support process (i.e. re disease prevalence etc.)

• System specific for those general aspects not handled by MIQUEST (location, ? Reg data, significance)

• There will be a “Bank” of audits – how implemented

Other Aspects

• Two broad query sets:

- preparation for accreditation

- accreditation• Will need to be fed back to:

- practice

- facilitator/assessor

- PRIMIS+ (anonymised) • Standard output proposed to CHART

Patient Confidentiality

• E-audit output will be broadly anonymised

• BUT, assessors may need to see patient identifiable records

• There is guidance from DoH “permitting” this in this circumstance (?reference)

• A good idea to inform patients in the month before the assessment re any objections

What Facilitators need to do (1)

• Read and understand Good Practice Guidelines (2005)

• Support practices in submission preparation and throughout process

• Deliver baseline assessment and Training Needs Assessment (TNA) for practices

• Understand Information Governance and Data Quality re practices

Facilitators Role (2)

• Run pre-accreditation queries and assist practices in their interpretation

• Run Accreditation set

• Assist compilation of material for Assessors

0

50

100

150

200

250

1 2 3 4 5

Number of READ codes

Fre

qu

en

cy

Read codes / Hysterectomy

0

50

100

150

200

250

1 2 3 4 5 6

Number

Fre

qu

en

cy

No. of event dates for each pts Hysterectomy

Chart Showing A Single Entry Or Time Between First And Last Hysterectomies.

0

50

100

150

200

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300

350

400

450

1 Entry A Month Less than a year More than a year

Collated Hysterectomy Entry Data

Pa

tie

nts

0

10

20

30

40

50

60

70

1 2 3 4

ADQ1A Subset of patients on Tamoxifen in L5 yrsADQ1B Subset patients on Tamoxifen with Breast Ca Dx

0

5

10

15

20

25

30

35

40

45

1 2 3 4

ADQ7A Subset of patients on Cardiac Arr Rx in 5 yr 1 ADQ7B Pts on glaucoma Rx in 5 yr with Cardiac Arrythm Dx1Pts in ADQ7A

0

5

10

15

20

25

30

35

40

45

50

1 2 3 4

ADQ9A Subset of patients on Montelukast in 5 yr ADQ9B Pts on Montelukast in 5 yr with Asthma Dx

0

2

4

6

8

10

12

1 2 3 4

No of patients with Anklylosing Spondylitis

Number of patients with Senile Macular Degeneration

0

10

20

30

40

50

60

1 2 3 4

Proposed Tools

• CHART

• Handle MIQUEST & supplier queries

• Give feedback to practice

• Provide reports for facilitator & PCT assessor

• Feedback to PRIMIS online (comparison)

Ongoing Pilot Work

• Looking at query design

• Testing software functions

• In Autumn looking at whole process

• Bearing in mind may be subtle changes twixt now & then

• So what’s a fail then?

Summary• The process formalises what you have

been doing for a while (with £)

• It brings it up the practice agenda

• Mixture of formative preparation & summative assessment

• Perhaps a first stage

Questions?