Tuesday, 24 November 2009

Problems with Read Code Add in Guidelines

It is probably just me but why am I losing the start of text when I do Read Code add to a guideline? In design mode looks like this:

And when run like this:

Grrrr. A bug? Or me being overtired?


Friday, 6 November 2009

Seasonal Flu Macro

For Macro Express:


Wednesday, 30 September 2009

Using 'Patient Advice' in guidelines

Doing a Cervical Cytology refusnik disclaimer guideline. Not very exciting. More dealing with bureacracy than treating patients, I fear. However, needs must. I used 'Patient Advice' section in guidelines for this.

Hassle with this is, as I re-discovered whilst using it, that the text all prints on on one line, even though it appears correct on the screen.

The answer to this is to use simple HTML tags in the text display, as below.

Then it all prints out nicely.

A tad annoying though, if you are unsure of using HTML.


Tuesday, 29 September 2009

Chronic Disease Register Guideline

It has annoyed me for some time that we have no 'flag' for all the chronic disease registers nowadays, with QOF making the 'on the register' decision via formulae based on Read codes and Therapy. So the old Vision 'Registers' are not really relevant today, although the functionality is still there for thems that want it.

So, when I open a patient's record it would be nice to quickly be able to tell if they are on any of the QOF registers, and not just from yellow reminder texts. Of course, you could drive this from Recalls but this implies an overhead of maintenance as people's conditions change and they come off of or move onto registers. Better, I thought, just to have a guideline that lifted all the codes from the INPS V14 QOF guidelines for disease registers, and put them all in one place.

Now done this, but it has taken me most of the day between patients...and will probably still need tweaking.

First off, I can find no easy way of copying between guidelines. I know you can copy a whole guideline, but not between them. So amalgamating all the filter lines for each disease area means re-typing them. Bummer. I used Snagit to capture all the lines from the QOF guidance, like this:

Then I created a new guideline called 'Chronic Disease Registers' and, for each QOF disease area re-entered the Register line as from these screenshots. Except - not exactly. I used the 'All other Clinical Data' entity only, rather than individually using the 'Problems', 'Registers' and 'Medical History' entities.

I think this will be OK - we are not using problems (roll on 295 or whatever with problem enhancements), and this entity should capture any other entity with the shosen Read code and other attributes such as Date and Episode Type. We shall see.

From the QOF 14 lines, if the Read Code is fully defined, e.g. 'H33z200' then I think this means it is not doing a child search also, i..e it means 'equals this code exactly'. OTOH if it is not, as in 'H332' it will also include all children.

So, finally it looks like this:

Which when run looks a little easier to understand!

One thing I did learn was that you can copy lines on the same guideline, by holding down CTRL and dragging the line you wihs to duplicate.

Now put this guideline into the practice index and tell my colleagues it is there. This latter the trickiest part of any guideline - getting others to actually use the thing.


Thursday, 20 August 2009

Medication decision support options

"Never" is back on drug-disease checks, and 'suppress all' on duplicate therapy. I have changed my settings as follows:

I have left on duplicate therapy (doubling), as I like it but it would be good if we could use a shorter date offset for this.


at 10

Top tip:

"In Event Date on a data entry form, you can enter the phrase "at [patient's age]", eg at 7, and Vision will enter the year when the patient was this age. This is useful for entering historical records."



Yay, we got this last week. Finally. Staff had training on this a few weeks back, but I missed out on that. I have downloaded the User Guides, which are helpfully located on the INPS Web Site:


And I see now require you to click your country, as the development of services in the various parts of the UK continues to diverge.

Recalls is what I want to get my teeth into - a simple change but one that I have been wanting since first getting Vision in 1997 and watching the number of recalls for patients steadilly expand. Now with three statuses - Outstanding, Cancelled, Complete (and ) these become much more useful, but only with a little thought as to where to apply them. PHQ9 second assessment would seem likely, as we have missed a few of these already.

Not sure if 2nd PHQ9s actually do anything at all for patient care, but that would almost be a political statement and surely no the kind of thing I would want to be associated with.

Anyway, new recall functionality should be good. And hopefully put an end to the convoluted recall searches we had to do in the past.


Tuesday, 21 July 2009


In Scotland we can (and probably should) use the ASSIGN score to meet the hypertension QOF requirement. I have a small guideline for this, though it needs some changes to get the various advice codes in correctly. Meantime you use:

#38D6 to code it, and on the INPS QOF guideline this goes into a 'Scoring Test Result' SDA. Mine just drops into Medical History, I should probably change it :(

ASSIGN is on line in Scotland:


and can be completed manually. I am sure (and hopeful!) that INPS will incorporate more directly the algorthm to Vision 3.

Perhaps sometime after we get DLM 280..... ahem.


Tuesday, 9 June 2009


We are being somewhat pressurised by being in one of the influenza hotspots. I have a guideline for flu, looks like this:

No Read Code for 'No contact with Infectious Disease' or whatever, a little annoying.

Anyway, e-mail me for a copy. I'll see if the UG wish it for the website.


Tuesday, 5 May 2009

NHS Mail

Stimied again. NHS Mail just causes me so much hassle.


Broken Con Man view

Somehow I managed through carelessness to screw up my consultation manager view. This happened during the local UG meeting we ran a couple of weeks ago.


Then I added the 'Current Consutlation' tab in rebuilding the view, and this cannot be removed AFAICT and simply replicates the Consutlation Pane. Not everyone likes the Consultation Pane, so presumably the Current Consultation tab is good for those folk. But, with a wide monitor, the Consultation Pane works fine.

So, more tweaking to do. I probably just need to re-do the thing from scratch.


Thursday, 2 April 2009

QOf ooops

So figures a little wrong on account fo the 'patients registered in last 3m' QMAS / INPS reporting problem. Like everyone. This statement if you have not seen it before:

"Following the QMAS transmission on 31st March 2009 INPS were made aware by practices that there seemed to be an error in figures reported to QMAS. The error is apparent in any audit line where registration dates and dates of birth are calculated to Reference Date, where the program mistakenly calculates these figures to next year’s Reference Date of 1st April 2010. This issue was not apparent during the extensive testing both before and after conformance of the audits and has been difficult to isolate even now.

We spent most of the day yesterday investigating the extent of the problem and trying to assess the implications for each practice, but INPS deeply regret that it is likely that ALL INPS sites will be affected by this and the data on any practice’s monthly submission could be incorrect. The level of inaccuracy in the figures will have dependencies on practice size, population turnover and demographics.

We are talking to the QMAS/PCAS/CMWeb teams in England / Scotland / Wales / Northern Ireland and will be negotiating with your PCT/LHB/HB as to how this situation is best managed. In the meantime we would advise all practices that their QOF submission is NOT signed off until a fix and resolution is available."

The senior management have kept the User Group informed of this situation and how they are dealing with it.

We hope that it will be resolved over the next few days. Information will be made available on the INPS website as soon as possible.

A special team has been formed on the help desk to deal with it.

We would emphasize the advice from INPS that no practice should sign off on their QOF submission until this issue has been resolved. If you have already signed off then contact your PCT/LHB/HB and advise them that you have just found out that your figures may be wrong and that this matter is being investigated by INPS.


Tuesday, 31 March 2009


Ah, end of yr QOF time. Happy days. Surely the reason why we all came into General Practice in the first place. :(

Anyway, a combination of Contract Plus, Clinical Audit and almost working systems of recall seems to have been as good as we can do this year, with epilepsy and diabetes slipping away from us by one or two patients. Of course with a big chunk of the QOF dependent on a citizen survey (evidence based health care, this is what we like...) it is out of our hands.

Contract Plus has been very good and Clinical Audit is superb just now, with the direct access to audit groups in searches and Patient Groups making life just so much easier.

Then...it all kicks off again tomorrow.




Tuesday, 17 March 2009

Paisley / SW Glasgow UG

As per below, practices in Paisley and SW Glasgow are invited to attend a local Vision User Group meeting at our practice on the evening of Thursday 23rd April at 6:30 for 7:00pm. No later than a 9 pm finish. Dinner provided by a pharmacuetical company.

Our address is:

Glenburn Health Centre
Fairway Avenue

Please mail me or phone Marina on 0141-884-7788 to advise if you are planning to attend. Thanks!


Consulting with Vision - hints, tips, and how tos.

General discussion, queries and suggestions for future meetings.

I will chair / lead this but do not intend it to be a lecture! Open discussion encouraged.


Tuesday, 10 March 2009

Local UG Meeting

Hi all

I am arranging a local NVUG meeting at Glenburn Health Centre in Paisley on the evening of Thursday 23rd April, from 18:30 for some food then going on till 9pm (or earlier) - subject matter yet to be decided. We can accommodate no more than 20 people though, so e-mail me sooner rather than later if you would like to attend.

paul at doctormiller.co.uk


Friday, 23 January 2009

Using 'Medical History'

Thanks for comment re DLM260 post.

To force an item to the medical history rather than the SDA you can:

  • Use F11, which opens the 'add medical history' form.
  • Do ALT, A, L which normally will open the 'add medical history' form
  • Use a clinical data hotspot on a guideline, and force the Med3 code into the 'Add medical history' form.
Hope this helps!