Wednesday, 1 December 2010

NVUG Local User Group Meeting
Monday 6th December
12:00 for lunch, provided by pharmaceutical company
12:30 till 14:00 for meeting

Place:
Glenburn Health Centre
Health Education Room
Fairway Avenue
Paisley
PA2 8DX
tel: 0141-884-7788

Brief:
This is a small clinical user group meeting. We have places for about 15 people, and about 10 are coming already. Please e-mail me at paulagmiller at gmail.com to confirm your attendance.

Agenda:

  • Installing, configuring and using Macro Express with Vision
    (with apologies to all Authohotkey fans!)
  • Electronic Palliative Care Summary in Vision - how to and options
  • Q&A / discussion
Hope to see you there!

Read more...

Monday, 25 October 2010

Stop using the journal!

Fix the views - stop using the Journal

Yes, hello again. This is a slow and very occasional series. If anyone else wishes to volunteer as an editor / contributor please let me know.
Right, what is this about? It is the next step in using Vision with a modicum of success for consulting and it is mostly about telling you to STOP USING THE JOURNAL!
When, when you had paper records, did you ever lay each item in the record out in the order in which it was entered and make any kind of useful decision? It just is not how we use medical records - we use filters and structure (even in paper) to view the information we require. The Vision Journal is the TAB OF LAST RESORT. But, for reasons best known to INPS themselves, the Journal remains the first thing newbies see and the first tab most people are introduced to.
Well, stop it. Please. It is too much.
Here are some alternatives:

Patient Record Views

The ‘Patient Record View’ is the name for all the sections and tabs you see when you look at the patient’s record. That is all it is. There are some default system views available for you to use and, better still, you can make your own or tweak your current one. Most people seem to end up on View 4, which is not awful. View 7 will give you a Consultation Pane as well, into which you can manage Consultation Topics (also useful for Problems) but not everyone likes the loss of space to the Consultation Pane. (get a 23’’ widescreen monitor, it makes life so much more pleasant!)
You can change these from, where else but, Consultation Manager, Options, Setup. Then the ‘Patient Record’ tab:


So, you can select ‘Standard system distributed options’ from the topmost dropdown and this will let you select from system views. Try some out, it is easy to change back, and see if you find one you prefer. If a tab is missing or there is one you do not need, these can be changed so don’t panic if the view you look at is not immediately providing everything you require.

Some of these Views still Default to Journal!

Yes, they do. Lets deal with this. Depending on your role there will be different things you wish to look at when you first enter a patient record. As a GP I am more interested in the clinical narrative, i.e. the stories, rather than the test results or the prescriptions. Journal view fills up with results and scripts, and this is at least partly why it is not of value for everyday consulting. You can create an ‘Initial filter’ in Vision so that the first thing you see is filtered to only show specific data items. I use this to exclude scripts and results (and some other stuff). The feature for doing this is hidden away and not by any means immediately obvious, so listen carefully.
You will see on the top of this list are the words ‘Initial Filter’. As well as being words this is actually a control, i.e. a bit of functional interface that does stuff. Right click on it:
And you get this menu. You will see you can ‘Save selection’ - what selection, where? I will tell you. Also you can ‘Rename Initial Filter’. All this does is change the words ‘Initial filter’ in the navigation pane to say words of your own choosing. I will say no more of it!
When setting this up you need to first select ‘Show Items with no data’ as this will display in the Navigation Pane all possible data types that can be recorded and shown in the patient record. This will allow you to select them for the Initial Filter, even if that particular patient has no records of that type.
So, do that!
So now you can see all the possible items of data that can be recorded about a patient.

We need to select the ones we wish to use as our ‘Initial Filter’ - the data items that are displayed on our filtered tab. To do this, hold down CTRL and click on each data category you want to display. For example:


Happy with that? Now (R) click on the label at the top ‘Initial Filter’:


And select “Save selection as Initial Filter”. Then do the same again - (R) click, and deselect “Show items with no data”.

Next you need to set up the ‘Filtered List’ tab as your initial tab, assuming you want this to happen. As things stand whenever you first click on the ‘Filtered List’ tab it will now show you data items from the Initial Filter - i.e. the ones you just selected by CTRL+clicking.

To make it the initial tab, (R) click on the tab label:


to see this:


Select ‘View Options’, and this opens:



If you check on ‘Initial Tab’ here then whenever you start in Consultation Manager this tab will show first. And NOT the journal tab. So now you can begin to see the wood from the trees :)

Read more...

Thursday, 16 September 2010

Keyboards!

Use the Keyboard

To use any clinical computer system with a modicum of success in General Practice you are going to have to learn to type. Worse than that, you are going to have to learn how to use a computer keyboard and then learn and use some Vision 3 specific shortcuts and keystrokes.
Do not despair!
Well, unless you have never really used a keyboard at all, in which case your ‘learning curve will be steep’. A euphemistic way of saying you have a lot of work to do...

I’ve never typed before!!!!

In this scenario you have two options, maybe three but the third is a little desperate.

Option 1

Learn to type.
OK, not to be facetious but really, unless option 2 below is possible for you, spending some time actually learning to type and use a keyboard is what you will have to do. You need to plan for this, get the time and, of course, in the brave new world of re-validation and appraisal, you can add all the hours into your PDP. Not that that necessarily cheers you up.
There are free online typing tutorials and lessons - use Google. Or you can buy commercial computer assisted learning packages, or you could go to night school. You do not need to know how to touch type, just enough to find your way around a keyboard and do more than one finger typing. Touch typing is a bonus, but not something I have ever learned or been taught.

Option 2

Can you retire? Seriously, the input device for your computer system is a keyboard and, in one form or another, this is likely to be the case for many years to come. If you cannot learn to use a keyboard, then you cannot use your computer.

Option 3

Wait for technology to do something better.
This is a bit of a stretch. Voice input needs you to be competent with a computer, able to navigate documents and, in fact, to be able to type. It also requires significant training to increase the accuracy, and this takes time. Further, talking to your computer is not always easy, especially with the patient in the room.
Perhaps new technologies and innovations will suddenly make the QWERTY keyboard obsolete. Perhaps, but not very likely. I would not pin your hopes on option 3, though it may make for an interesting debate as part of a procrastination strategy until, eventually, you can do (2) or face up to having to do (1).

Can’t I just use the mouse anyway??

Well, mousing is inevitable in pretty much any Windows application but using Vision with mouse and keyboard is slower than just using the keyboard, at least for the tasks that can be achieved with keyboard alone. Further, using your computer in front of patients is much more discreet if you can surreptitiously type ‘ALT, L, B’ to get the blood pressure listing up, whilst still paying them some attention. Mouse distracts the hand and the eye. Keyboard alone is better for rapport.

What can I do with Vision and the Keyboard?

Lots. Most of Consultation Manager can be navigated, and most of the functions accessed, via the keyboard. Although built as a Windows graphical interface program, Vision contains keyboard accelerators and shortcuts to let you do most of the work without ever touching the mouse.
It is definitely worth making the effort to learn. Force yourself to start using the keyboard today, and within a week you’ll never look back!

Windows Shortcuts

I got stuck on this section for several weeks for no more reason other than I think you could find these out yourself! However, the things that help are knowing how to manage text in documents, and how to navigate round forms and documents using the keyboard. So, FWIW, my to ten important ones would be:
CTRL+C: Copy
CTRL+V: Paste
CTRL+X: Cut
TAB: That’s the key on the left of the keyboard with two arrows going in opposite directions. You can use this key to move forwards through fields on a form. If you press SHIFT and the TAB you will move the ‘focus’ on the form back one step.
Arrow keys: Up, Down, Left and Right. Up and down often let you select new options in a list, e.g. in Vision Read term select. Left and Right will move back and forwards one letter in text, whilst up / down will move one line up / down in text. If you use CTRL+ an arrow key it will move one word right / left or one paragraph with up / down.
CTRL / SHIFT +CLICK to select: If you hold down CTRL and click on lines in Vision it will select them as you click. If you hold down SHIFT+ click it will select everything between two lines.
HOME: Moves to the start of a line.
END: Moves to the end of a line
Page Up: Moves a whole page upwards, and I am guessing you can work out what Page Down will do :)
Windows Key: if you have a Windows keyboard then the key between ALT and CTRL bottom left is the ‘Windows key’ and this can assist with a few shortcuts. Is use this key + L to Lock my PC when moving away from my desk.
ALT: The ALT key generally opens menus in applications, and is one of the mainstays of navigating round Vision with the keyboard.
More: Have a look at http://support.microsoft.com/kb/126449 for more information...

Vision Shortcuts

Function Keys

Traditionally new Vision practices are given a little keyboard overlay for the function (F) keys. This has some value :) The function keys generally do these things in Vision:
F1: Help. Should be ‘context sensitive’, in other words open at an appropriate place for the tast you are doing
F2: List Medical History. Just not so useful now we have the Vision 3 views, this was the default access to medical history list in early Vision versions and possible VAMP Medical.
F3: Find!!. It finds stuff, or opens the Find / Search form again depending on what you are doing. So, it should open the Find Patient form, or Find Read Term, or Find Therapy.
F4: Opens the ‘Scripts’ list
F5: Opens the ‘Repeats’ list
F6: (with CTRL) cycles through open Vision windows
F7: Starts a consultation and with SHIFT closes a consultation
F8: Opens the Add New Therapy form
F9: Once to create an issue of selected repeats, a second time to send them to the printer or ETP
F10: Expands the tabbed data display pane, hiding the others. F10 again to bring them back.
F11: Opens the Medical History Add form. Useful when you do want a specific SDA.
F12: Display the practice Guidelines Index.

ALT+A+?, ALT+L+?

Open Vision Consultation Manager and a patient record. Press ALT once (don’t keep it pressed down!). If you look at the menu across the top, that is the words ‘Consultation Summary Guidelines...’ you wills ee that some of the letters have been underlined.
Pressing the underlined letter will open that menu.
So, to ADD stuff, we can do:
ALT, A, the letter in the menu e.g. ALT, A, B will open the Add Blood Pressure form; ALT+A+W will open the Add Weight form.
ALT, L, the letter in the menu e.g. ALT, L, B will list the blood pressures.
So, the magic keys are (and I have only listed the most useful ones):
P: Problem
L: Medical history
G twice: Gets you to Allergy add.
I: Immunisations
B: Blood Pressure
H: Height
W:Weight
A: Alcohol
K: Smoking

CTRL+K

Does the same as OK or ‘Save’ on many, many Vision forms.

ALT+A for ‘Another’

On Medical History Add use ALT+A to add another. This lets you speed through Read data entry using keywords and keyboard. e.g:

srt, ALT+A, okthr, ALT+A, advrx, CTRL+K

Would record:

1C92. Has a sore throat
2DC4. o/e Pharynx NAD
677B. Advice about treatment given

CTRL+letter on tab

This lets you move to the tab in consultation manager that corresponds to the underlined letter in the tab title.
It works reasonably reliably, but not if you have a form open or if the focus has moved to another pane.

ESC for cancel

Don’t press ‘Cancel’, hit the Esc key instead! In the above (CTRL+letter for tab) if a form is open press Esc to dismiss the form, then the CTR+ combination to get to the tab you want.

Ok, I am done with keyboard shortcuts. Let’s move on!

Read more...

Friday, 11 June 2010

How to Consult with Vision: Part 2

Using Vision: Part 2


Hello again. Optimistically starting Part 2 the next day, though on call all day which may somewhat limit my time to write this.

Where are we? Now you have your head around Read Terms and Vision SDAs, which is great. Next you need to start to learn how to use Read Terms in the consultation.

Read Formulary

There are somewhere in the region of 120,00 Read Terms in the Read Dictionary (if we include synonyms). This is a LOT. In day to day general practice, for consulting, you probably need about 200 to 500 terms. Here are some of the terms you are not going to need:




Ok, so the chances of you ever needing these are pretty remote, though I agree in General Practice you can never say a thing will never happen. What you do not want though is, by default, when you are doing normal, everyday consulting terms such as these being searched on or presented to you. 'Jet' is the classic illustration of this. You may wish to record 'E274500 Jet lag syndrome', but if you type 'jet' as a keyword into an un-configured Vision system you get the one shown above. I practice in Paisley, which adjoins Glasgow airport. Even here I would hope my need of T546 above would be never or once in a career!
Vision provides a tool for dealing with this problem and this is called the 'Read Formulary'. Using the Read Formulary limits your initial search to a small set of practice selected Read Terms, so that you can avoid seeing a whole lot of inappropriate or crazy terms when you go looking. The functionality for turning on the Read Formulary is hidden away in Security, Edit User. As most clinicians never go near that bit of Vision, it is up to your system administrator, often the practice manager, to access this function and turn it on for each user that wants to use it (which should be everyone, in most circumstances). Unless your trainer or IT Facilitator has turned this on for you, you will find that you are currently using Vision with the entire Read Dictionary - all 120,000+ terms, and this will not be making your life easy, simple or pleasant. Now is the moment where you need to have this fixed, but - be warned - if you have been using Vision for a while you will be in the habit of finding a term to use despite the formulary not being on. When you switch it on, things will be different. So, do this for one or two people at a time to try it out, get a feel for the changes and then roll it out to everyone else.
The other thing you will need to do is to populate your Read Formulary with something, otherwise there will be nothing there.

Switch it on


You need to have access rights to Vision Security to do this. Check now - from the main Vision screen select 'Modules' then 'Security'. If you cannot access this (it is greyed out or absent) then you will need to seek out the person with admin rights to your Vision system and have them access it. If no one in your practice has rights to it, I would call helpline or complain to someone.



When you open this you get a listing of users like this:


Names have been blurred to protect the innocent.

Find your name (or the person you want to turn on Read formulary for), and Right Click on it, then select 'Edit User'.


This opens this form:


And that section in the red rectangle above is where you need to make changes. You must make sure that there is a tick in the checkbox labelled 'Select Read term from Read formulary', and that the radio button 'Keyword' is selected in the frame 'Read term selected by'.

Do that, click OK, save any changes and exit the security module.

Now that user is selecting from the Read formulary by default. Better get some stuff into it!

Populate Read Formulary


There are three ways to get things into your Read formulary:
  1. Add them yourself
  2. Import someone else's formulary
  3. Use the 'Create List' functions in the 'Populate Read Formulary' tool.

Of these, I would go for (2), with a bit of customisation over time with (1). Using (3) in a practice where a limited set of consulting codes has been employed is more likely to find for you ill advised terms ('Had a chat to patient'), and disease / condition terms. What you need is a formulary full of History and Examination terms, and this is often best obtained by importing someone else's.

To obtain a Read formulary for importing you can:

  • Download one from the User Group http://www.nvug.org. You need to be a member, and if you are not then JOIN!!!
  • Get one from a neighbouring practice, assuming they have one that is effective!
  • Ask on the NVUG forum for one to import. Again accessed via the NVUG web site.

They come as files with the suffix '.fmy'. These are essentially text files and can be viewed in Excel, if you are feeling competent and curious.

Open up the 'Populate Read Formulary' tool from the main Vision menu:


Opens this:


Is there anything there?

In theory in a new Vision system the Read formulary will be empty. If you have had Vision for a while, there may be stuff in there already. Also, in some practices, INPS may have provided the NVUG formulary for you, but not necessarily have turned on access to it for users. So, let's have a look and see what is there.
For this we use the menu option 'Formulary, Maintain':




which opens this (click on 'Display from Formulary' checkbox to see what is there):



Have a quick scroll down the list. If the codes in there are ones you like and want to keep, then great - you can add the imported formulary's terms to these. If not, start afresh - close that window and use the 'Remove all formulary entries' option above to clean it out, or just wait till you import one and choose to 'replace' at that time.

Import Read Formulary

Select the menu options 'File, Import Read Formulary':


[Note the other option above it that will let you export your current formulary. You may want to consider doing this as a backup before making any changes to the existing one.]

You then need to navigate to the folder and file where your borrowed or gifted formulary file is (the one suffixed '.fmy), select it and Vision will pause for a few moments whilst it analyses it. It might present you with some advice or warnings, follow what it says. Eventually you will get to this:



Now you can decide whether to Add or Replace. Add is usually safest, but it is your call. Decide, click OK and wait a few minutes.

Job done. You have now changed it so that you are selecting Read Terms form the practice's Read formulary by default, and are able to do so using Vision keywords.

The next part is hopefully going to be about getting stuff into Vision using keywords and menus. Better go do some visits.

Read more...

Thursday, 10 June 2010

How to record consultations with Vision

Using Vision: A beginners guide for clinicians

Part 1 of an occasional series

If you are new(ish) to Vision, or not so new but still feeling frustrated, then this occasional series is meant to help. It's occasional because it's written in my own time and there are no guarantees I can finish it, at this stage at any rate.

Comment if you find it useful - this may even encourage me to do more!

Why Vision is Different

Vision is different from paper records, and from many other clinical information systems, because it uses a very structured approach to data recording. What this means in practice is that nearly everything you record in Vision hangs off of a Read Term. This scares people at first, because all they want to do is type in text. But, generally speaking, computers are not very good at understanding text so, if you want a high quality (and thus usable) medical record you need to record the stuff you need to record in a way the computer can use it.
The consequence of all this is that unless you understand Read Terms at least a tiny bit you will find Vision a mystery. Most clinicians (but not all) do not understand Read Terms. Some think they do, which can be a good start, but actually they misunderstand them through limited exposure and use. Some understand their structure very well, but not how to use them in clinical practice.
The other big difference with Vision is that it lets you the user, and your practice, configure it and set it up to work as you want it to. This is both a blessing and a curse. It's great to be able to choose, but unless you (or someone in your practice) bothers to learn how and why to use the configuration tools and then implements these changes, it can remain a frustrating mess. OTOH, once you have learned the basics, and set it up, it will work like magic :)
Don't panic, it is actually dead easy to use and to use well, but you will have to learn what you are doing - it won't just magically happen.

Why bother with Read Terms?

Because without them your computer system will just be a jumped up word processor. Unless you tell the computer that the patient has Hypertension using a code, then the computer will not know the patient has Hypertension. We have learned some of this through QOF, I think. But Read terms also contain many, many other codes and descriptions for many, many other pieces of clinical information. Not all of these bits of clinical information are hugely useful on their own. For example, the term 'O/E Blood Pressure Reading' is of limited value if all you do is type in some free text for the systolic and diastolic values. Remember - the computer cannot use text alone; it needs structured data. So Vision associates Read Terms with special forms or 'Data Areas' for capturing all this other data in a useful (i.e. 'structured') way. So, the Read term 'O/E Blood Pressure Reading' is associated with a Blood Pressure form, where you can add lots of other things about a blood pressure if you so wish. Storing Systolic and Diastolic in this way means that they can be searched on, reported on and analysed both for individual patient care, and for other uses such as QOF.
Vision does this for lots of Read terms - associates them with forms that let you capture the other bits of data relevant to that Read term in a structured way. They call them, rather annoyingly, 'Structured Data Areas', which when Vision first came out sounded cool, but in the iPhone age starts to sound a bit geeky. Whatever you call them, this method of associating clinical terms to clinical data is pretty much how things are done (or should be done) in clinical computer systems. It means that a blood pressure in Vision is always understood by the system as a blood pressure. There is only one place to store it (though lots of ways to get there), and that place captures all the bits of data about a blood pressure you may ever wish to record. For those who are interested, all this is the basis of an Information Model.


So if they are so important, how TF do I use them?


And this is what gets folk confused and annoyed, because a) Clinicians like to write free text narrative (except very few of them really do that!); b) Read Terms are 'an abstraction of reality' so, inevitably, there are gaps, errors and ambiguities and c) Finding Read Terms can be tricky, especially if you don't understand how they are organised.
Regarding (a): in fact clinicians use convention and shorthand to record consultation narrative. Clinical notes are full of examples of this (e.g. 'o/e' for On Examination; the use of '0' (zero) prior to text to indicate the absence of something e.g. '0fc' for No finger clubbing), and most clinicians have spent large chunks of their careers learning how to do this. We do not just write long hand text. Vision can be used in a way that supports a lot of this clinical shorthand, making recording a consultation quick and intuitive whilst also gathering lots of useful data. How much of this you use or do is, of course, up to you - you can just enter a string of free text in the comments box, ideally underneath an appropriate Read Term, and this is often a good way to start.
(b) we cannot do much about, but understanding how Read is put together can help you in choosing a suitable term, even if it is not quite what you were trying to say. Qualifying or explaining the Read Term in the free text is entirely sensible, and what the free text is for!
(c) is overcome by this blog posting, which explains the basics of Read, and by the tools in Vision that make it easy to manage the Read Terms dictionary.

What are Read Terms then?


Read Terms are a 'clinical terminology', but you do not need to know this. Better to think of them as a 'Thesaurus' of clinical terms. They are a way of attaching a number to the stuff you do, so computers can make use of it and there are about 120,000 terms. These are organised in broad chapters, which are numbered (coded) beginning with the number '0' (Occupations) then '1' (History / Symptoms) and then continuing up to 9, then through A to Z. The chapters are hierarchical - that is, as you expand them the amount of detail, or how specific the term is, increases. For example:
Chapter 2 contains 'Examination / Signs' terms. It looks like this:





The number (and any dots that follow it) is the Read Code, thus '212A.' is the Read Code. Every Read Code has an associated description or term, in this case it is 'O/E Patient well'. There is other stuff that I am going to ignore for now, such as Preferred Terms and Synonyms, as you can get by without it. Read does, however, also have abbreviations for terms built in, which are typically short forms of the term. These can be up to 10 characters long. For example, 'MI' is an acronym for the Read Code 'G30.. Acute Myocardial Infarction'. This is important because Vision makes use of these as 'keywords' that lets users quickly find the term they want. More later.

The Read Hierarchy

Read is split into broad chapters, as mentioned above. If you examine the picture below, even briefly, you will see that chapters 0,1 and 2 are about history and examinations; chapters 3 to 9 are about stuff that clinicians and others do to, for or about patients; and chapters A onwards is all the disease stuff.
Now, clinicians often get hung up on trying to find a diagnosis for a patient every time they see them. If you are one of these people, please stop! In general practice we manage a lot of chronic disease and a lot of uncertainty. Much of the time there is no diagnosis, or the diagnosis is not new. What you want to record is what the history was, what the findings of your examination were and what you are going to do about it. IOW, terms from chapters 1 and 2, and sometimes 3 to 8.
If you do have a diagnosis, by all means add it and, usefully, abbreviations (or 'keywords') exist for many common ones, such as 'uti' or 'urti'.


Bad things to do with Read

Use 'Chat' and 'Patient Reviewed'

Because people get lost in Read, they latch onto an inappropriate and often useless Read term to give them a comment box to free text in. It is better, when learning, to at least use high level chapter headings about the stuff you have done and capture it there, e.g. '1....History / Symptoms' for free texting the history and '2....Examinations / Signs' for free texting the examination.

Say 'not' in free text


Classically, 'G20.. Myocardial Infarction' as the code, with the free text 'Negative'. Read does not say 'not a thing' very well, but it has some terms for 'negation' and they should be used where possible. Where not possible, record symptoms. For example '1822. Central Chest Pain', free text 'MI Screen negative'.

Free text values and data that should be captured!


For example, adding a blood pressure as free text is not much help:



If there is a 'Structured Data Area' for the thing you are trying to record, use it!

Read more...

Wednesday, 26 May 2010

'How do you just look at the record w...

'How do you just look at the record without opening a consultation'

First way:

If you see this form when you select a patient:



Click on 'Cancel' or, better yet, just hit the 'Esc' key top left on your keyboard. This will dismiss this form without starting a consultation.

If you don't see that form before you start a consultation, i.e. Vision just immediately opens a consultation without asking, then use the second way...

Second way:

Change the settings for Consultation Manager. Click on Consultation, select Options, then Setup, like this:



Opens this form:



Uncheck the box 'Start a new consultation automatically when patient is selected'. (note it is checked in the picture, you would uncheck it!).

OK that.

Now, when you select a patient you will not start a consultation.

As shown, you can control whether you ever see the 'Consultation Form' shown in 'first way' above using the options under 'Display Consultation Form'.

To start a consultation:


When you want to, press F7 (or press the 'chair') icon to start a consultation.

Read more...

Monday, 24 May 2010

Consultation Types

Below is advice for our reception staff on selecting the correct consultation type



Consultation Types

Please use the correct consultation type for the encounter.

The consultation type is selected here:


And can be quicly selected by pressing the first letter of the type of consultation you are recording. For example, press 'A' twice to select 'Administration', or 'T' once for 'Telephone call from a patient'.

Alternatively, click on the drop down list with the mouse and select the correct one.

You can change it by double clicking on the bottom right part of the screen, here:



Which will open back up the Conusltation details form as above.

Which Type?

Use some common sense to select the best type. Do not, for example, use 'Home Visit' unless you are actually seeing the patient on a home visit!

Please use:

ADMINISTRATION:

Use for any mail processing, recall management, records review and coding.

TELEPHONE CALL FROM A PATIENT

Use for any phone calls received from patients or their carers or representatives. Commonly use for Home Visit requests.

TELEPHONE CALL TO A PATIENT

Use whenever you call a patient or their carer or representative.

THIRD PARTY ENCOUNTER

When contacted by a patient's relative, carer or other person about a patient at the reception area.

MEDICINES MANAGEMENT

For all updates to prescriptions and prescription requests.

REPEAT ISSUE

For repeat prescriptions issues.

SURGERY CONSULTATION

When seeing a patient for HCA activities, i.e. in a consutling room for BP checks etc.

RESULTS RECORDING

When transcribing any results from paper to computer record

OTHER

For anything else, including e.g. encounters at the reception desk with the patient which require some entry in the record, but are not prescription requests.



Read more...

Monday, 17 May 2010

Vision 3 therapy and Emergency Care Summary

To include a medication in ECS

Vision 3 sends Acute prescriptions and Issues of Repeat Prescriptions to ECS. Acute prescriptions are included regardless of whether they have been printed or sent to eAMS provided their Date Prescribed value is within the last 30 days. Issues of Repeat Prescriptions are sent regardless of whether they have been printed or sent to eAMS provided their Date of Issue is within the last 12 months.
Note that Repeat Prescription Masters are never sent to ECS – only issues.

To include a medication in ECS but not generate a prescription

In Vision 3 this can be achieved by creating an Acute medication or a Repeat Prescription Master and un-checking the ‘Print Script’ check box.
For an acute medication this will be available to ECS on the next upload, with the time constraints as above. For Repeat Prescription Masters the user must select the prescription and Issue from it (F9 once) as the issue will appear in ECS.
Items with the check box ‘Print Script’ un-checked will not be printed or sent to eAMS.

To include medication prescribed outside the practice in ECS

Vision 3 offers a drop down selection box on new medication forms for ‘Source of Drug’. This is to allow practices to record items supplied outside the practice on the local system and thus inform decision support as well as providing a more complete record.
All Acute medications, regardless of the value for ‘Source of Drug’, will be sent to ECS if within the 30 day time limit. If a medication remains current for a patient after 30 days a new Acute will need to be added if still required for ECS. It is good practice to append the Dosage field with text indicating the source of the drug, as ECS does not import or display this value.
Repeat Master Medications with a Source of Drug value of anything other than ‘In Practice’ cannot be issued from, and thus will not be displayed in ECS. As a workaround for this users can create a new Repeat Prescription Master and leave the Source of Drug field as ‘In Practice’, un-check the ‘Print Script’ check box and append the Dosage value with text to indicate the source of the drug. This master should then be issued, and the issue will remain valid for ECS for up to 1 year.

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DLM 300

Got this last week, enable eCMS which, for those not in Scotland, is the new electronic prescribing service known as the 'Chronic Medication Service'. Be interesting to try when it arrives - I think we need to be switched on by the Health Board, and have some local pharmacies also capable.

Annoyingly discovered recently that eCMS is only available to patients receiving free prescriptions by virtue of age or specific chronic diseases. Humph.

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Tuesday, 9 February 2010

295

On DLM 295. This:

http://www.inps4.co.uk/my_vision/downloads/dlm/index.html

is currently the place to go for DLM Help files. Every time you get un update, which happens automatically, it is sensible to check the user guide to see what's new.

As it happens, in 295 there is not a lot for Scotland! Installment prescribing we already have - it is a little button adjacent to the Advice for Patients one on therapy-add forms and simply lets you free text the installment dispensing arrangment. AFAIK in CMS (which is the Scottish e-pharmacy model of repeat dispensing (and so much more, of course!)) the installment info goes along with the message when sent electronically, although I do not think this applies as easily to the AMS model.

Not sure, frankly. Whatever, it is just a button that lets you type in some free text instructions.

CVS risk has been updated too, though still no ASSIGN. I use a guideline linking off to the ASSIGN web site, and in this guideline I display all the relevant bits of data such as LDL, HDL etc. ASSIGN is here:

http://assign-score.com/

We have just signed up to PTI which is an NHS Scotland service run by Information Services Division (ISD). Sounds a tad Orwellian, but we will let that slide for now... They hoover up data (anonymised, or as much as it can be) and analyse activity then provide reports on data quality and workload back to practices. Not a bad thing, we hope. Slightly concerned that they do not gather data from Telephone Encounters, of course now about 25% to 30% of our workload. Perhaps a need for more GP involvement at the receiving end?

Awaiting the new Problems functionality impatiently, as I like working with Problems but become frustrated by clutter, and footerieness of the current implementation albeit it is usable, but just not wonderful. Using a Problem orientated approach with Vision does start to make more sense of your patients' conditions and, indeed, problems than the simple journalised narrative plus priority approach (although this is very powerful method of working with V3).

Meanwhile GP appraisal beckons yet again, and yet again I have failed to make use of DXS tools for helping with this. Perhaps one to add to my PDP for next year: learn how to record learning with DXS. A tad recursive, but I understand educationalists don't mind this sort of thing.

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