3.  MANUAL CHART REVIEW vs. 'ELECTRONIC' (RPMS) AUDITING

For patients at your facility, diabetes care elements and certain outcome measures may be determined in one of two ways: either by sitting down and physically reviewing the medical record (a manual audit), or by performing a computerized review via RPMS' Diabetes Management module (an "electronic" audit, or e-audit). The instructions in this document refer to the manual chart review process. Specific instructions for the electronic audit are available in the User's Manual of the Diabetes Management System (BDM). If not readily available locally, the pertinent sections of the User's Manual may be viewed in PDF format at: http://www.ihs.gov/Cio/RPMS/index.cfm?module=home&option=documents (select Diabetes Management System from the menu).

There are pros and cons to both the manual and electronic audits. The manual chart review is more time consuming and is subject to both the benefits and liabilities of requiring human judgment in the audit process. The electronic audit is much quicker, although it requires time and attention to careful set up before the first audit can be run. E-audits are independent of human judgment (determinations are made by internally programmed computer logic) and are therefore more consistent than manual audits. Their accuracy is much more subject to proper documentation, coding and data entry issues.  More and more facilities are opting to perform e-audits due to the time savings and ease of performing regular periodic audits once the initial setup has been completed.

For facilities that wish to do their audits electronically, it is imperative that they initially run simultaneous manual and e-audits and compare the results. In theory, the results from the manual and e-audit should be quite similar.  If the results of one or more of the elements are significantly different, an investigation into the reasons for the divergence needs to be undertaken. Once the differences are resolved, the two auditing methods should yield analogous results and electronic audits could then be used as the primary source of audit data.