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.