| Rationale |
| Procedure |
| Using the Usual Doctor |
| Using the Audit Trail |
| Using the Summary Sheet |
| Notes |
In order to maintain the accuracy of the disease register, certain housekeeping procedures should be followed at least annually and more frequently initially. This is because errors inevitably creep in when coding patients medical records. For example a patient might be seen with chest pain and coded as having CHD, when subsequently the patient is shown not to have the condition. Conversely a patient might be admitted through casualty with an MI and the diagnosis then fail to be coded despite being commenced on nitrates. Housekeeping is designed to systematically identify these errors with the minimum of effort. Housekeeping is a systematic way of creating and maintaining disease registers and is essential for reliable audit and recall. It may also carry medico-legal benefits. Erroneous codes finding their way unchecked into electronically generated medical reports saying that a patient has heart disease when in fact they do not could be a cause for complaint. E.g. if a patient was turned down for insurance or had their premiums unnecessarily loaded.
A Housekeeping set of Miquest queries is available for the purpose and can be downloaded from the website. These are run as usual. They should be run 2-3 weeks before the audit queries so that the registers can be corrected prior to the audit. These are analysed in-house using the spreadsheet that comes with the set. Download the set and the spreadsheet to a blank floppy and upload the set to your clinical system from the floppy and run them as usual. Download the response files onto the same floppy. Open the spreadsheet that you downloaded and it will automatically open the response files and analyse them for you once you have enabled the macros. Once analysed it contains lists of patients who are likely to have the conditions covered by the set, but are not correctly registered. The notes of these patients, electronic or otherwise should be reviewed and these patients disease registration amended accordingly using the appropriate template or erroneous coded entries removed. The instructions for doing so are on the spreadsheets.
The Housekeeping spreadsheet can sort the identified patients by usual doctor (which defaults to registered doctor if a usual doctor is not specified). This means that the job of checking the patients can be divided up between the doctors, with the doctor most likely to know the patient doing the check. (It also means that those doctors whose ongoing efforts at coding are good will end up with less to check when housekeeping is performed!)
Sometimes it is clear that a systematic error in coding is occurring. E.g. someone, despite everyone theoretically knowing what to do, keeps adding erroneous codes. It is possible in EMIS to use the audit trail to track down the culprit and have a quiet word. In EMIS select the patient in whose records the problem appears. Then type PO, D, A. You then select the date range that includes the coding problem you identified. On displaying the report to screen you should then be able to see when the erroneous code was added and who by.
(If anyone knows how to do this in other systems please tell us )
The housekeeping analysis also breaks down the patients that need checking by patient and disease register. A number of patients will need checks done for more than one register. This sheet allows you to see this easily so that all the register checks needed for each patient can be done in one go, avoiding repetition.
The housekeeping set for CHD & diabetes also checks for other cardiovascular disease namely AF, Atherosclerosis, Stroke, Heart Failure and Diabetes. Practices at the stage of doing CHD alone can ignore these sheets and stick to the three that deal with CHD i.e. those entitled CHD1, NITRATE and CHD2. Some patients on the Nitrate sheet will have been prescribed nitrates for anal fissure these are identified on the sheet, as they are unlikely to have CHD! Some patients appearing on the Nitrate sheet will also appear on the CHD2 sheet. These are identified as duplicates on the CHD2 sheet to avoid checking their records twice.
The diabetes sheets DM1 etc perform a similar job to ensure accurate identification of patients and the correction of inconsistencies in coding.
Initially, the housekeeping set usually generates a lot of patients for checking, particularly if a practice is attempting a register for the first time. Experience has shown that it will rapidly bring the number of patients on the register close to the expected value.
However, with good training of all staff on ongoing coding of patients and effective systems for handling information, the number of patients these searches pick up subsequently should be relatively small. It is important to run the search and act on it at least annually to prevent the accumulation of errors in the disease register.