California Cancer Registry 2010 Remote Access Feasibility & Reabstracting Audit Final Report The Data Standards and Quality Control Unit (DSQC) of the California Cancer Registry (CCR) performed a reabstracting audit remotely from the offices in Sacramento in 2010. An audit utilizing the Electronic Medical Record (EMR) remotely had not been performed and it was determined to design an audit to evaluate the efficacy of performing audits in this manner. Two facilities were initially contacted and invited to participate in this audit, unfortunately; only one facility in southern California was able to participate. The CCR had an advantage in that the facility that was able to participate for this pilot had a reabstracting audit performed in 2009. This allowed the CCR to use the prior year’s audit as a benchmark. The audit design evaluated the efficacy of performing an audit remotely while performing a routine reabstracting audit. The audit had two separate and equally important elements; audit performance and data quality. The audit performance component evaluated the efficiency of remote access, reliability of the EMR information accessed, and quality of the audit process being performed in this manner. The data quality component evaluated the quality and completeness of the data reported. A total of 50 cases were recently abstracted cases were selected for this audit. The 50 cases consisted of 25 Lung and Bronchus (C34.0 – C34.9) and 25 Colon and Rectum (C18.0 – 20.9). The 25 Colon and Rectum cases were further broken down to 13 Colon cases (C18.0 – 19.9) and 12 Rectal cases (C20.9). The 52 data items reabstracted from each source record for a total of 2600 possible discrepancies. The list of audited data items are demonstrated on Table 1. Standard audit procedures were followed. RESULTS Audit Performance The results of this audit in comparison to the traditional on-site audit revealed there was 227% increase in the number of potential discrepancies noted prior to reconciliation. As a result the hospital had a significantly higher number of cases needing reconciling. Upon completion of reconciliation, it is determined that the result is comparable to the benchmark on-site audit performed in 2009. This is demonstrated in Table 2. DSQC/Audit Files/Reabstracting Audits/2010 Reabstracting Audit-Remote Access/Final Report – Remote Auditing Pilot – 300.54 Page 1 California Cancer Registry 2010 Remote Access Feasibility & Reabstracting Audit Final Report There are advantages and disadvantages to performing an audit remotely. Some of the advantages to performing reabstracting audits remotely are:      Increased quality of audit – more admissions and records available for review by the auditors. This allowed a more detailed review of records to determine the quality of the submitted data. Many EMR’s included documents from Physician’s offices. This facility had the ability to include pertinent physician office documents such as consultation notes, treatment summaries, and outside pathology reports into their permanent EMR. This resulted in the auditors having access to more information to be used in determining the correct codes. Remote access allowed more records to be reviewed. Additional cases included in an audit results in a significantly statistically reliable audit. Since the records are available by accessing the EMR utilizing a web-connection, there was no travel needed. This resulted in a savings of approximately $1200 in travel expenses. Elimination of hospital staff time to arrange space for an on-site audit visit. Disadvantages of performing reabstracting audits remotely are:    Not all facilities that utilize EMR’s have the availability to allow remote access. One facility contacted to participate in this audit had an EMR but lacked the ability for remote access. Beyond the software capabilities, the health care system had policies in place that restricted out-side access of the EMR. Most EMR systems are “service date oriented” and attempting to determine the correct date of the records that are needed can be challenging. This is especially challenging when attempting to locate the appropriate documents to completely reabstract cases such as Class 20 cases. Significant considerations must be paid to allotted time that the auditor has access to the EMR. While it is an advantage to conduct the audit without having to travel to the facility, the distractions of routine office responsibilities such as meetings can easily dominate and preempt the auditor’s time. DSQC/Audit Files/Reabstracting Audits/2010 Reabstracting Audit-Remote Access/Final Report – Remote Auditing Pilot – 300.54 Page 2 California Cancer Registry 2010 Remote Access Feasibility & Reabstracting Audit Final Report Data Quality Of the 50 cases audited, 29 cases had no discrepancies identified. All discrepancies occurred in 21 cases. Nine (42.9%) of these cases were colon and rectum cases and 12 (57.1%) were lung cases. Of the 39 discrepancies identified, 15 (38.5%) occurred in colon and rectum cases and there were 24 discrepancies (61.5%) found in the lung cancer cases. The overall accuracy rate for this audit is 98.5%. CONCLUSION Conducting reabstracting audits remotely is a significant step toward improving the quality of reabstracting audits and conducting them in a timely and efficient manner. The results of this project demonstrate that conducting a reabstracting audit remotely affects the quality of the audit in a positive manner and should be pursued on a routine basis. DSQC/Audit Files/Reabstracting Audits/2010 Reabstracting Audit-Remote Access/Final Report – Remote Auditing Pilot – 300.54 Page 3 California Cancer Registry 2010 Remote Access Feasibility & Reabstracting Audit Final Report 140 Reconciliation Comparison On-Site vs. Remote Access 121 120 100 80 60 39 37 40 16 20 0 Pre Reconciliation Post Reconciliation Pre Reconsiliation 2009 On-site audit 2010 Remote Access Table 2 DSQC/Audit Files/Reabstracting Audits/2010 Reabstracting Audit-Remote Access/Final Report – Remote Auditing Pilot – 300.54 Page 4 Post Reconciliation