Tuesday, 25 March 2008

Rec9

Doing the anlysis for this QOF indicator this week and last. We do not use problem linkage to our repeats to meet this indicator - I have always found it too cumbersome. Although possibly once the overhead of adding problems for the majority of them has been done it would be OK to work with thereafter.

Anyway, we use an indication in the Dosage field. For example, "Take two puffs twice a day [ for asthma prevention ]".

We routinely, as far as possible, use the square brackets to enclose this 'indication' text and we have set up most of our standard drug defaults to include it so that it populates automatically. Clearly this needs tweaking from time to time, as not all drugs are taken for the same purpose.

When it comes to analysis of this, I run a search and export the information as dbf tables, then import it into Excel and do some simple counts on the data to produce a percentage score. By this method we currently get 79.6%! Damn! Although this method includes all appliances and monitoring equipment, which I understand can reasonably be excluded from the QOF target. I have been unable in the search to exclude the Action group for Diabetes monitoring agents - it produces an error which sets the field value to 'null'. This be a bug, methinks.

The search is this:


and yes, I know, you can do an initial patient list search and then load that group in.

V3 does not know when repeats were commenced. It knows when they were re-authorised, but not when they were started as every re-authorisation event stops (inactivates) the previous repeat master and creates a new one. The QOF requirement only applies to repeats started after 1/4/04, but in V3 terms this means anything re-authorised after this time. A 'date commenced' is intended as a separate attribute for repeat masters in V4.

While we are on searches, if you save your search using a description prefixed with some initials, then it makes them easier to locate in the adhoc search list. e.g.:



So then I import the tables into excel and I get this:


The formula for counting how many have the square brackets is:

=COUNTIF(D2:D4358,"*[*]*")

79.69%

damn

Still, be fixed by end of month and really we are achieving this already, but it would be nice and reassuring to have a spreadsheet that clearly shows it.

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Wednesday, 12 March 2008

And from Karen

Karen Lefevre e-mailed me to say this re the post below:

"You can copy the current guidelines that Vision has for each of their management plans. Under 'Guidelines, 'Select Guidelines', all of the Management Plans start with '@'. Being careful to copy this to a different name these can then be edited to fit what you want.

I've also used this to copy and alter others such as the Maternity Management plan as we found this was missing some things we wanted and had other fields we didn't want. Looking at these can be useful to see how to set up the special formats also."

Thanks Karen


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Tuesday, 11 March 2008

A Data Grid for Results

In the land of Renfrewshire we are somehow denied the ability to have electronic results transmission. This is sad, and has been such for the whole 11 years I have been using Vision. Oft promised, never yet delivered. Peter Wiggin's practice has had electronic results for years, but this was a bespoke arrangement with a local lab. The rest of us seem to have to wait for SCI to get its house in order, and the most recent DLM from Vision is meant to at least enable the technology, if not the business process. We are stuck, I suspect, waiting for someone with the decision making clout to actually enable the change technically, so we can use it locally. This, of course, will never happen until we get the time and energy to find the people responsible and make the change occur. Until then, we have to manually enter paper path results into our bells and whistles clinical system. Making this an easier task is best affected using a data grid entry form in a Vision 3 Guideline.

Management Plans

If you Right Click on any topic header in the Medical Record Overview (the navigational click-able hierarchy on the left) you can select an option of 'Management Plan' for any entity. Thus:


Clicking 'Management Plan' opens:

Which is functional but far, far too busy for routine use.

What to do then?

So, we fix it by making our own custom guidelines with simpler data grids that follow the reporting order on the lab form. Here is a biochem form:



And for getting the staff to enter it successfully I have created this grid:

And this one:

Making these

To add these you start by creating a new guideline in the usual way:

And in 'Edit' mode you click on the New Data Grid icon:

Which opens this form:

You then select items in the order you wish them to be entered, which in our case attempts to correspond to the order they appear on the pathology form. So, our grid design for U&E looks like this:

I have left everything as reporting a 'Value' but there are display string options you can apply to see a long format, short format or 'Special' which has some obscure syntax.

In Design mode in the guideline it looks like this:

and at run time, when used for real, should let our staff enter the results from the form in a more stepwise and logical fashion than before. It also has the advantage of letting us see the results in a more filtered way, although I still find I refer to the scanned paper copy and until we get electronic path results this is always likely to be the case. Mind you, the grumbling about mail manager in its current iteration does not inspire me to rush to change!


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