CHART case study

Improving patient care through quality data 2009

High-quality data is a critical component of a modern healthcare system.

As GP practices move towards a patient-led NHS, they are being challenged to demonstrate the quality of their patient care. This means improving data quality.

PRIMIS+ helps practices achieve quality data with training, support and analysis tools, including the free provision of CHART.

CHART is a software tool developed by two GPs with the real-world needs of practices in mind. CHART queries extract data from the practice”s clinical system using the MIQUEST interpreter.

The data is then displayed in summary sheets, graphs and Microsoft Excel spreadsheets.

CHART comes with query set libraries, including Local Delivery Plans (LDPs), the Quality and Outcomes Framework (QOF) and national data collections on flu and pneumococcal vaccine uptake. Other query sets are also available on the website.

Using CHART for the QOF

June Hartigan is the Data Quality/ Primary Care Programme Manager at Bury Primary Care Trust (PCT) and a PRIMIS+ facilitator. All the practices that June works with use CHART to analyse their clinical data.

“Some use it to look at the QOF or for doing their audits,” June explained. “They also use CHART for the LDP smoking and obesity returns and to help with learning disability registers.”

For those who have used CHART for the QOF, June felt that the “whole patient picture” was useful.

“Practices have found it helpful to look at all the data across one line for each patient, and to have all the information in one place.”

June’s practices also use CHART to look at each individual QOF area and print out a report of the information for the practice GPs. In particular, practices have been using CHART to identify potential patients with learning disabilities.

June said: “Practices may have compiled a disease register by searching their clinical system and asking the doctor who has personal knowledge of patients.

“By using CHART queries in addition to traditional sources, practices can check to see how accurate their information is.

“They can run the CHART query and easily cross-check it against the list they had already created. This is a great way to see if there is a patient they have missed.”

For June, a highlight of CHART has been the ability to get greater detail. “I like the fact that the summary sheet comes up first, because that’s what you’re querying for.

“You can then drill down to where you want more information. It’s all there ready for you. If you need detail, you can then go onto the spreadsheet and use the filters.”

Helping to simplify a shared server

One of the practices under June’s care is the Minden Medical Centre, where three practices share one clinical system server.

Maria Routledge, Computer Manager for the Centre, explained: “CHART has been a big help to us, because we are a group practice system. Everything we do is set up as if we were one large practice, including our data searches.

“CHART has helped by enabling us to split each practice’s data into separate lines through filters.

“Before CHART, things were so complex. It was difficult for me to individually create searches for all the necessary points of the GP Contract. With CHART, everything is preset. We just run the search and it does everything for us.”

June understands that the level of data in each of her practices can vary considerably and that this can affect their use of CHART.

“All the practices work at different levels,” June said. “Some have been using their clinical systems and producing the information they need for several years, and others haven’t been computer literate for very long.”

Flu vaccine uptake reporting

For national data collections such as flu vaccine uptake, CHART creates a summary which can be uploaded electronically to the Health Protection Agency. CHART also enables the practice to look at data quality in at-risk groups in order to validate them and to recall and monitor patients who fall into these areas.

Using CHART, PRIMIS+ facilitator Paul Wood and the North Yorkshire and York PCT, where he works, were able to plan their vaccination campaign, monitor their own progress and report nationally.

According to Paul, CHART made it easy for his GPs and practice staff to work with their patient data. “Previously GPs and practice staff were provided with a printed sheet and were asked to fill in the boxes,” he said.

“Practices don’t like this because it feels like nothing more than a “tick-box” exercise. By using the CHART queries, practices could share all the graphs and data with the entire primary care team.”

Paul believes the primary care sector needs an approach to uptake reporting that provides complete and consistent national data.

He said: “CHART was excellent because we had consistency across all practices. CHART also helps to identify where local codes have been used, something we are trying to eliminate as we work towards putting data on the national Spine.”

The efforts made by Paul and his PCT towards the annual flu data collection have truly paid off – with a 100% response in reporting on the flu vaccine update. In Paul’s words: “We couldn’t have done it without CHART!”

Pneumococcal vaccine uptake reporting

Wakefield District PCT Information Support Officers, Katherine Holroyd and Diane Ferry, have used CHART to help their practices improve pneumococcal vaccine uptake reporting.

Both feel CHART has made the process easier for their practices.

Katherine said: “It puts the information in front of them in an easy way so that they can see exactly who needs vaccinating.”

Diane added: “CHART saves administrative time for our practices and for ourselves. Sometimes practices don’t have IT support and their administrators do everything. CHART helps practices see who is most at risk.”

Rebecca Bailey, Office Manager at Middlestown Medical Centre, is based in Katherine and Diane’s PCT.

Rebecca said: “Before CHART we were just using searches on the clinical system and all we would get out were patient details. Now in the summary sheet in CHART, the at-risk groups and vaccine uptake are listed together.”

Once CHART was installed, Rebecca found the software user friendly. “We had no problem installing and running it, and after a couple of hours of training with Katherine and reading the instructions I felt confident that I could run the software.”

Both Katherine and Diane felt that CHART was an improvement on past methods of extracting and displaying the clinical information that practices need.

“It’s definitely an improvement on the system searches,” said Diane. “And for flu and pneumococcal, I would say it is very good. CHART gives the exact criteria asked for. It’s all done for you.”