Thursday, 31 May 2007

Style Guide

Having read Peter Wiggin's PowerPoint on Guidelines, I wondered if we could overcome the problems of inconsistent styles and formatting by using a Template guideline which could be copied from to create new ones. The process would then be to delete the style stuff once the guideline was complete. So this:


could be used, perhaps. Problem is I have never been very good at doing sensible formatting in guidelines, so perhaps these styles are not the best!

I should read Peter W's presentation again and copy his, but it is going home time really...

I once did a nice Index for Fortrose Medical Practice near Inverness, but then somehow managed to lose the backup I had on my laptop. Still, this was 3 years ago and I have never managed to create an index or style of guideline I have been entirely happy with since.

Going home....now. Bye :)

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INRs

We do some INR monitoring stuff here but it has annoyed me that I have to footer about to get the results. So, a I have created a quick and simple guideline to help.

Looks like this:
If anyone has a better one feel free to share :-)

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Tuesday, 29 May 2007

More on Post-Dating Acutes

It's Tuesday, so drugs clinic day. So Dr Brown attempts to copy an acute Rx for Methadone and change the date to a future one, as discussed previously, with all the complex dose/frequency information that this includes. And gets this:


So it does not allow it. A little more investigating finds that if you Add New it is allowed, but the 'Date cannot be in the future' warning appears if you copy and change the date to a future one, or if you attempt to edit the medication record and then OK it.

It's a bug, I think. Not a critical one, but a tad annoying.


Read more...

It's going around

Being stricken with a gastroenteritis at the holiday weekend (as happens :-( ) I have not been at my best so may be somewhat quiet on the blogging front. OTOH it brings up this annoying bit of Read:

If you do a search for 'gastroenteritis' in Vision you will perhaps find the code 'J43.. Gastroenteritis'. 'Ah ha! Found it.' you would think. Alas, no. A quick check up the hierarchy shows this:

So, in fact, our 'J43.. Gastroenteritis' is a Read Synonym for non-infective gastroenteritis. Now, I checked and my Temperature was fairly consistent at around 38.5 deg C most of yesterday and I feel somewhat wobbly today, so I am fairly sure some micro-organism was to blame. So, a bit more determined searching finds this:


which I would be happy with, though clearly you could use 'A0803..00 Infectious gastroenteritis' instead. Whatever...

Once you are happy with it, trap it by Right Clicking and adding a Keyword such as 'geinf' then, forevermore, you can quickly get to an appropriate code for the Gastroenteritis we are all most familiar with (but not always in a good way).


Now I am going to do a surgery. I promise to wash my hands.

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Friday, 25 May 2007

Things I wish

So this is for sharing understanding of what are RFCs, and what are "User Training issues"
I'm a near-beginner (9 mo) (I'm Colin) and Paul's an expert.
I think these are linked - if it needs training, the usability isn't there, so it's a lesser RFC.
Or put another way -if the workaround is too laborious it becomes a RFC.

#1 Prescribing
When copying an acute to Rpt Master - can it keep the special dose instructions? - would facilitate starting long-term Rx.

Why are all DRUG NAMES IN CAPS - visual abuse; and more importantly it breaks the alphabetic sorting of display.

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Post Date an Acute

You can do this (as discussed on the Vision Forum - thanks George). I tried this on Tuesday and was sure I received a 'Date cannot be in the future' warning. But I wonder now if this was for a repeat master...

Anyway, to post date an acute you simply change the date prescribed value to the one you want. The prescription will then print with this value on it. (In EPS (England) the prescription will be sent but really queued somewhere until the date prescribed date actually arrives at which point it will automagically appear for the dispenser).

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Thursday, 24 May 2007

Instant Messaging

eJabber is Open Source and available at no cost. Installs to Windows via a setup.exe and runs as a service. You can download various clients though I have just grabbed Spark which seems OK.

Allows auto registration of local users, conferencing and broadcasting with a web based front end to the admin tools.

I will play with it over the next few days and see if it can be of any use in the practice.

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Wednesday, 23 May 2007

DXS Working!

Many thanks to the DXS team who sorted my DXS. I have come to rely on it for PILS and self help info.

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Advanced Guidelines

Can I recommend Peter Wiggin's PowerPoint on the NVUG web site (password required) which I just read this morning. I never knew there was a 'screenshot' button for guidelines. Very nice.



Though I can never format guidelines to look nice, somehow I just can't get the fonts and colours to all work together :-(. This is just me, though. I think templates or cascading style sheets would be cool for guidelines, but maybe not going to see them in V3.

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Tuesday, 22 May 2007

Bigger is better isn't it?

Some of our clinicians struggle with 17" screens so when we replaced five recently we upgraded to 19" and now they use 1280 x 1024. I think Vision looks better at that resolution.
I have a Dell 24" screen at home so I took that into work to try out some different resolutions. Turns out that 1900 x 1200 on a 24" is probably too small for some, so a £200 22" screen at 1680 x 1050 (WUXGA)like this one http://www.overclockers.co.uk/showproduct.php?prodid=MO-007-BE should do the job nicely.
It would mean that I could finally teach someone about Vision and they could see the screen at the same time. My practice manager was keen for appointments so you can see all the columns at once.
I suppose adjustable font size in Vision would help but no sign of that anytime soon...
Maybe it will make us a target for thieves. Maybe it will make everyone else in the practice unhappy because they will all want one too and our budget does not go that far.
What do you think?

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May medication reviews

Are all done :)

Mind you, it is nearly June so need to start them next week.

:-(

At the end of the year though all our repeats should be fairly clean. The challenge with the med review SDA is that when you mark a review as done it creates a new 'Due' record which copies over the text from the review done form. So you need to either be careful to delete it or just not use the SDA for free text. Which is annoying as clearly the most appropriate Read Term is 'Medication Review Done'.

Anyway, May done and dusted. June recalls planning on Thursday. INPS in Dundee tomorrow on EPS2 requirements and Immunisations.

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Post Dating an Acute Prescription

For the drugs clinic this would be extremely useful, not to mention much safer and give a better chronological listing of the patients prescription history. At present, as we cannot issue more than 28 days of methadone to an acute script so we have to do 2 scripts (if the patient is well, stable etc and we wish to see them in about 6-8 weeks) the second of which we have to amend the date on by hand.

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Another contributer...

I think the blog would be all the better for having a variety of contributers and authors commenting on the stuff they do with Vision. So, Richard Kinsman has joined today. Hi Richard, and thanks!

Anyone else interested in making regular (or occasional) contributions please let me know.

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37 messages

37 prescriptions needing attention and phone messages this morning. Ugh. Vision 3 does not handle messaging well, though to be fair it was never intended to. We are using appointments notes to display the message currently, but I think this would be better managed by entering it into the journal and creating an appointment book of patients with messages by type. Perhaps.

By the time I have processed all the above items though, it will be time for the next surgery!

Messaging needs some work though.

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Monday, 21 May 2007

Recalls again

I now run my recalls for June report, having been through the list and corrected any not needing done. The numbers have fallen from about 60 to only 24. I can report on this as a standard report from V3 and print it as a PDF. I just downloaded Desk PDF for this, first hit from Google, but there are lots of PDF printer programs available.

I can then circulate the recall list with the practice team for comment using NHS Mail.

Ho hum, Monday... Far too much to do this week. :-(

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Friday, 18 May 2007

Visioneer wiki

A link to Colin's Visioneer wiki with info for system changers and new users.

http://visioneer.pbwiki.com/

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Blog Changes

Welcome to NVUGTECH subscribers.

NVUGTECH is the more technical list hosted by the User Group, useful for queries about hardware, encryption and networking problems. Access to it is from http://www.nvug.org/forum/ and you can sub to it as a mailing list (straight to your inbox) if you wish also.

Comments on the blog are currently open to all users, not just registered ones, and I will try and keep it that way till the first time I get flamed.

I have added Colin Brown, my partner at Glenburn, as an author on the blog also. He will make more sense than me, I am sure ;)

Also, I will keep tweaking the appearance and modules on the page, so if you check the blog and it looks suddenly different try not to panic.

If anyone else feels inspired to start blogging their Vision stuff, let me know and I will link to you from here.

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Thursday, 17 May 2007

Medication Reviews for May

So using the below process I have a group of about 40 patients who have a Month of Birth (hereafter referred to as 'MoB') of May and will require a medication review for QOF.

I can work through them. I am in the surgery 5 more days before the end of May (I work a minimum of 3 full days a week in the practice) so 40 divided by 5 means I need to do 8 a day to complete medication reviews for May.

So, that is good. Almost feels like progress.

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Medication Reviews in Vision 3

Medication Reviews in Vision 3

About

This document outlines the process to use for managing medication reviews as required by QOF in Vision 3 in Glenburn Health Centre. This is a first iteration of this and should be treated as draft guidance only.

What is a Medication Review

QOF requires that any patient on Repeat Medication has their medication reviewed at least every 15 months. Whilst this can be analysed using a Vision 3 monitoring audit, it is not reported to QMAS directly. Rather, it is assessed as part of the QOF assessors review and success claimed by auditing the figures through Vision Clinical Audit.
The QOF requirement of what constitutes a medication review is as below:

'Involving patients in prescribing decisions and supporting them in taking their medicines is a key part of improving patient safety, health outcomes and satisfaction with care. Medication review is increasingly recognised as a cornerstone of medicines management. It is expected that at least a Level 2 medication review will occur, as described in the Briefing Paper http://www.medicines-partnership.org/medication-review/room-for-review/downloads.
The underlying principles of any medication review, whether using the patient’s full notes or face to face are:
1. All patients should have the chance to raise questions and highlight problems about their medicines.
2. Medication review seeks to improve or optimise impact of treatment for an individual patient.
3. The review is undertaken in a systematic way by a competent person.
4. Any changes resulting from the review are agreed with the patient.
5. The review is documented in the patient’s notes.
6. The impact of any change is monitored.
Medicines DO NOT include dressings and emollients but would include topical preparations with an active ingredient such as steroid creams and ointments and hormone preparations.'

This document http://www.npc.co.uk/med_partnership/assets/room_for_review.pdf gives four levels of medication review:
  • Level 0
    Ad hoc review often of single item - does not count for QOF
  • Level 1
    Prescription review. Often without notes and not reviewing full repeat list. Not for QOF.
  • Level 2
    Treatment review. Review of full repeat list with full clinical notes. Patient not present. Minimum for QOF.
  • Level 3
    Clinical Medication Review. Review of all meds including acutes and repeats with patient present and full clinical notes.

QOF assessors guidance states:
"Medicines 11.4 Assessors’ guidance
The assessors should ask the staff to demonstrate how the system works and in particular how an annual review is ensured."

So we are required to
  • review the patients notes and medicines with or without them present or consulted
  • record that this has been done
  • record any changes we have made
  • ensure a system exists to allow 'annual review' (although QOF requirement is actually 15 months).

Vision 3 and Medication Review

The method within Vision for tracking Medication Reviews involves using the medication review SDA as shown below.



Accessed by the menu function Add->Medication Review.



The Medication Review form lets you record a Medication Review as having been completed and then sets a reminded for the next one. This reminder only shows up in the F5 Repeat Medication tab and changes colour when overdue. When this starts happening can be defined in the Consultation Manager Set-up screen, though the defaults are fine for us.



Some difficulty arises as it is possible to add multiple medication review records for an individual patient, and thus end up with multiple reminders.

We only really need one rolling annual medication review record for any medication PLUS one for asthma specific medication and one for epilepsy specific medication if appropriate to the patient At most then a patient would have 3 rolling records. There is no need to add new Medication Review Records - further reviews should be recorded using existing ones.

Where we see multiple records we need to tidy up the medication reviews by removing unneeded ones.

We can list all medication reviews for a patient by doing List->Medication Reviews.



In this example, because this is a GPASS conversion we have lots of reviews. We also have two reminders outstanding, we only need one.

The other problem with Medication Review forms is that they carry forward the text of the review with every new record. This means it looks like you end up with lots of duplicate and spurious records.

which is confusing. At least part of the problem for us here is the conversion data which has attached free text (GPASS comments) to medication review records. Thus, when tidying these up we need to be careful that we do not delete clinical notes or relevance.

Medication Management Guideline

We can use this guideline to help sort our medication reviews and management. It is called 'Medication Management' and can be accessed from the practice guidelines index.



When deleting reviews containing text it is important that we check the record to make sure that the comment text is entered elsewhere.

When adding a new review we should use the existing ones and check the 'Review Done' button, or mark it as done from F5. This will then setup the next one with a due date of 1 year from now.

Try not to put text into the medication review form, and if you do so make sure you check and delete this from any future review records otherwise we end up with lots of spurious records. I suspect this is not an intentional 'feature' and it is annoying as it requires a conscious decision to remember to check and tidy it.

Monthly Medication Reviews

For this we need to run a search every month for the patients in that Month of Birth group who have Active repeat medication items. Store the output of this search as a group.



Then select this group in Consultation Manager and, essentially, work through each patient reviewing their medication.

We can refine this further by identifying the patients who have had their QOF Medication Review done within the QOF year (i.e. from 1/1/2007).



Then either add this criteria as an exclusion to the first search or use Patient Groups to remove common patients.

What do we do at a Medication Review

This is a list that is likely to be revised as time progresses and we do more of these, but each medication review should assess:
  • Is the patient on safe medication?
  • Is their compliance adequate?
  • Are there any items on their repeat list that they are not taking or not needing any longer?
  • Any obvious interactions that need addressed?
  • When possible, re-authorise each repeat master line for 1 year.
  • Ensure a 'dosage indication' is present.
  • Add or complete a medication review for the patient
  • Add or complete an asthma or epilepsy medication review for the patient if appropriate
  • Check the acute list to make sure no other conflicting items.
  • Check for duplicates
  • Check for items with 'as directed' and, where possible, change to a clear dosage instruction.
  • Note any changes using the appropriate Read Code from the Medication Management guideline.

Read more...

DXS stopped working

My DXS stopped working since the error we had earlier in the week. I discovered this whilst trying to find a PIL on Olecranon Bursitis. Prodigy keeps changing its interface so I never know where I am with it any more, and Prodigy in Vision is out of date. GP Notebook was not working yesterday either and does not seem to be today yet.

Vision, Control Panel, File Maintenance, Staff should be where DXS is turned on or off, but I just see this:So I dunno what is wrong with it. Have asked our PM to try and find out.

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Wednesday, 16 May 2007

Glenburn Guidelines

Current guideline index. You can edit these by selecting U_INDEX as the guideline name in Select Guideline. The 'U' is for 'User'. Well, I have always assumed so :) Remember the guideline index is practice wide. Nice to keep it neat, and put it into everyone's Patient Record View as a tab.

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Medication Reviews

These do lend themselves to month of birth checking very nicely. But I do actually need to do the work :-(. As we missed April I plan to start this formally this week. So, we will use the MoB cohorts (a clinical audit you can download from INPS web site) and search these people for Active Repeat Masters, create a group, then go through the group doing medication reviews. I am guessing there will be 70-80 pts, which over (normally) 4 weeks works out as 20 a week or 10 each if we split it between us.

Not likely to get to this today though. PCV medical, docman workflow and surgery today.

Coffee first.

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eps2

Busy day today. Paperwork and surgeries and visits and stuff.

Yesterday INPS in Dundee on EPS2 requirements. EPS2 is not an easy thing to model as it has 2 distinct phases and 2 additional areas of 'not on yet' functionality (private ETP and Controlled Drug ETP) but that need to be available and turn-onable later on. And then there is ADS (advanced digital signature) implementation and some bulk siging functions. It makes sense at the time ;-).

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Monday, 14 May 2007

errors aargh!

So the same error returned when we tried to re-boot the server at lunchtime. See screenshot. Quick search of O:/Program shows a gds32.dll and a further search of Google says Firebird is the problem. Which is DXS's database.

Anyway, PM to Helpline. I went to do some house calls. Sorted by my return. Phew. Surgery to do...


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Con Man View


This is my Patient Record View in use. I have pixellated and hidden any pt identifiable stuff. I am using a 23" widescreen monitor (Viewsonic VG2230wm) , which I would recommend to folk everywhere ;-). Admittedly hard to get your PCO to agree to it...
V4 is being defaulted to 1024x768, but like all minimum specs it is often nicer to exceed them. The Viewsonic is nice as it can be swivelled to and from patients, and raised/lowered and tilted. I only have a d-sub analog out from the graphics card on the PC (an HP P3 with 1GB RAM), so no digital out. But I guess unless playing HL2 (which I rarely do at work) this is no big loss.
I like to work with the Consultation pane, which does ok in larger resolutions but is a bit of a pain at 1024x768. It does allow 'topics' though, which are a natural way of splitting your consultation recordings into the 4,5,6 or whatever things the patient had on their list.

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Monday login

Tried to login 9:00am. Password expired. Bugger. I have passwords for the network, for NHS mail, for Vision, for my gmail, yahoo mail, banking, Carenet, DNUK etc etc. The only person that frequent enforced password changes stops accessing my stuff is me. grrrr.

Then a weird error. Something to do with software validation in Vision - looked as though some add on was error checking and finding an error and thus making everything else hang. Then repeated warnings (with horrible 'chunk' sound) then Con Man bombed out with an 'overflow error'.

Happened twice. Then OK third time. Weird. Anyway, Monday.....

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Saturday, 12 May 2007

QOF recall codes

I found a copy of this file on this PC, so here it is.

ASTHMA


Code / Term Keyword
Recall 9OJZ.00 Asthma monitoring admin.NOS recasthma
First Letter 9OJ4.00 Asthma monitor 1st letter asthma1
Second Letter 9OJ5.00 Asthma monitor 2nd letter asthma2
Third Letter 9OJ6.00 Asthma monitor 3rd letter asthma3
Verbal 9OJ7.00 Asthma monitor verbal invite asthmaverb
Phone 9OJ8.00 Asthma monitor phone invite asthmafone
Use Group for Register Monitoring Audits ASTHMA01



CORONARY HEART DISEASE


Code / Term Keyword
Recall 9Ob2.00 Coronary heart disease monitoring default recchd
First Letter 9Ob3.00 Coronary heart disease monitoring 1st letter chd1
Second Letter 9Ob4.00 Coronary heart disease monitoring 2nd letter chd2
Third Letter 9Ob5.00 Coronary heart disease monitoring 3rd letter chd3
Verbal 9Ob6.00 Coronary heart disease monitoring verbal invitation chdverb
Phone 9Ob9.00 Coronary heart disease monitoring telephone invite chdfone
Use Group for Register Monitoring Audits CHD05



CHRONIC KIDNEY DISEASE


Code / Term Keyword
Recall 9Ot..00 Chronic kidney disease monitoring administration recckd
First Letter 9Ot0.00 Chronic kidney disease monitoring first letter ckdlet1
Second Letter 9Ot1.00 Chronic kidney disease monitoring second letter ckdlet2
Third Letter 9Ot2.00 Chronic kidney disease monitoring third letter ckdlet3
Verbal 9Ot3.00 Chronic kidney disease monitoring verbal invite ckdverb
Phone 9Ot4.00 Chronic kidney disease monitoring telephone invite ckdfone
Use Group for Register Monitoring Audits CKD01



DIABETES




Recall 9OLZ.00 Diabetes monitoring admin.NOS recdm
First Letter 9OL4.00 Diabetes monitoring 1st letter dm1
Second Letter 9OL5.00 Diabetes monitoring 2nd letter dm2
Third Letter 9OL6.00 Diabetes monitoring 3rd letter dm3
Verbal 9OL7.00 Diabetes monitor.verbal invite dmverb
Phone 9OL8.00 Diabetes monitor.phone invite dmfone
Use Group for Register Monitoring Audit DM 19



COPD


Code / Term Keyword
Recall 9Oi..00 Chronic obstructive pulmonary disease monitoring admin reccopd
First Letter 9Oi0.00 Chronic obstructive pulmonary disease monitoring 1st letter copd1
Second Letter 9Oi1.00 Chronic obstructive pulmonary disease monitoring 2nd letter copd2
Third Letter 9Oi2.00 Chronic obstructive pulmonary disease monitoring 3rd letter copd3
Verbal 9Oi3.00 Chronic obstructive pulmonary disease monitoring verb invite copdverb
Phone 9Oi4.00 Chronic obstructive pulmonary disease monitor phone invite copdfone
Use Group for Register Monitoring COPD01 Register



EPILEPSY


Code / Term Keyword
Recall 9Of..00 Epilepsy screen administration recepil
First Letter 9Of0.00 Epilepsy screen invite 1 ep1
Second Letter 9Of1.00 Epilepsy screen invite 2 ep2
Third Letter 9Of2.00 Epilepsy screen invite 3 ep3
Verbal 9Of3.00 Epilepsy monitoring verbal invite epverb
Phone 9Of4.00 Epilepsy monitoring telephone invite epfone
Use Group for Register Monitoring Eplilep05



HYPOTHYROID


Code / Term Keyword
Recall 9Oj..00 Hypothyroidism monitoring administration recthyroid
First Letter 9Oj0.00 Hypothyroidism monitoring first letter thy1
Second Letter 9Oj1.00 Hypothyroidism monitoring second letter thy2
Third Letter 9Oj2.00 Hypothyroidism monitoring third letter thy3
Verbal 9Oj3.00 Hypothyroidism monitoring verbal invite thyverb
Phone 9Oj4.00 Hypothyroidism monitoring telephone invitation thyfone
Use Group for Register Monitoring Thyroi01



HYPERTENSION


Code / Term Keyword
Recall 9OIZ.00 Hypertens.monitoring admin.NOS rechbp
First Letter 9OI4.00 Hypertens.monitor.1st letter hbp1
Second Letter 9OI5.00 Hypertens.monitor 2nd letter hbp2
Third Letter 9OI6.00 Hypertens.monitor 3rd letter hbp3
Verbal 9OI7.00 Hypertens.monitor verbal inv. hbpverb
Phone 9OI8.00 Hypertens.monitor phone invite hbpfone
Use Group for Register Monitoring BP01



ATRIAL FIBRILLATION


Code / Term Keyword
Recall 9Os..00 Atrial fibrillation monitoring administration recaf
First Letter 9Os0.00 Atrial fibrillation monitoring first letter af1
Second Letter 9Os1.00 Atrial fibrillation monitoring second letter af2
Third Letter 9Os2.00 Atrial fibrillation monitoring third letter af3
Verbal 9Os3.00 Atrial fibrillation monitoring verbal invite afverbal
Phone 9Os4.00 Atrial fibrillation monitoring telephone invite affone
Use Group for Register Monitoring AF01



HEART FAILURE


Code / Term Keyword
Recall 9Or..00 Heart failure monitoring administration rechf
First Letter 9Or3.00 Heart failure monitoring first letter hf1
Second Letter 9Or4.00 Heart failure monitoring second letter hf2
Third Letter 9Or5.00 Heart failure monitoring third letter hf3
Verbal 9Or2.00 Heart failure monitoring verbal invite hfverbal
Phone 9Or1.00 Heart failure monitoring telephone invite hffone
Use Group for Register Monitoring HF01



STROKE / TIA


Code / Term Keyword
Recall 9Om..00 Stroke/transient ischaemic attack monitoring administration reccva
First Letter 9Om0.00 Stroke/transient ischaemic attack monitoring first letter cva1
Second Letter 9Om1.00 Stroke/transient ischaemic attack monitoring second letter cva2
Third Letter 9Om2.00 Stroke/transient ischaemic attack monitoring third letter cva3
Verbal 9Om3.00 Stroke/transient ischaemic attack monitoring verbal invitati cvaverb
Phone 9Om4.00 Stroke/transient ischaemic attack monitoring telephone invte cvafone
Use Group for Register Monitoring Stroke 1



DEMENTIA


Code / Term Keyword
Recall 9Ou..00 Dementia monitoring administration recdem
First Letter 9Ou1.00 Dementia monitoring first letter dement1
Second Letter 9Ou2.00 Dementia monitoring second letter dement2
Third Letter 9Ou3.00 Dementia monitoring third letter dement3
Verbal 9Ou4.00 Dementia monitoring verbal invite dementverbal
Phone 9Ou5.00 Dementia monitoring telephone invite dementfone
Use Group for Register Monitoring DEM01



MENTAL HEALTH


Code / Term Keyword
Recall 9Ol..00 Mental health monitoring administration recmental
First Letter 9Ol0.00 Mental health monitoring first letter mental1
Second Letter 9Ol1.00 Mental health monitoring second letter mental2
Third Letter 9Ol2.00 Mental health monitoring third letter mental3
Verbal 9Ol3.00 Mental health monitoring verbal invitation mentalverb
Phone 9Ol4.00 Mental health monitoring telephone invite mentalfone
Use Group for Register Monitoring MH08

Read more...

Guideline for recalls

Given the workflow, I have kicked off a QOF Recalls guideline which will eventually show current recalls and invites along with Read code links to enter new invites.

The intention is to run with a single rolling recall for each QOF area, not add a new recall every year. Now I know we could do a combined 'Chronic Disease Recall' instead of individual ones for each area, but I think that may be trickier to manage in that it would not clearly show the CDM areas that the patient was in and if the circumstances changed (as will happen as we tidy up the data) then they may need taken off the combined recall and put on an individual one. I also think it will make reporting easier if we use the individual recalls per CDM area.

I will publish the list of recall codes next week. They should be on this comp also but do not appear to have synchronised over. We are using BeinSynch to keep practice and personal files synchronised on various machines. I am not sure yet that it is software I will continue with as I am increasingly trying to keep my stuff on line, using Google Docs or the more recently discovered ZoHo which also does project management stuff online.

Read more...

Nested equation 13 levels

The ideal situation is to combine people with multiple recalls of the same type into groups. This would mean essentially identifying the intersects between all the Chronic Disease recalls each month. I have set up 13 of these. Thus we we would need 13*12*11*10....etc separate calculations to work this out. This cannot be done easily with patient groups in V3 nor am I going to write all the searches to do it. I think doing this by hand with some filtering tools, like Excel, is probably more sensible :)

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Print it all out....

Well, having hacked away at this for a couple of hours yesterday in the end the best solution was to print out the results of the June recalls search as a standard report.

This, at least, lets us go through the patients one by one (there were about 64 of them) and review the appropriateness of the recall. There is no other easy way to do this as we need to exclude anyone who is housebound or lives in a care home and also anyone who has had there stuff done recently.


So I went through some with our PM and it was an interesting exercise. Those with pure HBP recalls (IOW only Hypertension, no other QOF Chronic diseases) do not need called in before 9 months from the QOF end date i.e. from July 2007 onwards. This assumes their BP is controlled. So any of those we found we simply changed their recall to later in the year. Now this immediately screws up our birth month recall approach, but we can use the export and charting below to make sure we do no overload any one month with work. In theory, at any rate...

Also found people with wrong codes or wrong registers. E.G. a patient with possible hemiplegic migraine who had snuck onto the TIA register with a TIA code. A person with '?TIA' on an A&E letter after an unexplained collapse coded as TIA event, and thus on the CVA register.

Currently, then, it looks like the task of reviewing these recalls is quite clinician dependent. Our PM can review them to an extent, but mostly it needs me or my partner to go through them.

We also need to code housebound or in nursing home to make sure we do not send letters to such folk.

Having done all that we ended up with around 35 patients to recall in June. Now I need to start on the medication reviews in a similar way.

Read more...

Friday, 11 May 2007

Recalls Chart

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Sort by Date the Solution

With thanks to Richards Neep and White.

The problem here is that Vision exports the date values as text, so we need to make excel turn them into dates. The way to do this is to create a new column called "DATE" (or whatever) and then use the Excel function "DATEVALUE" to turn the text string into a date value in this new column.

Works fine. Now I have my charts.

Read more...

Thursday, 10 May 2007

Sort by date in Excel Pivot Tables

How do you do this, dammit?! I am trying to sort the recall date columns into date order but it keeps sorting them into 1st number order, i.e. 1/may/2007 then 2/feb/2007 then 3/dec/2007 and so on 1st, 2nd, 3rd.

Not what I want at all...

I am going home now. :(

Read more...

Recall Counts

Here is a capture of the data in Excel showing how many of each recall type we have. Hypertension and Asthma are the largest of the QOF ones. Incidentally we have around 3000 patients.


Read more...

Adding the recalls

I sat down and went through the QOF areas and worked out which codes we would use for recalls - mostly chapter 9 ones as AFAICT they do no trigger QOF / QMAS analysis. I added keywords for those and then worked out the system, as below, for getting the recalls on.

Process for creating the first recalls

· Identify Chronic Disease Cohort from Clin Audit

· e.g. Asthma is from Monitoring Audits ‘Asthma01 Register’

· Save this group

· Highlight in Clin Audit, patients are listed.

· ® click on the patients, select ‘Save this group’

· Save it pre-fixed with ‘CDR’ e.g.’CDRASTHMA’ (CDR= Chronic Disease Register)

· Identify and save month birth cohort group as BMG_month e.g. ‘BMG_JAN’. BMG Birth Month Group

· Do for all months.

· In Patient Groups – double click on the CDR group to make it your active workgroup

· Then highlight the BMG_JAN (or whatever) double click to make it selected.

· Now do ‘Keep patients that are common to selected group and work group’

· Should show you just the patients on the Disease Register with the chosen birth month.

· Save this group (this step may not be needed but could be useful for checking…) as ‘BM_AST_JAN’ or whatever month and add a description e.g. ‘Asthma January’

· Now do Group Applications->Add Recall->To Workgroup

· Click ‘Create’ on Add Recall to Medical History

· Use the Recall Code ‘keywords should all be pre-fixed ‘rec’ so, e.g. ‘recasthma’

· Set recall Date to 15th of Month birth 2007 / 2008 – the date must be in the future and no more than 1 year from now.

· Click Start to process all.

· Repeat for each birth month / chronic disease cohort.

:-)

So, next challenge is to actually use them for something.

I have tonight run a search for everyone with a recall from now till 1/4/2008. We have 624 patients with 1104 recalls. Not all of these will be QOF ones though. Next I need to stick all that in Excel and see what appears.

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Recalls

So we want to run a recall system for QOF in Vision. Coming from GPASS this means that we have no recalls previously set up. There are of course numerous ways of running QOF stuff with Vision but most folk use either prescribing reviews or recalls to do the bulk of the work. We are going to use recalls in part because we still have a lot of work to do in tidying up the repeat masters from the conversion, and including in that doing all the QOF work is probably untenable.

First task then is to do some research, and we re-read Richard Neep's presentation of Recalls and QOF on the NVUG web site. I once gave this talk so you think I would have a clue...

Anyway, he uses Excel and pivot tables for a lot of the analysis. We can do this, but it would be good to have the system designed such that staff don't have to learn Excel before they can manage the recall system. It may be good to use that type of analysis for work volume planning, but ideally not for day to day recall management.

I ran a search for all recalls on our current patients, and found not very many and the ones we do have were wrong or innapropriate. This means we need to set up the recalls from scratch, which is in itself a big chunk of work.

Here then is my summary of the rough plan of action:

Summary

· All patients on QOF areas should have a recall set

· This recall is based on birth month

· The code for the recall reflects its purpose but should not interfere with other QOF analysis

· Searches need to be run every month

· Identify those with a recall due

· They get an invite letter

· If they turn up and get stuff done, then the recall is deleted and a new one created

· If they don’t they are picked up in the next search

· Need to avoid calling in people who have had stuff done

· Need to create a whole lot of recalls for the first time

· Need to have a guideline or two to manage adding and deleting and viewing them

· Need to consolidate people with multiple recalls into one appointment.

· Specific gaps (e.g. a Diabetic with everything apart from a Cholesterol) will need to be addressed probably on a per case basis

· Exception adding should be after 3 invites if they are not meeting all or any of the required targets

· Ad hoc opportunistic invites also need to be caught and recorded – this could reasonably be done with ‘Reports’ to generate letters. Not clear if RHS is reliable enough in QOF terms given no guarantee that pharmacist will supply pt with RHS.

Next the way we have dealt with adding the recalls.

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About me

Hi all

By way of introduction, I am a GP and have been using INPS Vision in its various releases since 1997. I have changed practices, worked in some GPASS sites as a locum for a while and am now back working with Vision 3 in an ex-GPASS conversion practice in Paisley, Scotland. I also work on requirements analysis 1-2 days a week for INPS on Vision 4.0 development in Dundee.
The GPASS conversion happened late in 2006, so the practice is still getting to grips with new systems of working with Vision. With luck I will manage to update and post here any stuff I do or the practice does with V3, in the hope that this is useful to other users.

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First Post

Hi all

Just an INPS Vision Blog for the hell of it. Keep in touch.

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