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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Thursday, 13 September 2007

Dosage Codes

Question on the forum about this. Here is a quick 'howto'.

Dosage codes are shorthand ways of getting dosage text instructions into therapy items. So, you type 'bd' and it expands to 'twice a day'.

Very good :)

To access the list of them, and add, edit or delete them, you need to open up a Therapy Add form - i.e. do F4 then F8 in consultation manager then Right Click in the Drug Name box. Like this:



You can 'Add' or 'List'. 'Add' gives you this form:



which is relatively straightforward.

List shows this horrible listing in a datagrid that was written when the UI specialist was perhaps on holiday:



It is, however, perfectly functional. You find the code you want to edit or delete, and Right click on it. e.g:



The one that causes annoyance is 'OF' which expands to 'Every Fortnight'. Post from Mark Morgan of INPS (thanks Mark!) then says if you prefix the word with ' i.e. an inverted comma, known to us (just) over 40 yr olds as an apostrophe (and we multiply things, not 'times' them. Oh, its all changed since I were little, grumble, grumble etc..) then you will get the word you type, not the abbreviation. e.g.:


that is a good tip. :)

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Wednesday, 12 September 2007

SDAs

So, a V3 Structured Data Area (SDA) is simply a place where you can add details about a thing, like a result or a finding. Always, in V3, attached to a Read Code. The BP example below shows that Blood Pressures have many attributes, but will be captured against a single Read Code (although you can choose one from lots of different codes for each entry).

This stuff is becoming very important informatically speaking, as it determines the shareability. SDAs are sometimes (though not specifically by Vision users!) referred to as 'archetypes' (or templates, where they use more than one archetype. sort of..) and for good or ill every system supplier in the UK has gone off and done their own thing with them. Which was fine, until the new networked world hit and we had to start sharing stuff. Which is why GP2GP has taken so long to get going. A Vision representation of a Blood Pressure will not be a GPASS one will not be an EMIS one, and so on...Work by NCDDP in Scotland and CfH in England on Clinical Content Models, plus the OpenEHR stuff is all looking at this.

Quote from Ian McNicoll I like courtesy of Derek Hoy (thanks Derek! oh yeah, and Ian!)

"The information model is the crux of current electronic clinical records but, by being application or message specific and usually proprietary, it hampers interoperability."

OK, so this is more than you need to know. What I am getting at is to show why SDAs exist at all and are needed. Medicine is complex and needs, inevitably, a complex model to underpin what we do electronically. The complexity is largely hidden from the user in V3 but it is impossible to hide it all. Thankfully, people in general practice are usually smart enough to cope. There are somewhere in the region of 400 SDAs in Vision, if you count all the result ones.

It is a good idea to get to know how and when to use them. Honest. :)

More later.

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Tuesday, 11 September 2007

ways to do it

Some folk coming from GPASS get annoyed coming to Vision because of the requirement to enter a Read code before you can do anything. It is, I agree, challenging to go from one method of electronic recording to another. And I have had, and continue to have, endless debates about the value of narrative versus codes in recording the consultation. But, hey, that is not for today...

In fact Vision lets you do GPASS style recording, pretty much. You do need to enter a code first, but it can be a fairly broad code and you can attach it to a happy little keyword like 'addstuff', say onto '1....00 History / symptoms' as a heading.



Then you can just type away merrily. And, of course, you can enter more than 512 characters. ;-)

But Vision 3 does like structured data entry; it tries hard to encourage it. And generally when you have a value or an examination finding you should stick that in the correct place - the horribly named (especially to scare newbies) 'Structured Data Area'. These little beasties confuse folk terribly, particularly when you are used to dumping everything into a narrative either on paper or text box. But essentially they are just ways of recording stuff you do in a logical fashion, with less ambiguity than narrative and in a way that allows you to search or report on this information.

In fact, GPASS also has SDAs but they are not as well modelled (in my opinion! - though I miss SPICE for workflow and simplicity!). It also has the troubled BP data entry with multiple methods recording in different places in the database and no error trapping. But when you enter Systolic and Diastolic into a specific box or boxes, this is a structured data entry. Vision allows for more complexity and detail in the recording, but it also allows for this to be very simple. And has error trapping, and one place in the database for recording it. Write once - Read often.

So, if we do this:



Then it is no use to QOF, no use to CDM in general and little use in 10 years when you want to list all the BPs for the patient.

If I just want to record BP simply but correctly in V3 I need to use the SDA. You can get to it by doing ALT, A, B for 'Add -> Blood Pressure' (or use the mouse if you must!)



As is often the case with Vision, you can do things many ways. This is good - we all consult differently - but also bad (for beginners, who want to know the one true path...). You can also record get the BP SDA up by typing 'bp' into the Read Popup on a Journal screen.

Anyways, here it is again:



So all you need to do is enter systolic, tab to move to the next field, diastolic, and then OK. Done. You can, however, also record lots more stuff about your BP measurement and I tend to do so routinely (but you don't have to!). You can navigate the form using the keyboard quite quickly, with a little practice.



So here I am recording which arm (important clinically sometimes) and which cuff, good to know in obesity particularly.

Takes some learning to use the keyboard, but you do not need to make the effort to do so immediately - you can take your time as the defaults are fine for most purposes.

Anyway, I have to go do some real work...

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Tuesday, 4 September 2007

A big boy did it then ran away

It was annoying us that in Journal views where some receptionists are making entries, the initials on the view made it look as though a clinician was responsible. So, e.g. Joanne (one of our reception staff) goes into the journal to record a special request message, and this then appears with the initials 'PAGM' after it so, at first glance, it looks like I did it. But, it wisnae me!

The fix for this it to make staff who are using the journal to make entries be set as type 'Other Health Care Professional', as 'Receptionist' roles are assumed to be non clinical, thus entries made by them are the responsibility of an allocated clinician.

So, change this. And now her initials appear.



You can check the actual logged in user who made the entry by (R) clicking and selecting 'Audit Trail'. But not best convenient ;-).

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