Monday, May 29, 2006
This Web Site was last up-dated in Feb 2006
Tuesday, November 02, 2004
Addressing the backlog information:
Our center recently presented a talk on addressing our backlog at the November 2005 CIBMTR/NMDP meeting. We were able to decrease the amount of forms due from our Feb 2005 report to October 2005 by over 1400 forms. We worked with the registry the last couple of years to accomplish this. Our data staff, BMT physicians, manager and administration made the commitment to accomplish this after the registry informed us that we would not be able to stay a research center if we did not become more compliant with our data reporting. The mentoring group requested that we post the tools that we have made on the web site so you may contact us to receive them. Please feel free to contact any one of us from our medical center to get an electronic or faxed version of our tools.
Norine Huneke (TED, TED FU, pre-registration of pediatric patients, CORE, CORE FU) 507-284-9925 huneke.norine@mayo.edu
LeAnn Batterson (TED, TED FU, CORE, CORE FU) 507-538-8331 batterson.leann@mayo.edu
Joni Amundson (adult pre-registration and NMDP patients) 507-538-0735 amundson.joni@mayo.edu
Here is a list and brief description of them. Please feel free to revise to suit your center.
We had trouble getting our pre-registration reported. We made laminated flags to try to streamline this for each disease. These have gone through several revisions over time. Our nurse coordinators prompt the doctors with the flag at the time of the pretransplant visit so the doctors will include the needed information in their dictation. We also made pocket versions of these as some doctors wanted them easily accessible. We also post reminders in the area that the doctors do their dictation.
We have a sheet that is used when we go the BMT unit each week to collect problems, procedures, mucositis scoring, and engraftment so we can come back and enter these into our database. We do this on each transplant patient-inpatient or outpatient until they come back to our clinic. For allogeneic transplant patients we have a weekly GVHD scoring sheet that is used at this weekly meeting.
Our database is able to print a helper report of the information that we enter to ease filling out the Core forms. It has the page and question number of the Core. We are happy to send a copy of it to see if you are able to get something similar to this generated from your database.
We then made day 100-annual visit flags for each disease so the doctors are reminded to include the necessary information in their notes. We also have a Day 100 GVHD scoring sheet that the doctors fill out on allogeneic transplant patients. We also have a questionnaire for the patient to fill out at these visits which we keep in our folder that we start for each patient with a copy of the forms that are submitted.
We have a spreadsheet of the transplants for each year. On this we have their clinic number, registry ID, name, date of transplant, transplant type, diagnosis and last date submitted to the registry. Patients are removed from the list when deceased and death has been reported to the registry. This way we are able to sort the list by date last seen and know when a follow up will be due instead of waiting for the report from the registry. Our database is able to generate a list of patients each month that have not been updated for 180 days. We then look to see if they have been seen at our center or if the LMD has sent in an update. We update our database at that time so we will have the needed information for the registry. If we do not have either of these, we then rotate between contacting the patient or LMD. We are happy to share these letters with anyone that is interested. We include a post paid addressed envelope when we send these out for a better response on these.
We track our progress each week and have expectations with the amount of forms that need to go into the registry. This will hopefully help us to prevent a future backlog.
Norine Huneke
Source documentation:
What is a source document?
A source document is the original document (or a copy of the original document) that proves that a specific event has occurred. e.g. if a patient is diagnosed with AML then the source document is the first biopsy or bone marrow examination that proves this is correct and the date of biopsy or bone marrow on this document is the patient’s date of diagnosis. As a part of good medical practice and especially when audited then a question might be is the date of the patients diagnosis correct? This copy of the test will prove that the date reported is correct by showing the source documentation
Interpretation of source documentation:
Not all events that occur are as clear-cut to prove as the example given above and they need to be interpreted and documented by the physicians, e.g. to be able to diagnose some diseases then the combination of different examinations and test form the basis on which the physician makes the diagnosis. The source document is all the different examinations and tests and also the documentation for the physician’s decision regarding the diagnosis. Sometimes a patient’s disease is monitored by different scans. How to interpret results from different scans can be tricky so the source documentation is both the results from the different scans and the evaluation of the results in the patient’s medical records by the physician.
When is source documentation necessary?
Source documentation is necessary whenever a question on report forms is answered. In general key source documents are the source documents that support the information given on the CIBMTR Pre-Registration form, M-TED, TED Follow up, Core Form, TED form, and also information about the graft and donor. Sometimes the source documentation is not available or cannot be reproduced, then it is a good idea to keep documentation showing the effort you have done in order to obtain the source documentation e.g. the e-mails or letters that you have mailed to other institutions and their replies to prove that you have taken action to find the documentation needed, but with out any success. A “NOTE TO FILE” to put in the medical record chart documenting the steps that were taken and the outcome, the date and your signature, is also a good tool to use.
How to obtain source documentation?
In an ideal world, a source document should be a part of the patient’s medical record but in reality things are a bit different. So to solve this problem, CRP and DM often develop different individual strategies or institution specific systems to solve this problem.
In general the problem can be divided into 3 main areas
1. To obtain information and documentation regarding the patient’s medical history and diagnosis information before transplant.
2. To obtain information and documentation in relation to the patient’s transplant course.
3. To obtain information and documentation in relation to the patient’s medical history after the transplant.
To inspire you how to address these problems we will provide you with tips and ideas that CRP and DM at different institutions have found to be useful.
Our center recently presented a talk on addressing our backlog at the November 2005 CIBMTR/NMDP meeting. We were able to decrease the amount of forms due from our Feb 2005 report to October 2005 by over 1400 forms. We worked with the registry the last couple of years to accomplish this. Our data staff, BMT physicians, manager and administration made the commitment to accomplish this after the registry informed us that we would not be able to stay a research center if we did not become more compliant with our data reporting. The mentoring group requested that we post the tools that we have made on the web site so you may contact us to receive them. Please feel free to contact any one of us from our medical center to get an electronic or faxed version of our tools.
Norine Huneke (TED, TED FU, pre-registration of pediatric patients, CORE, CORE FU) 507-284-9925 huneke.norine@mayo.edu
LeAnn Batterson (TED, TED FU, CORE, CORE FU) 507-538-8331 batterson.leann@mayo.edu
Joni Amundson (adult pre-registration and NMDP patients) 507-538-0735 amundson.joni@mayo.edu
Here is a list and brief description of them. Please feel free to revise to suit your center.
We had trouble getting our pre-registration reported. We made laminated flags to try to streamline this for each disease. These have gone through several revisions over time. Our nurse coordinators prompt the doctors with the flag at the time of the pretransplant visit so the doctors will include the needed information in their dictation. We also made pocket versions of these as some doctors wanted them easily accessible. We also post reminders in the area that the doctors do their dictation.
We have a sheet that is used when we go the BMT unit each week to collect problems, procedures, mucositis scoring, and engraftment so we can come back and enter these into our database. We do this on each transplant patient-inpatient or outpatient until they come back to our clinic. For allogeneic transplant patients we have a weekly GVHD scoring sheet that is used at this weekly meeting.
Our database is able to print a helper report of the information that we enter to ease filling out the Core forms. It has the page and question number of the Core. We are happy to send a copy of it to see if you are able to get something similar to this generated from your database.
We then made day 100-annual visit flags for each disease so the doctors are reminded to include the necessary information in their notes. We also have a Day 100 GVHD scoring sheet that the doctors fill out on allogeneic transplant patients. We also have a questionnaire for the patient to fill out at these visits which we keep in our folder that we start for each patient with a copy of the forms that are submitted.
We have a spreadsheet of the transplants for each year. On this we have their clinic number, registry ID, name, date of transplant, transplant type, diagnosis and last date submitted to the registry. Patients are removed from the list when deceased and death has been reported to the registry. This way we are able to sort the list by date last seen and know when a follow up will be due instead of waiting for the report from the registry. Our database is able to generate a list of patients each month that have not been updated for 180 days. We then look to see if they have been seen at our center or if the LMD has sent in an update. We update our database at that time so we will have the needed information for the registry. If we do not have either of these, we then rotate between contacting the patient or LMD. We are happy to share these letters with anyone that is interested. We include a post paid addressed envelope when we send these out for a better response on these.
We track our progress each week and have expectations with the amount of forms that need to go into the registry. This will hopefully help us to prevent a future backlog.
Norine Huneke
Source documentation:
What is a source document?
A source document is the original document (or a copy of the original document) that proves that a specific event has occurred. e.g. if a patient is diagnosed with AML then the source document is the first biopsy or bone marrow examination that proves this is correct and the date of biopsy or bone marrow on this document is the patient’s date of diagnosis. As a part of good medical practice and especially when audited then a question might be is the date of the patients diagnosis correct? This copy of the test will prove that the date reported is correct by showing the source documentation
Interpretation of source documentation:
Not all events that occur are as clear-cut to prove as the example given above and they need to be interpreted and documented by the physicians, e.g. to be able to diagnose some diseases then the combination of different examinations and test form the basis on which the physician makes the diagnosis. The source document is all the different examinations and tests and also the documentation for the physician’s decision regarding the diagnosis. Sometimes a patient’s disease is monitored by different scans. How to interpret results from different scans can be tricky so the source documentation is both the results from the different scans and the evaluation of the results in the patient’s medical records by the physician.
When is source documentation necessary?
Source documentation is necessary whenever a question on report forms is answered. In general key source documents are the source documents that support the information given on the CIBMTR Pre-Registration form, M-TED, TED Follow up, Core Form, TED form, and also information about the graft and donor. Sometimes the source documentation is not available or cannot be reproduced, then it is a good idea to keep documentation showing the effort you have done in order to obtain the source documentation e.g. the e-mails or letters that you have mailed to other institutions and their replies to prove that you have taken action to find the documentation needed, but with out any success. A “NOTE TO FILE” to put in the medical record chart documenting the steps that were taken and the outcome, the date and your signature, is also a good tool to use.
How to obtain source documentation?
In an ideal world, a source document should be a part of the patient’s medical record but in reality things are a bit different. So to solve this problem, CRP and DM often develop different individual strategies or institution specific systems to solve this problem.
In general the problem can be divided into 3 main areas
1. To obtain information and documentation regarding the patient’s medical history and diagnosis information before transplant.
2. To obtain information and documentation in relation to the patient’s transplant course.
3. To obtain information and documentation in relation to the patient’s medical history after the transplant.
To inspire you how to address these problems we will provide you with tips and ideas that CRP and DM at different institutions have found to be useful.
