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About the audit

What is the audit about?

The National Clinical Audit of Rheumatoid and Early Inflammatory Arthritis audit was established in 2013 and since 2017 has been known as the National Early Inflammatory Arthritis Audit (NEIAA) and delivered by the British Society for Rheumatology (BSR), working in partnership with Kings College, London and Net Solving. It is a national comparative audit of the assessment, management and outcomes of adults presenting with early inflammatory and rheumatoid arthritis in NHS secondary care settings in England and Wales and aims to drive improvement within the NHS for the benefit of patients, carers and those working to deliver care. Since September 2023, the audit has also collected data on some rare autoimmune rheumatic diseases at the request of its funders, recognising the need for improved care quality for patients living with these conditions.

Participation requirements

NHS funded settings offering Rheumatology services in England and Wales are eligible to participate in the audit.

Hospitals are required to participate in line with the NHS standard contract, which dictates that organisations providing NHS care must participate in all relevant NCAPOP audits and enquiries. NCAPOP audits and enquiries are those commissioned by HQIP.

If departments do not participate in relevant NCAPOP audits they will be in breach of their contract with their commissioner, therefore any non-participation would need to be agreed with the commissioner and CQC as the regulator. Further information is available on the HQIP website (www.hqip.org.uk).

Which patients are eligible for the audit?

Adults aged 16 years and above referred for the first time to secondary care rheumatology clinics in England and Wales with a confirmed clinical diagnosis of the below diagnoses are eligible for recruitment to the audit:

Early Inflammatory Arthritis (EIA)

Rheumatoid arthritis
Psoriatic arthritis
Axial spondyloarthropathy
Undifferentiated inflammatory arthritis
Juvenile Idiopathic Arthritis

Systemic Vasculitis

Giant cell arteritis
Large vessel vasculitis (not giant cell arteritis)
Anti-neutrophil cytoplasmic antibody associated vasculitis
Small/medium vessel vasculitis (anti-neutrophil cytoplasmic antibody-negative)
Behcet’s syndrome

Connective Tissue Disease (CTD)

Systemic lupus erythematosus
Primary Sjogren’s syndrome
Systemic sclerosis
Idiopathic inflammatory myopathy
Undifferentiated/other connective tissue disease or overlap syndrome

The ‘demographics and referral’ and ‘diagnosis’ questionnaires should be completed for all patients eligible for recruitment. Similarly, Patient-reported Outcome Measures (PROMs) questionnaires should be completed by all patients eligible for recruitment.

The ‘clinical baseline’ and ‘3-month follow-up' questionnaires should only be completed for patients eligible for follow-up with early inflammatory arthritis.

Patients with early inflammatory arthritis are defined as those that the treating rheumatologist considers to have a new diagnosis of early inflammatory arthritis based upon history, physical examination and laboratory testing. This can include new presentations of rheumatoid arthritis, psoriatic arthritis, or axial spondyloarthritis.
Patients eligible for follow up are those who have a peripheral arthritis with a ‘rheumatoid’ pattern of disease, irrespective of their EIA diagnostic category.
Patient questionnaires should be completed by all patients.
Previously, all suspected cases were entered into the audit – please note that the audit now only focuses on confirmed cases of EIA at the point of diagnosis.

Can the audit be completed in other languages?

We currently provide all information in English language. Unfortunately, we cannot provide translations of the documentation at this time.

Registration

Registering a new user

To register a new user, you must be a site admin. For GDPR purposes, new users should only be registered by a colleague with site admin permissions.

While logged in, go to ‘User Admin’ > ‘Add New User’.
Type in your colleagues' details (name, email, etc.).
Navigate to ‘Permissions’ and tick ‘Clinical’.
Navigate to ‘Clinical Permissions’ and tick ‘Clinical Services’.
Navigate to 'Clinical Role' and select from the drop-down list which type of user you would like to set them up as. Do this for all of the sites they need to be registered at.
Make sure to click ‘Insert’ at the bottom of the page to apply the changes.
The final step is to inform your colleague of the email you have registered them under and ask them to go to the arthritisaudit.org.uk website and reset their password using the forgotten password link.

NB: Please note that we do not send new login emails to newly registered users. You must inform any new users that you have added them and tell them to follow the steps to reset their password. See Troubleshooting > Logging In/Difficulty with password section below if needed.

Who has access/permission to do what on the system?

Users with Organisational Audit permissions:

Organisational Admin: Can create a new organisational form and register users
Organisational User: Can fill in the organisational form
Organisational Viewer: Can view the organisational form

Users with Clinical Audit permissions:

Clinical Admin: Can register others, input data and download data
Clinical User: Can input data
Clinical Viewer: Can view data

How do I register a colleague for different permissions on the system?

Organisational Admin	To register a colleague as Organisational Admin, navigate to ‘Permissions’ > tick ‘Organisational’ + ‘Organisational Services’ and on the drop-down list under ‘Organisational Role’, select ‘Organisational User’ for each site they require access to.
Clinical Admin	To register a colleague as Clinical Admin, navigate to ‘Permissions’ > tick ‘Clinical’ + ‘Clinical Services’ and on the drop-down list under ‘Clinical Role’, select ‘Clinical Admin’ for each site they require access to.
Clinical User	To register a colleague as clinical user, navigate to ‘Permissions’ > tick ‘Clinical’ + ‘Clinical Services’ and on the drop-down list under ‘Clinical Role’, select ‘Clinical User’ for each site they require access to.

I need to enter data into the audit platform. How do I register?

For data protection reasons, only users with ‘site admin’ permissions can register new users at their place of work. Please contact a colleague with these permissions at your site and request that they register you.

Please note that newly registered users are not notified that they have been registered, meaning you will not automatically receive an email informing you of your registration. The person with site admin permissions who has registered you will need to inform you once you have been registered.

Once you have been registered, you will need to crease a password via the forgotten password function.

Troubleshooting

Logging in/Difficulty with password

If you have forgotten your password, you can change your password by entering your username (usually your NHS email address) on the 'request password reset page'

Once you have entered your username and clicked the ‘email password reset link’ button, you will receive an email containing a link. When you click the link, you will be directed to a website where you can create a new password.

Please note that sometimes when you (successfully) reset your password, it brings you to a new screen that can say "You are not authorised to access this page". If this happens after you reset your password, please click 'login' in the top right corner of the screen and then enter your new login details.

If you are still having issues your account may be locked, please get in touch with the audit team if this is the case.

What if my email address changes?

If your email address changes, you have two options:

You can change you own email address attached to your account by accessing 'My profile' from the menu, but your username will remain the same.
If you want both your username and email address changed so that they match, contact us as soon as possible via audit@rheumatology.org.uk - we will change the email address attached to your account.

Many of the questions do not allow scope for units that are doing things differently. How can I record this?

To be able to analyse the data, our questions cannot allow for much variation. There are hover boxes which will guide you towards the correct response if you are unsure how to answer a question.

Why am I receiving reminder emails?

Follow up and incomplete form reminder emails are sent automatically to everyone registered on the website as a site admin. As a site admin, you are able to add colleagues and download your data.

What if I have moved to a new trust/location and need access there?

A colleague with Site Admin permissions at your new site can add you as a user at your new place of work. For more info, please read the FAQ: Registration > Registering a New User. If you do not know who has site admin permissions, get in touch with us on audit@rheumatology.org.uk and we will check for you.

Entering clinical data

How is data being entered?

Data collection is taking place via two online data collection web tools – one for clinicians and one for patients myarthritisaudit.org.uk

This is a continuous audit with real time data collection. It is hoped that clinical teams will enter the data in real time but you can also enter data retrospectively.

You can download and use the paper forms; however data will still need to be uploaded online.

Mandatory sections on the tool will be highlighted at the point of submission if they have not been completed. You will only be able to submit your data once all mandatory sections are completed. You will however be able to enter and save data for completion at a later stage should you, for instance, be awaiting investigation results.

Ideally we are requesting that patient baseline and follow up forms are completed by patients via the patient website. To access this, patients will be asked to provide an email address and the links to the website and instructions for accessing to site will then be sent to them via email.

For patients without internet access or for those that do not wish to use this option, paper questionnaires can be downloaded; the answers to the questions will then need to be uploaded to the clinician website via staff in the rheumatology department.

Missing/Incomplete data

Though we request that you complete as much of the form(s) as possible:

We do not penalise for missing or incomplete data.
We are still able to analyse forms that have missing data.
You can still save forms that have missing data.

How do I record DNAs?

DNAs (Did Not Attends) should have their appointments rescheduled and the new dates entered into the system. If this falls outside the 1-5 month date allowance, leave the 3 month follow up blank.

NEIAA Certificate of Achievement

What is the NEIAA Certificate of Achievement?

The NEIAA Certificate of Achievement recognises the contributions of those who recruit eligible patients to the National Early Inflammatory Arthritis Audit. Clinical Leads at rheumatology services participating in NEIAA are responsible for awarding certificates. Certificates should only be issued to individuals who have entered at least five eligible patients into the audit. The date range used on each certificate may be determined by the Clinical Lead issuing a certificate.

I think I am eligible for a NEIAA Certificate of Achievement – how do I obtain one?

Clinical Leads with 'Clinical Admin' permissions on the NEIAA website may issue the NEIAA Certificates of Achievement to eligible participants (i.e. those who have entered >5 patients into the audit). The certificates and (and accompanying guidance) can be accessed via the User Admin tab > 'Certificates'.

Should the Clinical Lead need to obtain Clinical Admin permissions, please see the following FAQ for instructions on how to do this: Registration > How do I register a colleague for different permissions on the system?

How can I see how many patient records have been created by a specific user?

You can see how many new patient records have been created by a specific person by clicking 'Advanced Search' on the Clinical Record Management page and entering the relevant username. This can be used to determine if an audit participant is eligible for a NEIAA Certificate (i.e. if they have entered more than 5 patients into the audit).

To navigate to Advance Search, click on the 'Clinical Audit' tab > select 'Clinical Data' from the dropdown menu > click 'Advanced' and then navigate to the 'Created By' field and enter the username in question. The username is usually the same as the NHS email address.

Follow-up data entry

Follow up data entry

To enter clinical follow up data, go to the clinical record and click across to the 3 month tab.

Please note that 3-month follow-up data can be entered 1-5 months from date of first assessment and 12 month follow-up data from 9-15 months from date of first assessment. Follow-up data submitted outside of those windows will not be accepted for the audit.

To enter PROMs data on behalf of the patient, open the clinical record. At the top of the screen you will see the tabs 'patient baseline' etc. Click into these and fill in the forms as the patient did on paper.

If the patient has missed a question, scroll to the bottom of the form and select 'other' in answer to 'why was the patient unable to complete the follow up'. Enter 'patient missed question'. This will allow you to save the form and go onto the next part of the questionnaire.

How do I know when patients are due for follow up?

All those registered as a site admin will receive weekly emails with a list of patients due for follow up in the next month.

Patient no longer eligible for follow up

If a patient moves away, or is no longer available for follow up, then no further information should be entered into the record. Simply answer 'no' to the question on the 3 month follow up form 'is the patient still eligible for follow up?'

In the event that a patient enrolled in the NEIAA passes away, you may ‘complete’ their record to ensure that no further follow up comms are sent.

Go into the patient's clinical record
Go to the 'patient baseline' tab
Scroll to the bottom
Enter the reason that they cannot be followed up as “patient is deceased”

To stop receiving notifications about the PROMs data, enter the clinical record, and go to the 'patient baseline' or 'patient 3 month' tab. Scroll to the bottom of the questionnaire and choose from the drop down list the reason why the patient was unable to complete the follow up.

Can I re-enrol a patient into the audit who was previously part of the audit?

Patients who were previously entered into the audit cannot be re-entered. The system will only accept an NHS number that has not previously been entered into the audit.

Patient Reported Outcome Measures (PROMs)

PROMS data: patient missing question

If a patient has missed a question on the paper forms, scroll to the bottom of the PROMs data entry page, and answer 'other' to the question 'why was the patient unable to complete the follow up?'

This will allow you to move on and save the form.

When/where should patients fill out their section?

When you add a patient's email address to the online portal, they will be sent a link to the myarthritisaudit.org.uk web tool and from there they can fill out their forms. The steps are as follows:

Clinician enters patient’s email address on diagnosis form.
Patient is sent an email inviting them to participate.
Reminder emails sent automatically.

Alternatively, you can input data on behalf of the patient during a clinic, or the patient can fill out a paper form which your team can then add to the IT portal at a convenient time.

To enter the patient questionnaires yourself, open the patient record in the clinical tab. Once in the record, you will see tabs along the top labelled 'patient baseline' 'patient 3 month follow up' and 'patient 12 month follow up'. Click on the relevant questionnaire and enter the data.

Patient forms: unable to submit

If you or a patient are unable to submit a patient form, please do the following:

Make sure all the questions have been answered.
Then, check that you cannot click 'next' and are on the final page - this is a page asking about being contacted for further studies.
Click 'save' and then 'submit'.

If the submit button is greyed out even after these steps, contact us.

How can I change a patient’s email address?

You can update the patient's email address on the diagnosis form.

Quality Improvement

How can I download data from the audit platform?

To download data, you must have site admin permissions. If you require these, please speak to your clinical lead or another colleague who has these permissions. They can either give you site admin permissions or download data on your behalf. They can do this by following the instructions in the hover box on the 'user admin' page.

Once you have logged in to the platform, navigate to 'clinical audit' in the main menu which runs horizontally across the top of the website. A drop-down menu will appear, please select 'control panel'. A selection of buttons will then appear, select either 'export service data' or 'export trust data' depending on your needs.

A new webpage will appear. If necessary, select a site from the drop-down list. Then, select a data set to download from the drop-down list. Depending upon the data set you choose, you might be required to input additional information such as start and end dates.

Then, you will need to create a password for the file, please type this into the 'download password' textbox. You will need to input this password when opening the downloaded ZIP File.

Once you have completed all of the above steps, click 'download report list'.

To open the document, you will need to enter the password you created prior to downloading the file.

Please note that once you have downloaded data, it is your responsibility to adhere to Data Protection and GDPR rulings.

Information governance and data protection

GDPR / Data Protection

The legal basis for processing the information collected is article 9 (2) (i) of GDPR ‘processing is necessary for reasons of public interest in the area of public health’.

Most questions regarding GDPR and Data Protection can be answered by checking our patient information sheet and patient privacy notice.

Patient consent

The NEIAA has secured Confidential Advisory Group Section 251 approval to collect patient information without consent. The audit is fully GDPR compliant.

Local opt-out remains available. If a patient wishes to opt out, please send their Case ID to audit@rheumatology.org.uk with the subject line 'patient opt-out request'.

Local patient opt out

Patients will be able to opt out at any point up until analysis and reporting. If a patient advises that they wish to opt out, please email the Case ID to audit@rheumatology.org.uk with the subject header Patient Audit Opt-Out (the Trust email MUST be sent from an NHS account for Information Governance purposes), and the record will be deleted.

I am concerned about a data breach. Who should I contact?

If you become aware of a potential data breach, you should immediately contact the NEIAA team via email at audit@rheumatology.org.uk.

Please note that once you have downloaded your data it is your responsibility to adhere to Data Protection and GDPR rulings.

Who will have access to enter the data?

Users can include anyone involved in the care pathway together with audit and administrative staff.

Site Admins can register new users. To do this, go to the 'user admin' page and follow the instructions in the hover box.

All users MUST be registered with an NHS email address.

Does National Data Opt-out (NDO) apply to this audit?

The national data opt-out (NDO) allows patients to choose not to have their confidential health information used for purposes other than their individual treatment and care. Whilst this audit has special legal permissions (Section 251 approval) to collect confidential information without patient consent, it is not exempt from the national data opt-out (NDO). Therefore, clinicians will have to check a patient's NDO status before submitting any confidential patient information.

You can find out about how patient information is used here.

You can find out more about NDO here.

Who will have access to the data collected?

All data will be stored by Net solving, who have been commissioned to manage to IT platform for this project.

They will provide partially anonymised data to the British Society for Rheumatology and King's College London to allow reporting of the results. All of these organisations have stringent data protection protocols and a wealth of experience in handling healthcare data.

Rheumatology units will be able to see how well they are performing via the dashboard on arthritisaudit.org.uk.

Anyone downloading data at a local level is responsible for following their own Trust policies for data protection, and following guidance in concordance with GDPR law.

Best Practice Tariff (BPT)

Best Practice Tariff: eligibility

For a patient to be eligible for BPT, the following criteria must be met:

Referral: the patient must be seen within three weeks of referral
Audit: the patient must be enrolled in the audit within three weeks of diagnosis
Treatment: must start DMARDs within six weeks of referral
Education: disease education must be offered within one month of diagnosis
Outcomes: documented DAS28 score within audit by three months (no requirement to achieve a target)
Outcomes: documented Patient Reported Outcome within audit by three months

You can read our blog on BPT here: https://www.rheumatology.org.uk/News-Policy/Details/New-best-practice-tariff-early-inflammatory-arthritis-England

If your Trust is on a block contract, BPT may already be included. You will need to review your contract in order to find out whether BPT can be claimed on top of this.

To access the Best Practice Tariff dashboard, go to: Login > Charts and Reports > BPT > BPT Patient Level Data.

How each standard is calculated

How we calculate whether a patient has 'passed' each BPT standard:

BPT 1	Patient seen within 3 weeks of referral. This is based on Q 1.13 - date of assessment in rheumatology clinic and whether it is within 15 working days of question 1.17 - date referral received.
BPT 2	Patient enrolled in the audit within 3 weeks of diagnosis. This is based on whether the patient record was created within 3 weeks of Q 2.2 - date of diagnosis. You can see when each record was created by exporting your data.
BPT 3	Commence DMARDs within 6 weeks of referral. This is based on Q 3.9 - date treatment began and whether it is within 6 weeks of Q 1.17 - referral received.
BPT 4	Disease education offered within 1 month of diagnosis. This is based on Q 3.11.
BPT 5	Documented DAS28 score within 3 months of being seen in a rheumatology clinic. This is based on whether a DAS28 score has been entered on the 1 or 3 month follow ups.
BPT 6	Patient Recorded Outcome entered into audit within 3 months of being seen in a rheumatology clinic. This is based on whether a patient has entered their baseline data into the audit (or a clinician has uploaded the patient recorded data).

Failed BPT 2: patient enrolled within 3 weeks of diagnosis

BPT2 states that a patient must be enrolled into the audit within 3 weeks of diagnosis.

To calculate this, we use the date of diagnosis, and the date that the patient record was created on the online system. We do NOT use the 'date of form completion'. To check when the patient record was created, you can download your 'anonymous dataset' from the 'clinical' tab under 'exports'.

It is important to upload patients to the system in a timely manner, so we are able to contact patients to fill out the PROMs questionnaires, and so that you can claim for the tariff on time.

Contact the team

Contact us

If you cannot find the information you are looking for here and need to contact us, please email audit@rheumatology.org.uk

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Contact

British Society for Rheumatology Bride House, 18-20 Bride Lane, London, EC4Y 8EE

T: +44 (0)20 8194 0532 E: audit@rheumatology.org.uk