Let’s be honest. Audits are an annoying part of the clinical record-keeping process. They’re retrospective, repeatable, and ripe for automation. In our opinion, making improvements to your notes is easier to do when you have real-time feedback.
If you’re responsible for practice-wide audits, they can be one of the most dreadful tasks you have to carry out. Collating all the records and comparing them against the guidance is a lot of work. And if you’re about to be inspected - it can add additional stress.
So what if you could audit your notes as you write them? Or what if you could simply request the audit scores of the notes written by clinicians in your practice?
You can do just that with Kiroku.
Traditional vs Instant Kiroku AI audits
The problem with traditional audits is that you’re looking back at records retrospectively.
For one, there’s nothing you can do to improve that set of notes. Secondly, if you could, you might not remember details as clearly, so you can’t be sure if they were discussed but not recorded, or intentionally excluded.
That’s why we’ve built the ability for you to get instant feedback on your notes, within seconds of finishing them.
If you’ve not scored highly on your audit, you can easily make the relevant changes to your notes to improve the information contained, while it’s still fresh in your mind. Your patient may even still be in the room, so you don’t need to rely on your memory, and you can ask your patient about any missing information.
Kiroku’s stock templates are built following relevant criteria set out in the guidance. Using one of the templates in our library will help you to record all relevant criteria. However, it is your responsibility to ensure that your notes meet expected standards.
While your Kiroku Notes template may contain all the information you should be collecting, it’s possible that when you write notes you may delete prompts or decide not to follow them. If you have created your own Kiroku Notes template and want help improving it, our clinical team is on hand.
How to audit your notes with AI
Kiroku’s AI Audits have been added automatically to the following stock templates in our Library:
- Comprehensive Exam
- Basic Exam
- NHS Exam
If your audit score doesn’t appear when you click “Copy Notes” you may be using a previous version of your stock template which doesn’t have an audit attached. You can either get in touch with us and we can add the audit to your template (advised if you have made edits to your template), or you can download the stock template from the library again.
Otherwise, auditing your notes is no additional work. When you click the “Copy Notes” button, you’ll see a pop-up appear just under this button.
The audit will give you a score, and if the score is less than 100% it will point out which data is missing against the set criteria.
When you are happy with the audit score, your Kiroku notes can be pasted into the relevant section of your patient’s record in your practice system.
If you want to improve your score, remember that you can type information directly into your notes, or add existing sections from your library using the “Add Section” button. If your notes aren’t finished, save them as a Draft and come back to them later. You can still audit your notes when you start from a draft.
CGDent Audit Criteria
Our current AI Audits follow the “Basic” audit criteria set out by CGDent’s Clinical Examination and Record Keeping: Good Practice Guidelines (formerly FGDP):
- Medical History: New form completed or updated
- Socio-behavioural History: Smoking; Alcohol consumption
- Previous Dental History: Oral hygiene routine; Anxiety
- Factors Affecting Appointment: Reason(s) for attendance
- Extra-oral Examination: Face, Head; Neck; TMJ
- Intra-oral Soft Tissue Examination
- Intra-oral Hard Tissue: Charting of teeth present; Existing restorations; BPE; Caries; Defective restorations; Occlusions
A patient’s personal information (e.g. name, address, date of birth etc) is not routinely captured in notes written using Kiroku and so is not covered by our CGDent AI Audit criteria. This information should be stored in your practice management system with appropriate security, in line with data protection standards.
Our CGDent AI Criteria also does not include Chewing unrestricted and Restorative procedures as it is unlikely that these topics would be covered as part of a basic or NHS exam. However, if you would like these to be included as part of your audit criteria, please reach out to us and we can add these in for you.
You can test out our AI Audits, alongside our other AI tools, by creating your Kiroku account today and taking advantage of our 14-day free trial.
Other Audit Criteria
We are currently creating additional AI audits, so please get in touch with us if there are any criteria that you would like to audit your notes against.
Audit reporting for your practice
Anyone using Kiroku for their note-taking can automatically audit their notes in real-time but additionally, we can help practices using Kiroku across their clinical teams with historic audit reporting.
These historic audits allow owners, clinical leads or practice managers to get better oversight of their team’s compliance with record-keeping guidelines. We can work with you to create custom criteria to use against the notes of dental professionals in your practice.
Amr Nosir from My New Smile Dental Care said his dentists’ clinical audit scores improved from 60% to 90% just by using Kiroku. That’s less stress and time spent on notes that are more comprehensive and more compliant.
If you’re looking to audit your team’s records, we offer historic summary audits as part of our Practice Plans, so enquire today. You could get up to 40% off per clinician compared to individual subscriptions.
