IT SESSIONS AT ASHCROFT SURGERY
If you are unfamiliar with any of the following, please let me (Ram) know. If it is a quick thing, I can go through the uncertainties with you. Otherwise, we can cover them at the next Ashcroft IT training session (happens several times a year)
EMIS
In the following, consultation mode refers to the screen in which you add your day-to-day consultations with patients.
- Use of Templates
§ try to use templates where ever possible eg someone who comes in to see you regarding their asthma à use asthma template.
§ You don’t have to fill in all the template; fill in the bits you wish to fill in.
§ However, where possible, please try to fill in any missing items which have an asterisk (*) next to them. These are items that make a difference to our QoF figures.
- Shift F5 function: by pressing the shift and F5 (function 5) key, you can get a list of things which need doing (in terms of QoF) for each patient (once you’re in their records, of course). On our system, we have an extra EMIS software programme which actually tells us this automatically every time we go into a patients record (just look at the pop-up window that comes up in the bottom right hand corner when you go into a record). If you don’t have this, ask me.
-Referrals
§ All referrals should be coded and not just simply added in free text as “referral sent to urology”. If you dictate letters, our secretary will do this. If it is an e-form, you need to code the referral yourself (in consultation mode, press R)
§ Online Referral Letters – we have an electronic database of most referral letters. The advantage of these is that they import the permanent features of a patient’s record saving you time eg Name, DOB, Address, PMH, DH, allergies etc
§ e-GPR. This is an online insurance report (accessed in the same way you do electronic referral forms – look for a file called “eGPR”) which, like the online referral letters, imports a lot of the data needed thus saving you time. No longer do you have to fill out those paper versions which are so tedious.
§ Do not alter any online EMIS referral forms. Talk to me if you find anything that is incorrect, needs altering or is simply out of date.
- Sick Notes
§ If you have not seen the patient or issuing a back dated one PLEASE use a med 5 (pink) not a med 3 (white).
§ Log all sick notes you give to a patient in consultation mode under “Additional”; use read code “MED3” or “MED5” (note: no space between MED and 3)
§ Add sick note entries in the following format:
§ MED3 (the form) Asthma (the condition) 2w(duration) 11.5.06 (start date)
§ Private Sick Notes: you can issue a private sick note, eg first seven days of an illness, by using the form that is available online in the same folder you use to access EMIS referral letters. Don’t forget to charge for this.
§ Patients who do not need a sick note for the first seven days of an illness: Again, an information to educate employers or patients is available in the same folder where you access EMIS referral letters
- Lab Reports
§ you should know how to access lab reports (press ID in main EMIS screen)
§ You should know how to act on each result eg file, repeat, see nurse, etc
§ How to sending action messages to admin staff via practice notes to the “results” inbox eg “patient needs to make an appointment with dr so that ……”
§ How to determine whether an action message is urgent or routine (urgent = to be done this week; routine = can wait a week or more)
§ If sending a practice note on a lab result/investigation, YOU MUST type the message in the format the patient is to receive it or the way admin are to say it eg “needs to talk to a doctor later this week because the tests for her thyroxine levels are a bit too high. Nothing too serious to worry about.”.
- Practice Notes
§ usage in general is for communication about specific patients only
§ Do not make any embarrassing subjective remarks in practice notes because these are logged!
- Emails
§ Usage: not for sending action messages on patients (you should use practice notes, or the community care module for this)
§ Emails are mainly to encourage group discussions about patients or systems (posh term = collaborative working) eg diagnostic/management uncertainty or about other non-medical communication eg “I’m away on holiday from xxxx to yyyyy. Please do not send me anything urgent until I’m back”
- Important Read Codes
Try an put a “problem title” for every single consultation as it helps with auditing or looking up similar problems in the past. If you are uncertain for the diagnosis, then try using the symptom eg chest pain, rash, back pain etc
Also remember that when you press F8 to file the consultation, DON’T FORGET to classify the consultation in terms of significant, minor or nor a problem
Try to clean up the summary page if you have time. This is an essential requirement for GP training.
§ DNA (9N42)
§ Do NOT Read Code any cancers; just send a practice note to Pam Parker and Pam Brown and ask them to add to the cancer register. If you code them, you will wreck our QoF figures and hence pay!
§ For Depression use “Depressed” or “Anxiety with Depression”
- Medication
§ Try to prescribe most medicines generically: if you are not sure, there is something called the G/T switch function when ever you add a medication
§ When prescribing, try to choose a formulation from our practice formulary (which should be in each room and available in Paperport)
§ You don’t have to work out the number of tablets required. In the quantity section you can add 7d (for seven days) or 1m (1 month) and EMIS will work it out for you if it can
§ Link repeat medicines to the diagnosis where there is doubt over what the medication is being used for eg co-codamol, gabapentin. This is easy to do:
§ In the medication screen click shift and F7 (then wait a few seconds) à a pop up window will appear
§ The pop up window details medicines on the left and problem titles on the right
§ If a problem title has a (+) to it, it means it already has medications linked to it and you can click that (+) to see what
§ To link another medication, click on the medication name on the left and drag it (click and drag) to the problem title you want to link it to
§ If you find you have made or there is an incorrect link (eg simvastatin to low back pain), you can rectify it by: clicking on the medication to highlight it, then pressing the “delete” key on the keyboard.
§ Restarting/Finding medication issued in the past (press X , select item, and then R to restart)
§ Getting a history of a specific medication item eg how often issued, by who etc
§ Doing a medication review and coding it (code: MED REV DONE)
§ Adding a message to the medication screen (not for allergies)
§ Adding an allergy flag note
- Quick Tips
§ Making an appointment
§ Adding to the problem list
§ Searching by text or date (using T in Consultation Mode, useful when looking for a “X-ray” result
§ Viewing attachments using the *RL function
§ Filing your consultation – Significant/Minor/First Episode/Review
- How to Do EMIS Searches
- Web links through EMIS
§ Online EMIS BNF: a) do a drug search including doses (quicker than BNF) b) look up sub-chapter headings eg managing head lice etc
§ EMIS Mentor: a bit like oxford handbook of medicine; information resource
§ EMIS Dermis: dermatology atlas
POPULATION MANAGER
This is a subsection of EMIS. It is a great tool for helping you look at some really interesting practice figures (mainly for your QoF points) eg no. of post MI patients on aspirin.
It’s not all clinical; some of it is on organisational markers we need to achieve eg % of patient summaries.
If you are a practice lead for something, take a look at your area with it now. It really is quite a fascinating piece of kit and is especially good at looking at the effect of any changes you introduce. It can be highly motivating to use.
It can also tell you which patients you need to target eg under Epilepsy and the criterion “fit frequency recorded” simple click “patients not included” to get a list of patients that should have had this done but to date have not.
To access it, from main EMIS screen type:
§ ST à Z
§ Click on the (+) icons to open the folder out
§ Clicking on a your subject area
§ Click on the (+) icon until you get to the individual markers
§ Click on a specific QoF marker
§ Another screen will come up in the bottom of your screen which will tell you even more about that marker and which patients you are succeeding with and which you are not. You can even access their notes from this screen and return to it after viewing them.
Please note, any effect on figures will take 24h to happen from the time of entry.
INTRANET (PAPERPORT)
Paperport is basically a way of archiving information and protocols relating to our practice or locality eg protocols, local guidelines, other useful documents
§ Have a look at some Paperport folders now.
§ You can find a simple guide “how to use Paperport” in the root directory of the Ashcroft Paperport folder structure
§ Any folder with a (+) next to it means that there are more subfolders. Double click that folder to reveal the ones underneath.
§ The “GP Training” folder is useful to anyone who wants to develop further, not just the registrar. So take a peek and see if there is anything in there that tickles your fancy.
§ Key messages à do not add anything; send it to me and I will add. Be warned: additions will be removed if not authorised (mainly because we need to maintain usefulness rather than overwhelm the individual user with an extensive list of resources). Documents relevant to 1-2 people are not allowed; documents must be of use to a significant number of the practice team
WEBSITES
www.ashcroftsurgery.co.uk
Take a look at this referrals website: www.ashcroftsurgery.co.uk. There are so many services for patients out there that I have collated them together and organised them in a way to make them easier for you to digest. This website will help you to consider other options when managing a patient rather than going straight for referral. For example, rather than referring a patient for suspected PVD to vascular surgery, would you have considered referring to the district nurses first to get Dopplers done? If Dopplers are normal, you might want to have a re-think on the diagnosis; hence sieving out the “wheat from the chaff”. Another example: rather than referring for a suspected DVT, how about using the well documented “Well’s scoring chart for DVT probability” – it has certainly helped me in those times of uncertainty.
Ashcroft-links
This is what internet geeks (oh gosh, that’s me!) like to call a web portal. In other words, it is a website which mainly contains links to other useful websites. I’ve tried to keep the links for each section down to a maximum of 5-6. This is to stop it from becoming like the Yellow Pages where the process of seeking out that little link you require amongst the zillion others listed puts you off looking for it in the first place. In addition, by limiting the number, with repeated use you’ll probably be able to effortlessly memorize and recall the ones you particularly like over a small period of time.
Sections include:
§ Useful links for use in the consultation itself: to help you and your patient get the information you need in a time efficient manner without having to say to the patient “come back next week and I’ll find some information for you by then”; this latter approach wastes an appointment, wastes the patient’s time and adds to your workload.
§ Clinical Scoring Tools to help you in the consultation eg Depression scores, New Zealand scores to determine if a patient needs a hip replacement, Carpal Tunnel Scores, an online pregnancy calculator (no longer do you have to look for your paper wheel!) and many more.
§ Want to find the evidence behind what you preach? Click here.
§ Useful links for the nurse practitioner
§ Useful links for the medical student/registrar and others in training (actually, useful for those of us not in training too!)
§ A section on how to search for information on the net – useful for everyone (medic or otherwise)
§ A section on how to determine web validity – “official sites” cannot cover everything and hence there may be gaps when you come to look at those sites for specific information. This section tells you how you can tell whether a site that does contain the information you are after is reliable or not.
ASHCROFT NURSING HOME WEB
Ask me if you want to know more
OUTLOOK EMAIL
§ How to access it
§ Provides access to all Bradford and Airedale NHS Staff
§ Online Web version available – which means you can log in and look at your messages even from home! Just go to www.bradford.nhs.uk and click on the “webmail” icon on the left hand menu (towards the bottom). Your domain/username and password are the same that you use to log into the Novell client at work (NOT THE EMIS user/password)
MISCELLANEOUS
Critical Incident Forms