Video summary

3° COHORTE - MOD1 SEM3: 1°clase (asincrónica) Dr. Sergio Albarracín

Main summary

Key takeaways

Educational

Main ideas, concepts, and lessons

Purpose of the module (professional auditing intro)

  • Defines and characterizes professional auditing as applied in healthcare.
  • Sets expectations to cover multiple auditing areas, including:
    • auditing of professional care
    • responsibility in professional practice
    • quality auditing and evaluation
    • emerging artificial intelligence auditing

Audit of professional care (healthcare auditing)

  • Defined as a critical and periodic evaluation of the quality of healthcare received by patients.
  • Conducted by reviewing and studying:
    • medical records
    • relevant statistics
  • Core purpose: ensure patients receive the best possible medical care.
  • Specific objective: raise the quality of care.
  • Emphasizes a relationship between record quality and care quality:
    • by working from documented “what was done,” auditors evaluate both:
      • the quality of the records
      • the quality of the care provided

Essential criteria for an auditor

  • Independence from activities being audited
  • Management support to perform work autonomously and without hindrance
  • Objective mindset to preserve result integrity
  • Competence requirements:
    • in-depth knowledge
    • ability to apply relevant auditing standards, procedures, and techniques
  • Professional ethics:
    • honesty
    • objectivity
    • diligence
    • loyalty

Main stages of the audit process (as a structured program)

The auditor should document stages in a written program (ideally).

  1. Planning
    • define objectives and scope
    • identify activities to analyze
    • specify resources needed
    • conduct field analysis
    • identify critical areas, etc.
  2. Examination and evaluation of information
    • collect, interpret, and analyze the selected data
  3. Presentation of results
    • generate conclusions and recommendations/opinions
    • submit written reports
    • reports can be disseminated
  4. Follow-up
    • verify whether corrective actions are applied
    • check whether actions achieve desired objectives

Central documentation: the clinical record

  • The clinical record (medical history/patient file/report/discharge summary/any care-related document) is described as the key audit document.
  • It records:
    • all medical services received
    • examinations performed
    • requested studies
    • health status/pathology and actions taken to support recovery
  • Includes confidentiality and professional secrecy.
  • Requirements to function as a judicial/proof instrument:
    • clear and legible writing (if physical)
    • records must be:
      • complete
      • timely
      • relevant
      • clear, concise, and organized
  • Principle emphasized: “what is not written is assumed not to have been done.”
  • Clinical records are unique per establishment/institution.

Fields / scope of professional auditing

Auditing is framed as a clinical management tool that can extend across healthcare, administrative, and financial dimensions. Examples include:

  • Normative aspects
    • support development, review, and readjustment of:
      • norms
      • guidelines
      • procedure manuals
    • track degree of compliance
  • Medico-legal aspects
    • prevent inefficient medical practice
    • ensure compliance with legal regulations and health provisions
    • collaborate with legal advisory departments
  • Evaluative aspects
    • assessment of acts and behaviors (includes quality control)
  • Ethical aspects
    • compliance with ethical/moral standards of professional conduct
    • references “professional ontology” (duty of the professional)
    • mentions possible ethics committees at establishments
  • Administrative and market aspects
    • balances efficiency, cost, quality, and patient safety
  • Teaching and research aspects
    • supports teaching and continuous postgraduate improvement
    • includes educational and preventive effects
    • improves acquisition of learning and experience

Audit and professional responsibility

  • Responsibility: obligation of professionals to answer for damages caused by their actions.
  • Types of responsibility listed:
    • ethical
    • moral
    • disciplinary
    • administrative
    • civil
    • criminal
  • Criminal responsibility: actions/omissions classified as Penal Code infractions.
  • Links to patient rights protocol (systematizes legal norms about patient rights in healthcare).
  • Core legal-philosophical idea:
    • human acts done freely/voluntarily carry the principle of responsibility
    • all damage caused must be repaired
  • Health professional responsibilities described as:
    • serving the sick individual while working with implicit risks from diagnosis/treatment
    • responsibility also to conscience and society
    • professional ethics as responsible exercise of professional functions
  • Role of professional auditing regarding responsibility:
    • preventive and provocative perspectives to prevent malpractice and downstream consequences (e.g., lawsuits)
  • Defines malpractice:
    • professional act contrary to accepted norms
    • produces harmful results for the patient
    • may lead to legal action
  • Auditor’s purpose:
    • detect error and/or abuse in professional practice
    • measures aim mainly at preventing or reducing it

Quality audit and evaluation

  • Emphasizes a strong linkage between auditing and quality assurance.
  • Concepts:
    • Quality assurance: guarantees users a certain level of “perfection”/quality
    • Continuous quality improvement: permanent process control for optimization
    • Total quality: institution-wide resources oriented toward user satisfaction
  • Why professional auditing matters (benefits):
    • reveals mistakes and their causes
    • enables correction for better results/performance
    • allows rapid action on causes tied to organization of work
    • raises healthcare professionals’ awareness of responsibility for outcomes
    • improves medical records, which improves audits
    • functions as a postgraduate education tool for improved health work
    • supplies hospital/institution managers information to direct resources to problem-solving

Audit quality assessment: proposed propositions / requirements

  • Implement essential elements required to carry out professional audits:

  • Clinical and administrative standards

    • must be clear, known, disseminated, and updated
  • Clinical protocols
    • require existence (and alignment with standards)
  • Medical records
    • must be complete, legible
    • information should be clear, concise, and orderly
  • Hospital statistics
    • must be timely, truthful, complete
  • Qualified personnel
    • people in charge of internal control and clinical auditing must be qualified
  • Audit system across healthcare establishments
    • should enable permanent control and evaluation of care quality in:
      • hospital wards
      • clinics
      • specialty departments
      • emergency units
      • and other patient-care areas
  • Audit committee
    • institutions (hospital/sanatorium) should form an audit committee
    • committee should include:
      • an auditor
      • professionals from each clinical service/unit
      • trained in auditing (or trained for auditing roles)

Auditing artificial intelligence (AI)

  • Introduces “a new field of control”: auditing artificial intelligence.
  • Key points:
    • soon, auditors will need to audit AI algorithms
    • AI errors may be difficult because:
      • some errors arise from lack of action in broader clinical and collective contexts
      • AI itself may not predict these errors in isolation
    • AI systems can bring benefits but also have potential to cause harm
    • Types of AI errors may be hard to identify, explain, and mitigate
  • Because AI is rapidly adopted, there must be a framework for:
    • continuous performance monitoring
    • scrutiny of error and harm
  • Implementation risks highlighted:
    • AI often rolls out alongside new clinical pathways
    • may lack clear comparators for expected outcomes
    • examples of new pathways include telemedicine/virtual care pathways
  • Evidence caveat:
    • many AI systems are supported by evidence showing superior/equivalent performance vs human experts
  • Monitoring limitation:
    • monitoring of human performance isn’t routinely done in clinical practice in a specific way
  • “Professional algorithmic auditing” described as:
    • a process to investigate and prevent AI-caused errors/damage
    • a framework for reflective questioning about:
      • errors
      • unexpected results
      • both before and during real-world deployment
  • Requires:
    • clinical and technical expertise
    • conceptual knowledge to anticipate how deployment environment may expose algorithm vulnerabilities and increase likelihood of errors

Speakers / sources featured

  • Dr. Sergio Albarracín (speaker; doctor; specialist in higher education; medical director; certified performance auditor)

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