Audit Design Tutorial 1: Creating a basic BMI register audit

In this tutorial you will create a basic audit specification. The audit will contain one section that will show the number of patients in a practice that are:

1. underweight;
2. in normal weight range;
3. overweight;
4. obese

In this first tutorial you will focus on creating the audit specification in the Audit Designer and adding a section and appropriate measures to show the patients in the BMI classifications above. For classifications we will be using the WHO BMI definitions.

Step 1 - create the audit definition

Start the Audit Designer application and select File|New Audit. You will then be presented with the following screen:

Fill out the form on the Audit tab as shown above. There is no need to change anything on either the Register or Display tabs. Once you have finished entering the data hit OK.

Step 2 - define the variables required

For this audit only one variable is required to identify the BMI value entered into the clinical system. From the Variables menu choose New Variable and fill out the form as follows:

This has defined a new variable called BMI that will pick out the most recent patient note with a Read code of 22K, which is the body mass index reading. You should then see that single variable listed in the Audit Designer Variables tab:

Step 3 - create the audit section

You now need to create an audit section to record the BMI measures under. Click on the Sections tab and select New Section from the Sections menu and fill out the form like so:

There is no need to change anything in the Register Rules tab. You have now defined a single section and Audit Designer should show the following:

Step 4 - define the measures & rules

You will need to now create all of the measures under this section for the different classifications:

The last measure, BMI coding not present, identifies all patients that do not have a record of their BMI in their notes.

To create the first measure, BMI<18.5, select New Measure from the Measures menu. You will then see a form like this:

Fill out the details on the Measure tab and then click on the Numerator tab and add the following rules:

The first rule will reject all patients that do not have a BMI reading in their records. It does this by checking that the date of the latest BMI reading is defined, i.e. does not equal zero. The second rule then accepts all patients where the value of their latest BMI reading is less than 18.5, i.e. underweight.

Once you have entered these rules click on OK and then create the BMI02 measure:

Note that the second and third numerator rule could have been combined into a single rule (BMI_VAL>=18.5) and (BMI_VAL<25) that would select if true.

You will need to repeat this for the BMI03 and BMI04 measures to create sub-sets of patients who are overweight (BMI25+) and obese (BMI 30+). This is left as an exercise for the reader to complete .

The final measure BMI05 collects all of the patients that do not have a BMI reading at all. You will need to enter the following details to define this:

Whereas all of the previous measure excludes patients without a BMI reading, this final one includes them.

Step 5 - save the audit and test it

You have now successfully defined your first audit, well done! Save it with the name bmi.xml.

The next step is to test the audit in iCAP. To do so follow these steps:

1. Copy the bmi.xml file in to the iCAP audit directory: c:\Program Files\Informatica Server\Client\Files\Audits;
2. (Re)start the iCAP application;
3. Double click on the iCAP icon and you should see your audit listed as BMI Analysis;
4. To see any data you must re-analyse the clinical data by selecting Analyse from the File menu and clicking on the *Analyse button in the window that appears;
5. Once analysis is complete click on the Close button and double click on the BMI Analysis icon, you should see a screen like this:

If there is no data in the audit after the analysis then go back and check that all of the expressions have been entered correctly.