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.