Cytology Prior Notification Lists (PNLs) for the Open Exeter system

Transcription

1 Cytology Prior Notification Lists (PNLs) for the Open Exeter system Screening Department User Guide Crown Copyright 2004 NHS Information Authority Hexagon House Pynes Hill Telephone: Rydon Lane Fax: Exeter Devon EX2 5SE

2 Introduction This guide should provide the reader with an overview of the way the Exeter system: 1. produces PNLs for the Open Exeter system 2. processes the PNLs returned by the GP 1 Background The HA/PPSA runs the analysis job AJ-RG to produce lists of women due shortly to be invited for a cervical smear test. The HA/PPSA sends the lists (known as the Prior Notification Lists (PNLs)) to its GPs. The GP indicates those women on the PNL for whom : the invitation should be deferred ; or no invitation should be sent now or in the future. The GP returns the PNL before a pre-determined cut-off and cytology records for women identified by the GP are updated as appropriate. In due course invitations are then issued for those women that are still due an invitation. Changes were made in 1997 to streamline the process by allowing for the electronic transmission of PNLs. However, the benefits of these changes were not realised because they were dependent on corresponding changes to the GP systems, which have not been forthcoming. The aim of this project is to realise these benefits by providing GPs with secure web-based access to PNLs, through the existing Open Exeter (OE) system. The Open Exeter PNLs (OEPNLs) will re-use existing processes where possible to monitor the receipt of PNLs and update the database accordingly. 2 How to set up a GP to view PNLs via the Open Exeter system Before a GP can access PNLs via Open Exeter, he/she will need: to be duly authorised by your appointed Data Controller; an internet connection; and to be operating an XML compliant browser Internet Explorer v6 or above. 2.1 Automatic Notification to GPs GPs can be set to receive notification via that a new PNL has been created for their attention. The will be sent to the designated address for the GP s Open Exeter Organisation. This is defined during the organisation setup process FD screen s sent to GPs will identify as the sender s address either : 1. the address entered on the FD screen for PNL Notifications to GPs ; or 2. the address entered on the FD screen for the Screening Manager The default address is that of the Screening Manager. If the screening manager wishes to appoint a deputy responsible for handling any enquiries from GPs on PNLs then his/her address should be added to the FD screen under the PNL Notifications to GPs option. This may alternatively be defined as a generic address e.g. PNL_NOTIFICATION@your_domain.nhs.uk This will prevent GP s replying directly to any automatically generated s. If neither address has been set up then no s will be sent.

3 2.1.2 LL Screen The text included in the body of the notification can be maintained via the Letter Library. To view or amend the text used for s access the LL screen with a qualifier of EPNL. 3 How to create Open Exeter PNLs, monitor their return and update cytology records 3.1 AJ-RG. AJ-RG runs as before. There has been a minor text change to the job request screen as follows: AJ-RG identifies if a particular GP is authorised to use Open Exeter PNLs. In order to easily determine which Open Exeter organisation a GP belongs to, it is recommended that the National Practice Code is utilised as the Organisation Code. If required AJ-RG can be set to produce paper copies of the OEPNLs. Set the Enter 'P' to produce Print copies field to P Progress of each Open Exeter PNL can be monitored via the LG screen. The functions of the LG screen are explained later in this document.

4 4 Viewing and returning Open Exeter PNLs The GP dials into the Open Exeter server in the usual way and selects Cytology Prior Notifications from the available list of applications. 4.1 Open Exeter PNL application This will display up to the first 30 entries for the whole organisation (i.e. for all the GPs in the organisation). For the purposes of display, women are grouped according to their recall types and displayed in the following order: Suspended Repeat Advised; Inadequate; Normal; and Called The GP/practice manager can view, paging forward and back, all women on the PNL for his/her organisation. The GP/practice manager should submit in batches (of max 30) possibly over a period of days, details for all women on the issued PNL. It is important all women are submitted and not just data for those to be ceased or deferred. To submit a woman leaving her cytology data unchanged the GP should a) tick the corresponding checkbox for the woman. When the page is submitted women for whom only the checkbox has been ticked will be returned marked as requiring no further action. To defer or cease a woman the GP should : a) tick the submit checkbox; b) Select the appropriate action/reason code from a drop down list; c) If recommending that the patient s invitation be deferred, select the appropriate length of delay; d) Add optional comments to the comments field (comments may be mandatory for certain action/reason codes e.g. if the reason code Other is used.) Comments may not be added to a woman who is not being ceased or deferred. When the GP/practice manager has marked up all the patients on the screen to be submitted, he/she should click the Submit Returns button. This will submit the data and page on to the next 30 records to be checked. If the GP/practice manager wishes to clear all fields and start again he/she should click the Reset button. Both buttons are at the bottom of the list of entries, along with links enabling users to page on and page back as appropriate. Note: Paging on and paging back will not submit the data entered on the form. Once submitted a patient is no longer displayed on the Open Exeter PNL listing. In this way the list of patients shrinks with each submission. Enabling the GP to submit patients in instalments should help avoid the situation where the whole return is delayed pending a decision on a few individual cases. Should later validation fail because some key data relating to delaying or ceasing a patient becomes corrupted then the patient will be redisplayed for the GP to re-enter all the necessary data. Once the cut-off date for a PNL has been reached, that list will not be displayed to the GP via Open Exeter. The GP will therefore be unable to submit from this date and the patients will be invited in the usual manner.

5 4.2 Validation Validation of GP s entries is done by javascript when the GP opts to submit the returns. Some options will only be available for certain patients. For example, only patients whose age is greater than the upper limit will be available to Cease - Due to age, and only then if they have never had a test or otherwise meet the ABC ceasing criteria for consecutive negative results. Validation will report: 1. If no entries have been selected for submission i.e. no entry has the Submit checkbox ticked; 2. If data has been entered for a patient but the Submit checkbox has not been ticked to ensure those details are submitted; 3. If a delay code has been entered for a patient but no period of delay specified; 4. If a cease code has been entered for a patient and a period of delay specified; 5. If the Comment field contains a tilde character. (~) 6. If the cease other code has been entered and no reason entered; and 7. If a comment has been added for patient that is not being ceased or delayed. 5 Processing returned PNLs 5.1 AJ-CIN (GPLCIN) Data submitted by the GP is written to a holding file which is processed via CIN. If the GP s partnership/organisation is set for automatic update then GPLCIN will update the cytology records for patients accordingly. If the partnership/organisation is not set for automatic update then the data is processed and can be viewed before updating via the LG screen. Incoming submissions for each organisation will be added to the current CIN entry which is processed at 23:00 each day. If no current CIN entry exists at the time of submission, a new one is created and automatically scheduled for 23:00 the same night. AJ-CIN produces a print confirming receipt of data in RETURNED PRIOR NOTIFICATION LIST SUMMARY UPDATE REPORT identifying the patients for whom some action has been recommended. An exception report may also be produced at this stage if data corruption has occurred. If an individual patient has been returned marked for no further action, CIN will increment the NFA count but the patient will not appear on the Summary Update report nor be accessible via the LG screen. Only those patients who have been recommended for Ceasing or Deferral will appear on these reports.

6 5.2 LG screen The LG Receipts screen shows: the Organisation Code; the date on which the PNL was produced; the cut-off date for replies the recall types for the run of AJ-RG; whether the PNL was created for transfer over the Network ( N ) or updating via Open Exeter ( OE ); and the number of women included on the PNL. As returns come in for the PNL the entry also displays: those awaiting update (column heading Wait ); and those that have been updated (column heading Up ); those that require no further action (i.e. those who are not to be delayed or ceased column heading Nfa.) the number of women for whom replies are outstanding (column heading Outst ); The number received is equal to the sum of columns Up, Wait and Nfa. The sum of these three columns and the Outst column will equal the number in column heading Recs. In addition, entries on the LG screen may be filtered by Practice or PCG code by placing the appropriate code in the Qualifier field. If your practices are using organisation codes which differ from their National Practice Codes, it will not be possible to filter by Practice. Alternatively, by placing a date in the qualifier (in the format DD.MM.YY), it is possible to show only those entries with an RG run date on or before the date entered. There are five actions available from the PNL Receipts Screen: Verify; Update; Delete; Migrate; and File.

7 5.2.1 Verify User can only verify one PNL at a time. This option will display the PNL Index screen. From here the user can opt to view the LG Transfer Detail screen for a particular entry. Alternatively the user can page through the full list using the standard page on and page back buttons. Paging on from the last one in the list returns the user to the Index screen but paging back from the first entry does not. From the LG Transfer Detail screen the user can opt to: return to the Index screen without updating the individual s cytology records (option A ); or update the individual s cytology records and move onto the next entry awaiting update ( U ) Reject the recommended action ( R ) and return the record to the GP for resubmission. An explanation may be entered and will be ed to the GP along with notice of the rejection.

8 If women are updated individually (i.e. from the Detail screen,) then an update report and any exception report is not produced until the last woman is updated. Deducted Patients It is possible that some patients may be deducted from your system between issuing the PNL and processing returns from the GP. In this case, a banner will appear at the bottom of the transfer details screen indicating that the patient is now deducted. You should update in the usual manner, which will effectively convert the GP s recommended action into a status of No Further Action and create an entry on the exception report Update The option to update is only available if there are records to update. This will update the cytology records for all the women pending update. Summary details will be available through the Summary Update Report produced. (See Update processing.. section below) Delete The delete option is available only if the cut-off date has passed and there are no print queue entries. If there are still entries pending update (i.e. awaiting verification) or outstanding then a query message will be displayed. This is so that lapsed PNLs (ie where cut-off date has passed and AJ-RP has been run) can be removed even if not all replies were received or actioned in time. A check has been added to the display routine to remove any redundant entries. An entry is redundant only if all entries have been received and all those requiring action have been processed and printed. That is if : there are no records outstanding; no records awaiting action no entry on the print queue If you intend to use the Unix download facility, it is therefore important that you download BEFORE deleting the print queue entry. Downloads may only be performed whilst entries remain on the LG screen!

9 5.2.4 Migrate If necessary, for example if a GP has temporarily lost access to Open Exeter, then the PNL can be printed to paper and sent out. The full PNL can be migrated to paper at any time. The on-line PNL will still be available and returns can still be made via Open Exeter. (See Update processing.. section below) File User can only file one PNL at a time. This option will generate a Unix file equivalent to the update report and, where appropriate, a second file equivalent to the exceptions report. This latter file includes details of any rejections made from the transfer details screen. Files will be exported to the path set on the SP-S screen with filenames in the format: ORG_CODE + up + UNIQUE_SEQUENCE +.dat And ORG_CODE + ex + UNIQUE_SEQUENCE +.dat These UNIX files can be stored permanently using your existing FTP software and eliminate the need to print reports. It is advisable to download these files when all returns for a particular LG entry have been received and prior to printing or deleting print queue entries Summary Update Report This report lists the update actions recommended by the GP Exceptions Report Update processing will report two different types of exception: 1. If the patient is not at the status GP Informed then no change is made to her cytology data. 2. If the key data returned from the GP has been corrupted somehow then again no update is performed. In this instance the patient s node on ^RGXML is re-set enabling the GP to re-submit as well as being included on the Exceptions print. All generated prints can be found associated with the application CGPL on the PQ screens. 5.3 Update processing of returned PNLs The returns from an Organisation can either be used to update cytology records automatically as and when they are received or placed on the LG screen for HA staff to verify first. Automatic updating is turned on or off for an Organisation on the OO screen. The OO screen is usually maintained by your appointed Data Controller who should be consulted before attempting to implement the Open Exeter PNL application. Update processing will amend the patient s cytology data, and log the changes to the audit files. It will also update the various counts displayed on the LG screen Error handling Update processing checks that key data is present. That the action is either delay or cease and is accompanied by a reason. It also checks that if the patient is to be delayed there is a period specified. It will also check the patient is still at status GP Informed. If the patient is not at GP Informed then something has happened to move the patient on e.g. a delay has been entered, a new test received etc