Improved data management through clean data will make looking after patients easier for both GPs and their medical practices, as Dean Denman explains.
The new Primary Health Networks (PHNs) will have an increased role in supporting practices undertaking chronic disease management. Under the new arrangements there will be a greater focus on data analysis at the practice level. In the past many practices, particularly those that have taken part in federally funded quality improvement programs, have used clinical audit tools such as PENCAT and Canning. Many of the contracts for using these tools have now expired and other options are being explored.
Nearly all clinical software has built in tools to extract data useful for the management of chronic diseases.
Medical Director (MD) and Best Practice (BP) are the two most commonly used electronic health record systems in Australia. Both companies have support teams with experience in running queries and they are a great resource to get your practice started in identifying and managing your chronic disease patients. Your PHN’s practice support teams should also be able to provide guidance on database interrogation.
“Garbage in, garbage out” is an information technology maxim. Clean data is a requirement for useful analysis. BP and MD both have tools to simplify the process and “scrub up” your data.
The two main tasks are inactivating old patients and coding “free text” diagnoses.
An up to date list of patients allows you to concentrate efforts on useful activities. It is also an accreditation standard.
Coding all diagnoses is the first step in preventing patients missing out on possibly useful interventions. It is also an eHealth Practice Incentive Payments requirement
Best Practice
Inactivating patients is a simple process in BP. With the built in Search Tool set the “From Date” to two years ago, tick the NOT option and click Add and OK. The search returns those patients who have not been seen for two years. To remove these patients from your active list use the “Mark as Inactive” option in the File menu.
Coding diagnoses is also a simple matter but laborious depending on how many diagnoses have not been previously coded. The BP Utilities program has a “Clean up History” tool that allows users to work through the list of uncoded diagnoses and assign them codes. When opened this tool presents two lists – the left hand panel has uncoded diagnoses and the right a search list for the coded diagnosis that could be used. A “Replace” button makes the change.
Medical Director
Inactivating patients in MD is similar to BP. The built in search tool is accessible from the main screen. Select the “Patient” option and set “Not seen since” to two years ago. Click Search and use the “Inactivate Patients” option.
Diagnoses are coded through the HCN Maintenance suite. The Diagnosis Coder tool is in the Medical Director section. Select the uncoded diagnosis on the left and the coded diagnosis on the right to perform the coding.
Coding Policy
The coding diagnoses procedure above is a one off process. If free text diagnoses are allowed the data will become unsearchable once again. To prevent this the practice should have a data entry policy which stipulates that all diagnoses, where available, should be using the coding option supplied by the program. This is available via a drop down box in most programs.
Querying for patients at risk of, diagnosed with, or receiving treatment for - or none of the above and combinations of any of these - can be done with confidence once you have clean data
Useful and commonly used queries can be provided by your software’s support teams. Many vendors will also assist with custom queries. However, when requesting these, be clear and accurate in what you want. A minor change in query syntax can make a dramatic difference to the list that is returned.
If using the analyses for chronic disease management, practices need to aware of the ramifications.
- Data cleansing is time consuming. You will need to allocate sufficient staff time.
- Staff members have to be vigilant about the data they are entering (encourage a little OCD in your doctors!).
- Your database queries may not give you the information you want. If you are unsure, your PHN’s Practice Support Officers may be able to assist.
- Clean data maintenance requires regular administrative activity over and above normal patient consultation time.
- Poor data can compromise patient care.
- The practice is accountable for the data being used.
Once you have made these commitments you can reap the benefits.
- Data quality improves and is maintained and can lead to better care.
- There is no requirement for installation of third party software or for data sharing agreements with external parties.
- It is internal to the program so you have direct access to the patient record. No need to swap between programs to get access to additional information on a particular patient.
- It is customisable. Queries can be easily tailored to the practice's own requirements.
- Generating reminders or recalls is simple once a list of patients in returned by a query. (e.g. Diabetics due for a HBA1c, asthmatics without a spirometry performed in the last year.)
- Patients do not fall through the cracks and your patient population is generally better managed.
- Data is kept inside the practice. Privacy is maintained.
- Clean data serves as a good starting point and is a precursor to more comprehensive chronic disease management through clinical audit tools.
Australia's population is ageing and complex and chronic disease is becoming more common. Improved data management through clean data will make looking after patients easier for both GPs and their medical practices.
Dean Denman worked at Best Practice Software support for seven years where he had a keen interest in data analysis for better patient care. Earlier this year he moved to the Sunshine Coast Medicare Local (now PHN Country to Coast) where he is working on meaningful use of data in practice software in their chronic disease management programs.
