Thursday, 20 December 2007

XMAS Guideline

Did this:




to try and capture the informal stuff we do and also to capture X-mas cards and gifts.

Found a code entered which said:

8C85.11 GIFT 'biscuits'

which, as coding errors go, is almost funny.

Though, on reflection, that is perhaps a bit geeky and sad. :-(

Anyway, we have fixed this now by using this guideline and have pointed the keyword 'gift' at:

9N57.00 Admin reason for encounter

and then staff free text the pressie / card / whatever. No pheasants though. I have never been a doctor that worked in area where patients brought me such things. Not sure it is really my style of practice anyway. grumble grumble....

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Contract Plus

Colin installed this for us. It is very good, isn't it?



Still have to pay for it though, but it is not prohibitive by any means.

I like the alert boxes, which are much more functional than the standard V3 yellow popups - very good at focusing your attention on what needs done for QOF purposes. And the daily analysis is excellent, with our projected for 31/3 reflecting a lot of annual work that was doen in 03/07. This means, in case you had not worked it out, that our predicted points for 03/08 drop by about 60 from today's level. :-( Still, at least we now have an easier way of identifying what work needs done to deal with this.

Also: messaging. Contract Plus does patient and non patient related instant messaging. Initially this is very 'in your face' - i.e. modal and non movable pop-ups, but there are options for changing this behavior to a more passive method (and indeed, with draggable (?sp) windows).

Still playing around with it, and not yet comfortable with how to use it. Has a lot of user options and tweakability, which is good but demands some learning.

Be saying goodbye to Spark and eJabberd though, I think.

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Tuesday, 11 December 2007

To Attach a 'Full Patient Record' Printout to Docman in Vision 3

Why?

The requirement is to attach to Docman the usual paper printout of the computer record that a practice would supply when a patient transfers out. The value of this is that with a Docman to Docman transfer, the 'Full Patient Record' will be included in the transfer.

What Does Vision 3 do?

The Vision 3 built in approach is to use the Patient Report 'Full' from Searches and Reports as shown below:


Note that the V3 Help files states:

'But there are some details the Full Patient report omits which strictly speaking by law the patient should see on the printout – the patient's Previous Surname, and the Second Forename and Other Forename (other than the first forename). It also does not record whether the patient is cared for by a carer. Note they are not allowed to see the name of the carer on a printout, just a Yes or No if cared for by one.'

and does provide workarounds for this.

Get a Virtual Printer Driver

It is suggested that your PCT IM&T department will deal with installing the 'virtual printer driver', as there are several different formats available.

Once that is done, move on to the next step.

Print the Report to the Virtual Printer Driver

The process to print is to select the 'Full' report and the patient as shown in the screenshot above and then click on 'Print':


Change the output type to Printer:


Then click on Print Options and change to your virtual printer:

Click Print again, and the again and the report will be sent to the Virtual Printer, again creating a file which can then be attached to Docman.


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Sunday, 9 December 2007

The batch file

It's a busy time of year, isn't it?! Must...post...more...

Anyway, here is the contents of the batch file as referred to in my last post:

subst o: /d
subst p: /d
subst O: F:\
subst P: F:\data

so, you replace 'F' with whatever your encrypted drive maps to.

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Tuesday, 20 November 2007

How to set up encrypted Vision 3 on a USB Drive

It is possible to setup a copy of your current V3 data onto a USB portable storage, typically a USB hard drive but if your V3 data + program is small enough, you may be able to squeeze it onto one of the larger capacity solid state drives or storage cards i.e. a 'USB Key' or 'dongle' or even onto a Flash or SD card.

If you do this then you MUST encrypt the data files (at least) as, although they are hard to assemble without access to the Vision program itself, it is far from being an impossible task for anyone with some database knowledge. If you lose unencrypted patient data - the USB drive is stolen or left on the train - then you may find yourself in some medicolegal difficulty. A recent directive suggested that, at the very least, if you lose such data you will be required to write to every patient involved and advise them of this. And then deal with the complaints. And then deal with the fallout if any actual harm occurs..

Thankfully, we have an excellent open source encryption program called Truecrypt which not only will encrypt your files for you, but will also run from the USB drive and automount (with a password) when you plug the drive into any Windows PC. So, how do we do this?

Choosing a USB Drive

I would recommend you select a drive whihc does not normally require external power - i.e. one which gets all its power from the USB socket itself. By default, Flash memory card like SD, MicroSD etc do this, but some USB Hard Drives do require an external power supply so you need to be selective in your choice.

Capacity wise it is unlikely that your V3 data is going to be more than 20 to 30 GB, and typically all portable HDs are at least 40GB, more often 80GB or more nowadays so this is not an issue. Our O:/ drive is 3.53 GB so a 4GB USB stick could take the whole lot, but then we are a conversion from GPASS practice and have yet to acquire the years of Vision data that others have accrued.

You can, of course, not take over the data/attach and data/wordproc folders which are often pretty large, and this can cut down the total volume of data which may let iq queeze onto a smaller drive.

  1. Get a USB drive with enough capacity for your O:/ folder
  2. Make sure the USB drive can run using only the power from the USB port
Install True Crypt
Next you need to get Truecrypt from:

http://www.truecrypt.org/

This is an Open Source (though not quite GPL) encryption program which does two important things:
  • Creates a virtual encrypted disk within a file and mounts it as a real disk.

  • Encrypts an entire hard disk partition or a storage device such as USB flash drive.
Open Source part of it means, effectively, you can use it at no financial cost. So that is good!

So, install it. Run it and you get this:



Try not to panic!

You need to create a text file on your USB drive that will hold all the V3 encrypted files. So, use Explorer to create a text file on the USB drive - call it something like 'visionsafe.txt' or similar.


Now we need to get TrueCrypt to turn this into an encrypted file of the appropriate size. So:

Click 'Create Volume' and in the next form take the default setting of 'Create a standard TrueCrypt volume'. Click 'Next' and then navigate to the file 'safestuff.txt' or whatever you have called it.



Click 'Next' again for encryption options. Just accept the defaults, unless you have a Scooby about what you are doing! Then you select the size of the volume. This should be at least as large as your current V3 O:\ drive.



I am just using a 2GB USB stick to demo this, so I have selected 512MB. Clearly this is not enough - you will have to use between 5000 and 12000 MB depending on your V3 install.

Click next and type a password, and then confirm. Use numb3r5 4nd l3tt3r5 for this.

Click next, and then Format. It will take a few minutes:

and then finish, and that is the volume created. Click cancel to finish.

So that is it created. Now we need to setup a 'Traveller disk'. This is in Tools -> Traveller disk setup on TrueCrypt. Here is what I did:


So you point it at the root of the drive you are using. and select 'Auto-mount' This adds 'Mount TrueCrypt Volume' to the autorun options when you insert the drive. Point the Mount settings at the file you want to mount, and give it a drive letter - here I am using 'E:'.

Click 'Create'.

So now when I insert this USB drive I see:



and Double Cliking on Mount TrueCrypt volume opens the password window. Type this in and OK it and the encrypted file will mount as a virtual drive mapped to E:/

Then you your a batch file to map O and P. This is sitting on my laptop, so I will need to update this for you later in the week!

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Monday, 19 November 2007

Vision 4 is hosted

Yes, yes. It is. But it is hosted in the same way that this web page is hosted, or accessing your webmail is hosted. In other words, the data and the program is effectively held on remotely hosted servers and you access that with your web browser. So, you log into Vision 4 and the web browser grabs the code it needs to access the data off of the Vision 4 servers. It runs with Oracle 10G at the data centre, then employs Java and Flex at the client to deliver the user functionality.

So, what this means is that you do not *need* to have a remotely delivered desktop as per current VES and other terminal service / Citrix etc style solutions. You can have a very fat client in your practice (i.e. your own personal computer) and even your very own Local Area Network and locally based server for all your practice stuff. Or, you could have a very simple web terminal that only ever accesses your Vision 4 data and nothing much else. Or you could have a Citrix style remotely delivered desktop from which you then run Internet Explorer and get into Vision 4 that way.

It depends on what you want, what you are capable of and perhaps willing to support and what your PCO allows you to do.

This is very Web 2.0. No, really. It is about a web service delivered program, in the same was as e.g. Google Docs or Zoho or any of these web based software applications function. This is why Microsoft were so worried by the rise of the internet and the web, because their futurologists could see that it threatened both their operating system market (the OS is irrelevant when all you need is a web browser) and their monolithic Office system (when web services let you choose which features of a word processor you want and when).

So, "Panic not!" colleagues who may have felt panicked by being 'forced onto a hosted system'. The model is superb from a GP business POV and from a PCO POV. We can have LANS and local desktops to run our non NHS stuff, the PCO can pay INPS to supply us with Vision 4 services.

We don't have to worry about backing up or repairing our Vision 4 data, because it is all held on the data centre.

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Thursday, 15 November 2007

Notes on Max Brighton

(These are my notes of MB's presentation to NVUG - not verbatim!)

  • 'Mood change at CfH'

News and Marketing

The News....:
  • GPASS
    • 'GPAS gives smokers a hard time' - glitch in GPASS mistakenly made smokers being advised to smoke were Rx Viagra - BBC SCotland
  • EMIS Branch performance struggles
  • CSC computers in data centre failed - compensation paid to NHS
  • System One failure on 18th September 2007
  • GP2GP and INPS
Case Studies
  • Phil Koczan on BT London hosted system
  • Regional News Bulletins on a regular basis
  • Exhibiting in HC 2007 - looks nice!
CfH In the News
GPSoc
    • A lot of work into agreements, close work with CFH team
    • Who Pays What?
    • All annual support costs willbe paid for centrally except for system support charge £650 pa.
    • Hosting
      • GPSOC will pay for all Vision hosting charges
      • An agreed path to hosting to CfH standards
      • GPSoC web site is very good!
      • Slides illustrating costs
    • SCR is proving to be 1st real test of data privacy and consent
    • List of INPS GPSoC product commitments
    • Agreed set of requirements at the outset
CAPGP
  • New assurance process
  • Stricter testing regime
  • All systems re-accreditation within one year
Support Obligations
  • 90% of all calls in 3 mins
  • Incident resolution / bugs / responsiveness 'transaction monitoring'
  • Availability 99.98% hosted to CfH standards
Helpline
  • Average response time to helpline 170 seconds currently. CfH standard is higher - more folk! Below 140 seconds for last 5 months
  • 60 helpline analysts - training / retention
  • Calls per practice per month <6
  • Split to Country based helpline teams
GPSOC Hosting
  • Resilience of system is the key
  • London Dockland connected two diversley routed to N3
  • 2nd Data Centre at LHR linked to Docklands through fibre optic network
  • 555 Hosted practices, increasing by approx 2 a week
  • Sure some practices will continue to have LAN hosted
GPSOC how does it work?
  • PCT must sign call off agreement with INPS
  • Schedule A to the call off agreement lists the GP practices and what products they take
  • There is an agreement between the PCT and the Practice
CFH News
  • 27/4 NAO review again
  • 30/5 Mike suggested Primary Care complete by 2010
  • 2/5 InformatioN governance take 10 years to complete
  • 29/6 BMA Votes for no co-operation - 'perhaps should gree to co-operate and do it properly' (my comment - yup :-))
Money
  • Vision 4 5.8M quids so far
  • More developers on V3 also
Sites
  • 2007 Gains 167, lost 23 including closures and merges.
  • Losses in North and NE
  • 2200 Vision practices (My comment - well done)
  • 104 new ones in Scotland
  • Data Centre opened in Scotland and gone well - thanks to Mark Norman and others
  • Not much movement in England overall
  • 91 conversion from GPASS - others from iSOFT
  • 26% market share in Scotland
CEGEDIM
  • Based in Paris
  • Parent organisation
  • Acquired US company 'Dendrite'
  • Cegedim is big company!
LSPs
  • London Vision 3 is contracted interim solution
  • re-contracting underway - takes time
  • Vision 4 added in 2009
  • + one year testing and acceptance timeframe so not till 2010 for V4 live to users?
  • Fujitsu Clear intention to host V4 as core solution
  • Everywhere else in England - GPSOC is king. CSC do System1
  • Original rational for LSPs is changing - ?? Hospital SC etc
Scotland
  • Progress has been good
  • Tayside - continue to do well
  • They won the EHI award
  • Deputy PM opened the offices in Dundee
Wales
NI
  • gained sites fro iSoft

Battery running out
MUst get better laptopl

Read more...

Notes from NVUG Tom Davies

  • TD commenting that Scotland / England may not do GP2GP the same.
  • EPS / ETP 'slowly being rolled out'.
  • C&B - here today!
  • SCR - spec changed several times, difficult for this to be developed, UG will support company in ensuring large areas of work do not interfere with other development
  • GP at a crossroads, partnerships being threatened, Birmingham putting GP out to tender..
  • Passionate about ownership of data.
  • OOH - single server not the answer
  • NVUG - 'fiercely independent'
  • Web site, engage membership, roadshows well supported
  • Alan Selwyn, David Anderton, Gary Mahn, Brad Cheek new panel members
  • Brad Cheek - Wellclose Square http://www.wellclosesquare.co.uk/
  • INPS - relationships good and honest
  • 27 % of Vision practices on hosted symptoms
  • Produce a buglist for nex year!
  • We want Vision in all 5 regions of England

NVUG Award for INPS Employee of the year

Mark Norman

Congratulations Mark!



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Wednesday, 14 November 2007

More Pics




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Paper Chains

20 or so delegates today for a beginners and new users theme. Seemed to go well. My presentations now complete, as far as they can be at this stage. Now starts the paper chains of assembling the delegate packs. As I type Richards Neep and White are busy assembling the manuals to support their talks on using Access and Excel with Vision Data.



Sadly internet access is a little unreliable from here currently, so attempts to live blog the conference may be yet scuppered. Fingers crossed.

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Reception Desk

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NVUG Annual Conference - Day 1

Hi all

quiet for a few days as busy writing presentations, working in Dundee and trying to have some kind of home life also! Anyway, day one of NVUG Conference - this for newbies.

Setting up Reception Desk



Not a busy first day delegate wise. We should have put on abus from Dundee and Aberdeen. Maybe a boat from Orkney...

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Tuesday, 30 October 2007

Presentation One

Is done bar the animations and transitions, but the content is there! There is so much to therapy in V3 that it is hard to know where to draw the line when talking to new users. Any hints and tips on the things that threw you when new to Therapy management in Vision 3? All suggestions welcome!

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Sort a search

Quickie off the forum:

To sort a report's output, click on Edit then 'Report Output' to find the sorting options. As below:





and then the options display:

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Thursday, 25 October 2007

busy busy busy

So, I am in Dundee every Wednesday and every Friday just now as we go through medication requirements in detail. This is good to do, but means I am in Dundee every Wednesday and every Friday and squeezing in additional work round the edges of the practice and home. Also, I have 3 presentations to prepare for NVUG. And my personal accounts from last year still need finalised. And the kitten is having some litter training 'issues'. And the builder never appeared so kitchen conversion is set back yet again....

All this by way of excuses as to the lack of blogging!

There has been some interesting discussion on the sorting of medication records on the Vision forum. I am sorta involved in this for V4 development and I am reading it and taking it all in. I cannot promise that it will all be delivered out the box, but as I will be using the system too I am also keen to see such neat and useful functionality. These things (like sort by indication) are on the list of stuff to happen, but what I am not sure of at this stage is when they will happen. The basic design and framework of Oracle, Java, Flex should make supporting clever functionality like this a) easier and b) nicer to the end user. So, happen it can and happen it will.

But when? dunno just yet. :-(

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Tuesday, 16 October 2007

Add to Address doesn't work

Further to Patient Details tab discussed below, there was then a coincidental discussion on the mailing list about the 'Add to Address' button for phone numbers. Apparently, it does not actually add the phone number to the address. To do this you need to go into Patient Registrations, where unwary GPs should not venture.

Ho hum :-(

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Thursday, 11 October 2007

tabs: Patient Details

Continuing the theme of looking at the tabs I use, here is Patient Details:



I like this tab as an easy way of finding phone numbers and addresses, mostly, and also adding and checking numbers. There is a school of thought that clinicians shouldn't have to do this stuff - keep phone numbers up to date - but my feeling is that it is everyone's job to make sure the data we hold is accurate and complete. hmmm, maybe a sore point ;-)

Anyway, ranting over what have we got? Names, addresses, identifiers and phone numbers. You can add, edit and delete numbers from here and add them to an address or to a patient.


Look at the tabs at the bottom of the form:


Identifiers lists all other IDs, like hospital codes and so forth. I don't use this but maybe you choose'n'bookers do?

Family is excellent as it lists all family members and allows you to double click on them to open a consultation. Great when mum comes in with 3 weans in tow.

Not such a great pic as all the detail has to be pixellated! It shows Address, Forename, Surname, DOB, CHI.



The 'Carer' tab lets you both see who is the carer of the patient or who the patient cares for. And to add or edit these things:


And lastly some Patient Preferences, which presumably changes with different regions of the UK. Preferred pharmacy is in here though, which is great to have for Drug Clinics. Perhaps in V3 you are using this for nomination in ETP2?


Anyways, I like this tab because it has all this useful stuff on it. I use CTRL+D to get to it quickly. As an aside, I do not like nor use the Patient Select tab. I always found it changed the behaviour of F3 sufficiently that I could not work with it. But hey, it is probably just me. Maybe everyone else loves it!

More on 'Paul's Favourite Tabs' next week!

Anyone else want to write stuff for the blog? If by some remote chance you do, please let me know. It is not difficult, and almost good fun. ;-)

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Thursday, 4 October 2007

Long Format Syntax for No Drug Allergies

Following on from earlier post this week, 'Nell' kindly supplied the syntax to make the grid look better when displaying no known allergies.

Here is the syntax:




And here is the result:

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Tuesday, 2 October 2007

Medication Review reminder that is not

This, this morning:

so a patient with NO repeat masters and the system is prompting me to do a medication review. Well, I don't wanna do that.

Here is why it has appeared:



So, patient has an outstanding reminder from a medication review previously done. V3 does not query the status of current repeat medication to determine if a review is reuqired. V4 might just do this, which would be nice.

Anyway, if you delete the review reminder:



then the yellow reminder text thing goes way.



phew!

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Monday, 1 October 2007

Show No Known Allergies in a Guideline

If you record No Known Allergies from the Alert Pane by double clicking the line as shown below:



then to display that record in a guideline or report (a report is a guideline that prints!) you need to select 'Absence of Condition' like this:



and it will then display...



'Negation' is not done well in Read - the 'not got this' codes are often under the chapter headings that imply 'got this'! Vision 3 has a special SDA for recording Absence of Condition, and it uses this for allergy negation.

Apparantly negation it is not too hot in SNOMED-CT either....but then no one understands SNOMED-CT, so maybe we won't notice ;-) (tho presumably you can use a post-cordinated term to negate anything??!! Kinda like the V3 Absence of condition SDA...). But I have not explored negation in SNOMED-CT to any degree, so this may well be apocryphal.

To change the display string in the report so it shows something more meaningful like 'No known allergies' then you need to change the second Read term in the form to e.g.'1151 No Known Allergies', tho' then it still says in big letters 'ABSENT'.




which is a little recursive and thus a bit odd.

So you could just add it as medical history, then it will list in the medical summary assuming you elect to display that priority, but then it will not turn off the alert option in the alerts pane...

Or, you can put it into a grid and elect to use the Long Format:



which is not very pretty either. P'raps someone nice could tell us magic syntax for the Special Format to make it look prettier?

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tabs

One of the best things about Vision 3 is the ability of the user to customise the interface for their own needs. Consultation Manager allows every user to set up their own set of views, choosing which panes to show and also allowing any number of customised 'Tabs'. My tab set is as below:


and I think it may be useful to talk you through them...

Appointments



OK, I always work with the appointments tab in my setup. I don't know of any clinical staff who don't use this. I have a keyboard shortcut of 'CTRL+T' to get to this quickly - you need to put an ampersand in front of the letter in the Tab View Options (Right click the tab to get this up):



So I can always quickly get to the appointments tab with CTRL+T. Keyboard is good - take time to learn it.

Have a look also at the tabs on this form - you can quickly see AM, PM or ALL appointments, review 'Other' surgeries (although this view does not persist), and find free slots into which you can book the currently selected patient.

But mostly, you can see what work you have done, what you have left to do and how long you are taking!

We also use an appointments book for messages, tho it looks a little weird this morning for some reason yet undiscovered:



but normally it works fine! I think someone had the wrong session type in place for the message book this am and has undone that error, replacing it with a weird looking thing!

I also like the bit at the top that tells you how many patients you have seen, and current time:



which is even nicer when it shows all pts seen and thus time for coffee and cake. ;-)

The check box that says 'booked' on the above, shows that some of my forms display a little oddly, sometimes truncating text. This is because I like to run my 'puters with large fonts (currently at 1680 x 1050, clear type, font size Large). I can live with this, but it is not normally a 'feature' of Vision 3 to truncate text in forms.

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Wednesday, 26 September 2007

Places to go, things to see

Quiet again, sorry. Doing yet another review of medication requirements for Vision 4 amongst other things, and off tomorrow to a very fine conference indeed in Oxfordshire with the PHCSG who are the 'Primary Health Care Specialist Group of the British Computer Society'. This is usually a slightly off centre take on medical informatics issues and their impact in GP land. Also, some beer is involved. So unlikely to be busy posting here again this week.

On the subject of conferences, the programme for NVUG Annual Conference in Stratford is being finalised and looking good. That is on November the 14th, 15th and 16th of November with day one (the 14th) primarily being for New Users. More info at http://www.nvug.org.uk.

Also coming up is the SCIMP conference (where we discuss scimpy things, fnar fnar) in Dunblane which looks excellent. Details here. The program clearly has Scottish bias but it is also turning into one of the largest applied medical informatics conferences in the UK. Go SCIMP!

On that note I am doing some of the judging of the Best Use of IT in Practice awards for SCIMP and am being informed ever so gently that I was meant to have that done last week, so I better get on with it.

later...

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Thursday, 20 September 2007

All the forms

If, in Con Man, you do 'Add->Select Data Entry Form', you can navigate a hierarchy of all data entry froms including all the Clinical Entities (SDAs!). Below is a very big picture of them all. The intention is to have fewer of these in V4 tho. Thankfully. :)

You may need to click and possibly save then zoom the picture to see it in its full format. If you want to...ah, go on...what else you gonna do?

Big long picture of all data entry forms in Vision 3

It is a very long picture!

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Tuesday, 18 September 2007

More on SDAs

SDAs then are a necessary evil (though, perhaps 'evil' is a little strong), to allow us to record the stuff we do properly. You can change how Vision behaves with respect to SDAs, and you can always force V3 to use the Add Medical History form for any code, regardless of whether it is associated with an SDA.

In Consultation Manager Setup, on the 'Patient Record' tab, you can elect to make Vision always select and use the SDAs or to use SDAs at all (but let you choose which one). Essentially, Vision 3 knows that certain Read Codes are used to record information best held within an SDA. So, when you enter one of these codes, V3 will know which SDA to present you with to best record the data.



In theory.

And, to be fair, it works most of the time. But some codes are necessarily represented in more that on SDA. e.g '242.00 O/E Pulse Rate' has 3 possible SDAs associated as below.



I work with V3 set to 'Record in SDA' but not to 'Automatically select best SDA'. Though maybe I should change it, but this is how I have always worked. I found that on occasion it presented me with a different SDA from the one I wished, but cannot now find an example of that. So, this being a living blog thing (wooh!) I will switch my setting to 'Automatic' and work with it for a couple of days and see how I get on.

'242.00 O/E Pulse Rate' when set to automatic gets me straight to this:



which is what I would have wanted.

OTOH, 'lmp' always brings up Pregnancy Dates, when mostly I want to record when it was, not that the patient was pregnant.



You can always force V3 to Add Medical History by either using ALT, A, L or F11. For those moments where you really want to avoid the SDA...

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