PCS Clinical Audit Tool

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PCS Clinical Audit Tool

• Using Data Wisely
• Improving clinical data quality identifying
  business opportunity

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Factors limiting General Practice eHealth uptake

• Lack of national Standards
• Patchy incentives for enhancement of information
  technology
• Limited investment in change management
• Limited focus on practice systems quality
• No time to consider and review
• Limited and variable support

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And the Outcome

• Limited and patchy adoption of IS at the practice
• Poor quality and lack of consistency in data
• Lack of resources
• Lack of integration into work practice

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Clinical Audit can assist here

• Simplify the assessment of data quality by the GP
• Devolve some of the data quality issues to other
  practice staff
• Support financial opportunities around data
  quality
• Identify target population risk groups easily
• Monitor data quality improvement

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An extract from an article in Australian Doctor
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Real Life Results
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DemonstrationCAT in (the) Practice
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Screen shots from the PCS Clinical Audit Tool

• For further information please contact
• John Johnston BSc DipSci AIMM
• john.johnston_at_pencs.com.au
• Mobile [phone]

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The Opening Screen of the PCS Clinical Audit
System showing its 3 panes. At the left, the
population snapshots from the Clinical Desktop
System The General, Disease State and Medication
Filters to the right and the Graphical Report
Section to the Lower Right
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The Extracts area is a library of data snapshots
taken from the GP desktop system over time so
that changes in practice performance can be
reviewed over time.

• The Help Button exposes a training manual.
• The Collect Button starts the preparation of an
  extract from the underlying GP data
• The Hide Extracts button removes this pane after
  a specific snapshot has been selected for review

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The second pane containing the Filters of the
data. Under general there are some broad patient
selection criteria based on Age, Gender,
Ethnicity, presentation regularity etc
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The Conditions Filter allows the operator to
drill down through the clinical data by broad
(and more specific) chronic disease
classifications
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And the Medications Filter allows further
investigation to identify patients that have been
prescribed (or not prescribed) a chronic disease
medication type
All 3 Filters can be used in combination to
assist the GP or practice staff member to
generate more complex queries
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The 3rd Pane is the Reporting Pane where patient
information is presented in a graphical way to
highlight issues of interest.
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Here is a useful example of the Age and Gender
Distribution of the Practice Population. Which
age groups are not presenting at the practice?
Are they at risk?
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In Australia there is a growing focus on
improving GP clinical data quality. There are
incentives to GPs if they can lift their Allergy
recording to greater than 90
We have to get these patients here to less than
10 to qualify.
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So we can identify them by selecting the
appropriate slice of the Pie Chart. In all
examples in this presentation the patient
identification information has been hidden as
this is real data from a real practice
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And because Smoking is such an important
contributor to chronic disease there are
incentives for improving patient smoking status
information as wellin this example 583 of the
1539 regular patients at this clinic have no
smoking status recorded in the computer system
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Here is an example of using an Age Range Filter
and a Body Mass Index Report to show the BMI
status of a population
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And this is a Disease Prevalence Report for a
practice population. Note that there are
undefined diabetics here. They are patients
with diabetic conditions for which no diagnosis
of diabetes has been recorded. We can fix this by
identifying the patients and correcting their
records
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And the same Disease Prevalence Report can be
represented in patient number terms so you can
see that there are 203 patients with Hypertension
in a selected population of 1214 patients.
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So which of our practice patients have Heart
Failure? Easy, Click on the Heart Failure Column
and the system will display the patients.
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And for Womens Health Checks which are normally
scheduled for every 2 years there are incentive
payments for GPs to focus on those women that are
more than 4 years overdue. Note that nearly half
of the eligible women have no Pap Smear Status
recorded for them in the Clinical computer system.
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Some more examples around Lipids
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In this example we have selected the Diabetics
and we are looking at HBA1c levels and BP status
to assess levels of recording and of patient
control.
Continued next page
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And the BP results for the Diabetic population
(remember in this example we filtered the
search to look at the Diabetic population only)
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Here is an example how the tool can really help
manage quality. We have selected Diabetics and
filtered those to determine which are not taking
an Ace Inhibitor
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There are incentives to GPs to ensure that
Diabetics receive the best practice cycle of
care. This slide identifies the outstanding work
that needs to be recorded for the Diabetics in
this practice. We have selected patients overdue
for Eye Exams and identified them.
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And this is a standard report produced by the
system that presents patient coverage and health
status metrics for patients with Diabetes and
Coronary Heart Disease
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And using a well documented Cardiac Risk tool
based on the Framingham studies we can identify
patients assumed to be healthy who are at risk
of heart attack. The red ones have 20 risk of an
incident in the next 10 years
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But if there is not enough data in the system for
the Risk Calculator to be useful this report
advises the practice about the level of missing
data. If the patients highlighted below have a
record added for Smoking and BP they will comply
with the risk calculator.
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Australia is also interested in identifying
patients that are at risk of misadventure because
of the number of medications they are taking.
They offer substantial incentives to general
practice to work with pharmacists to consider
medication reviews for those taking 5 drugs or
more.
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So which patients have records that show that
they have more than 8 medications recorded in
their current medication history?
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For further information

• John Johnston BSc DipSci AIMM
• john.johnston_at_pencs.com.au
• Mobile [phone]