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INFOGRAPHIC: Diabetes Control Chart

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I always liked graphics to represent my certain thoughts into meaningful graphical diagrams or visuals. I think they are better off then mere words. So in this post I like to establish infographics that I wish to share with you I think that indirectly relates to the HIM/Medical Records Management profession.

Before that, I think Wkipedia can help us understand what is infographics.

“Information graphics or infographics are graphic visual representations of information, data or knowledge. These graphics present complex information quickly and clearly, such as in signs, maps, journalism, technical writing, and education. With an information graphic, computer scientists, mathematicians, and statisticians develop and communicate concepts using a single symbol to process information”.

To start off my postings on infographics , we sure know diabetes is one bad disease. If you are a diabetic or some next-of-kin is, a sample of blood from you or some next-of-kin will show a test result reading for a HbA1c or A1c test.

Ever wondered what this test is all about?

So here is one nice infographic on Diabetes Control Chart to tell you what Glycated/Glycosylated Hemoglobin(HbA1c or A1c test) is all about.

I am not saying infographics say it all or are stand-alone. So I think some words to go along can do justice to an infographic like this one and also as a background to better understand the infographic.

So here goes – the HbA1c or A1c test is used as a guide to know what is your average blood glucose level during the past three months. Glucose tends to stick to red blood cells (RBCs) – so the more the glucose in the blood, the more RBCs have glucose on their surface. Normally 4 to 6 red cells in 100 have glucose attached to their surface; hence the range of HbA1c in a normal person is 4 to 6% (4/100 to 6/100 multiplied by 100 to give your the %)

This infographic is intended to show you instantly and graphically the HbA1c test Score, mean blood, and glucose levels in the EXCELLENT, GOOD & POOR ranges, those who already know about their HbA1c test result just use the Diabetes Control Chart to know their range and how well their diabetes is under control.

So the next time you find HbA1c or A1c test recorded in the patient clinical record, or in the Lab results attachments of your medical record, you know it already.

Any ways for Type 1 and Type II diabetics, better control of glucose means lesser the complications of diabetes related to your heart, blood vessels, kidneys, brain, nerves, eyes and feet. Keeping your sugars under control means healthier and longer life. It is worth all your efforts.

JCI MCI19.1 & MCI19.1.1 – Patient Clinical Record

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The Standard MCI.19.1 states “The clinical record contains sufficient information to identify the patient, to support the diagnosis, to justify the treatment, to document the course and results of treatment, and to promote continuity of care among health care practitioners” , while the Standard (sub-standard) MCI.19.1.1 states that “The clinical record of every patient receiving emergency care includes the time of arrival, the conclusions at
termination of treatment, the patient’s condition at discharge, and follow-up care instructions”.

The clinical record is only complete and can satisfy the above standards if your hospital has implemented a standarised medical record format and content of a patient’s clinical record to help promote the integration and continuity of care among the various practitioners of care to the patient.

Let us now view as below the standards, their respective MEs, and how I suggest (my suggestions in brown) each of these MEs can meet full compliance for these two standards (double-click on each of the following images BELOW for a larger view of each image which will then display in a new tab of the current window of your browser) :

NOTE: With the exception of MCI.19.1 and MCI.19.1, all the other standards in this post refer to other forms of entries in the patient clinical record.


11th International Classification of Diseases

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For the first time, experts in the public health community who work with patient diagnosis and treatment have an opportunity to contribute to the development of the next version of the International Classification of Diseases (ICD), which is WHO’s publication that ensures all members of the health community refer to diseases and health conditions in a consistent way.

WHO is releasing the beta version of what will be ICD-11 on a wiki-type platform that allows stakeholder comments to be added after peer review. The final ICD-11 will be released in 2015.

WHO encourages anyone interested to comment to develop a more comprehensive classification.

Foundation for reliable health data

The ICD is the foundation for the identification of health trends and statistics globally. Receiving input from health experts will greatly improve the representation from current medical practice and create insight from a broader diversity of medicine.

“Literally this is what doctors use to diagnose a patient,” says Tevfik Bedirhan Ustun, coordinator in the Department of Health Statistics and Information Systems. “It is how we define the cause of death when a person dies. In research, it is how we classify health problems based on evidence.”

The ICD is the gold standard for defining and reporting diseases and health conditions. It allows the world to compare and share health information using a common language.

In addition to health providers, the ICD is a key tool used by epidemiologists to study disease patterns, insurers, national health programme managers, data collection specialists, and others who track global health progress and how health resources are spent.

ICD-11 innovations

Using advances in information technology, this ICD revision will allow users to collect data on cause of death, advances in science and medicine, emerging diseases and health conditions, and compare information across the globe with more ease and diversity in the service of public health and clinical reporting.

New features of the 11th version

  • There will be a new chapter on traditional medicine, which constitutes a significant part of health care in many parts of the world.
  • It will be ready to use with electronic health records and applications.
  • It will updated through the development phase to reflect new knowledge as it is added to the classification.
  • It will be produced in multiple languages through the development phase.

How to participate in ICD-11

Public health experts interested in contributing to ICD-11 can review the classification and register to join the consultation now. The final version of ICD-11 will be launched in 2015.

Source: http://www.who.int/features/2012/international_classification_disease/en/index.html

JCI Standard MCI.1 – brochure example

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In my previous post JCI Standard MCI.1, I talked about the “Communication with the Community” and how the HIM/MR Department communicates with its community to facilitate access to care and access to information provided by the HIM/MR Department of a hospital.

I like to share with you (with expressed permission) this brochure (file will open in a new tab of your current window of your browser) from St Vincent’s Hospital Sydney Ltd, a facility of St Vincents & Mater Health Sydney, Darlinghurst, NSW, Australia. I have always admired the Aussies for a high standard in documentation!

I think it is a good brochure on communication with the community about the privacy of a patient’s health information.

JCI Standard MCI.19 Patient Clinical Record – a review

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In continuation to the post JCI Standard MCI.19 Patient Clinical Record, the first standard, its intent and the measurable elements are:

Standard MCI.19
The organization initiates and maintains a clinical record for every patient assessed or treated.

Intent of MCI.19
Every patient assessed or treated in a health care organization as an inpatient, outpatient, or urgent care patient has a clinical record. The record is assigned an identifier unique to the patient, or some other mechanism is used to link the patient with his or her clinical record. A single record and a single identifier enable the organization to easily locate patient clinical records and to document the care of patients over time.

Measurable Elements of MCI.19

  1. A clinical record is initiated for every patient assessed or treated by the organization.
  2. Patient clinical records are maintained through the use of an identifier unique to the patient or some other effective method.

Examining the intent and the measureable elements for this standard from above, I think it is important to know answers to the following questions:

Does your hospital initiate and maintain a clinical record for every patient assessed or treated?

A patient or clinical record is defined (Michelle, A.G. & Mary J.B. 2011, pg 70) “as the business record for a patient encounter, contains documentation of all health care services provided to a patient, and is a repository of information that includes  demographic data, as well as documentation to support diagnoses, justify treatment, and record treatment results.”1

1Essentials of Health Information” (Michelle, A.G. & Mary J.B. 2011, Management: Principles and Practices, 2nd edn, Delmar, Cengage Learning, New York

So since your hospital initiates and maintains a clinical record for every patient assessed or treated, who are these kinds of patient at your hospital?

Hospital patients are usually categorised as ambulatory patients (outpatients), ambulatory surgery patients(e.g., day surgery), emergency care patients, inpatients, newborn patients, observation care patients, and subacute care patients.

Now that you have identified your list of patient types/categories, how do you identify each of these identified groups of patients? State your method and how does it work?

Do you provide a single clinical record or multiple records?

Does your method use an unique identifier? If so, what is this unique identifier?
The Medical Record Number(MRN) is commonly used as this unique identifier.

How do you maintain your patient clinical records?
The above standards do not specify methods for record management,  all hospitals must implement systems to effectively manage and control records.
In addition, filing controls are established to ensure accurate filing and timely retrieval of patient records, including:

  • Chart tracking system (they could be manual or computerised)
  • File guides
  • Periodic audit of file system

It is the intent of this standard that using an unique identifier, your hospital can easily locate patient clinical records and to document the care of patients over time. How do you locate your patient clinical records using this unique identifier?

How do you link the patient with his or her clinical record?

A master patient index (MPI), sometimes called a master person index (MPI), links a patient’s medical record number with common identification data elements (e.g., patient’s complete name, date of birth, gender, mother’s maiden name, and social security number).

If your unique identifier is the MRN, then how is your MPI used to link the patient with his or her clinical record?

Your answers to the above questions must be outlined in the HIM/MR departmental policies and procedures. Your answers will provide the JCI surveryor(s) the opportunity to evaluate the compliance to this standard and chances are, he or she will give a full compliance score for this standard, if all is in order and well documented and answers answered well!