training handout This training handout is intended to support the learning outcomes for pre-install training for clinical staff. Getting Started / Basic Navigation Medical Record Accessing appointment book Adding Consultation notes Basic prescribing SCI-Gateway Referrals Getting Started / Basic Navigation EMIS PCS can be launched by double clicking on EMIS PCS icon from desktop The system will prompt for Login ID and Password (NB login credentials will be supplied to all staff after Commissioning). Upon successful login the front screen of PCS will be loaded (NB the number of available modules on front screen can be reduced to only include accessible options assigned to the user s security profile).
The PCS session can be locked or logged off by choosing either F2 Change User, or by selecting Change User from File menu. The Modules button can be used at any time to return back to the PCS front screen. The Internet button will launch the EMIS Common Room website that contains resources useful to PCS users. Training documentation can be downloaded from the User Documentation option in Library menu. NB the Internet function can be used as web browser, but isn t recommended as the system does not retain the current page when navigating away from the Internet view.
The Message button will open PCS Screen Messaging (instant chat). This facility allows logged on users to send messages to each other, or to all available users. NB the contents of a Screen Message are not retained in the system audit. If a sent message is not opened by the recipient the message will be lost when the recipient ends their session. For this reason it is not recommended that patient information is passed between users using Screen Messaging. The Organiser can be configured to show a set number of days future appointment sessions, incomplete tasks or unfiled electronic lab results.
The patient find button is used to manually search for active, deducted or deceased patients. EMIS PCS only requires a single search field which can be populated with forename, surname (in either order), date of birth, CHI number, post code etc search criteria. The patient status is identifiable by the text colour. Black text signifies the patient is currently registered, blue text signifies the patient has left and red text signifies the patient is deceased. The number in brackets is referred to as the EMIS Number. The Household icon can be clicked to display all other patients registered to the same address. Once a patient is selected their details are populated to the patient précis. At this point all patient specific modules (Medical Record, Prescribing and Registration etc) are loaded with the details specific to the patient. NB the patient précis is configurable per practice to rearrange, include or exclude patient demographic information.
Medical Record The Medical Record can be loaded by pressing F11 Medical Record, clicking Medical Record on front screen, or typing MR on front screen. The Medical Record will open at the patient Summary which will provide an overview of the patient s conditions, allergies and basic values. The Health Status section can be configured for the practice to include extra codes by choosing Z Configuration, Health Status Section. The rest of the patient s clinical data can be navigated by clicking on the various views. This course will look at Consultations, Problems, Values, Full History and Diary (Appointments).
C - Consultations Consultation History will show all migrated clinical entries and any new additions to the patient s record entered in Consultation Mode. The left hand panel shows the consultation entries grouped by year. A keyword(s) search can be performed by choosing Filter, New Filter. Enter the search terms and click Finish.
P - Problems Problems will show all active and previous diagnosis. Immediately after migration from GPASS, this will display all GPASS high priority codes as Active Problems. NB the management of patient Problems is covered in Consultation Mode training.
V - Values Values will show the most recent value or result of all read-coded entries that have a value or result attributed to them. The previous values for each code can be viewed by clicking on the sun dial icon The values can be plotted as a graph by clicking on the graph icon H Full History Full History will show all read-coded entries (except Values or Diary entries) in the patient s record in chronological order.
It is possible to Filter to particular types of codes in the patients Full History. It is possible to search for a particular code, clinical term or piece of associated text in the patients Full History by choosing W View/Find, 9 Find Code/Term/Text Y Diary Patient Appointments (upcoming, past, cancelled and DNA) is available in Appointment option in Y Diary menu.
Appointment Book The Appointment Book can be loaded by pressing F10 Appointments, clicking Appointment Book on front screen, or typing AP on front screen Patients with an A prefix have arrived at the surgery. Arrived patients need to be Sent In to be seen, by right clicking on the appointment cell, or by pressing S on the keyboard. NB It is possible to check the patient s record before sending in by double clicking their name in the appointment session to set them as the active patient, and pressing F11 to access Medical Record. Sending the patient in will automatically open up a new consultation. The system will prompt for the Consultation Header details. This can be set as default for the rest of the session. NB - See next section for adding consultation notes.
Once the patient s consultation is complete, the system will return to Appointment Book. The patient now needs to be marked as Left by right clicking and choosing from menu, or by pressing L on the keyboard before sending in the next arrived patient in to be seen. A follow up appointment can be made for the patient by navigating to the new date using PgUp - Next button, or O Calender, right clicking on a free appointment slot and choosing Currrent Patient (if still the active patient) or New Patient (which will prompt the user to search for the patient using patient find).
Consultation Mode Consultation Mode can be opened by pressing F6 Consultations, clicking Consultation Mode on front screen or by typing CM on front screen. Consultation Mode will also open automatically for consulters upon sending in patient from Appointment Book. The Consultation Header will open for each consultation unless the option to store as default is selected. The Consultation Window The consultation Mode window is made up of three panels. The panel outlined in red below is where new consultation notes will be recorded. The bottom portion of the screen shows previous consultation notes (from Medical Record Consultation History). The right hand panel shows 4 tabs for easy access to the patients Medication, Allergies, Alerts/Diary Entries and Problems.
Consultation Headings The consultation headings are intended to assist the clinician in organising the content of a consultation note. Not all headings need to be populated. Consultation headings can be removed per user, or can be re-arranged to a different order per user from I Configuration, Heading tab. Problem To be used only for read-coding a new diagnosis, restarting a previous diagnosis (past problem) or reviewing an existing diagnosis (current problem) see Consultation Problems section p18. History free text or read-coded entries Examination free text or read-coded entries Comment free text or read-coded entries Medication links to Prescribing module. See adding Prescribing from Consultation Mode p30. Social free text or read-coded entries Family History free text or read-coded entries Follow Up diary entry capture only Result free text or read-coded entries Test Request open test request form only New Referral manual or SCI Gateway referral. See SCI Gateway Referrals section p32. Allergy add EMIS format drug allergy or non-drug allergy. Referral Activity not required as has no link to SCI Gateway.
Changing Place of Procedure The consultation place of procedure can be changed by clicking on the green bar drop down. This will initially be blank, but can be configured with places of procedure in Consultation Configuration, Location Types tab. NB Available locations list can be amended to include practice bespoke locations via Locations Manager.
Populating Consultation Headings The consultation headings need to opened for text entry by double clicking on the heading, or choosing the keyboard shortcut (e.g. H History, C Comment). Upon typing, the system will offer read-codes matched against the word that is currently being typed. However it is possible to simply add free text by ignoring the suggested term list. It is possible to narrow the picking list options for clinical terms over multiple words by separating the words by a forward slash. Read coded parts of the clinical note are displayed in bold text. If no suitable read-code is offered in the suggested picking list, the user can access the read-code browser by pressing F4.
If users wish to only choose read-codes via F4 (read code browser), the picking list function can be switched off from I Configuration, Other tab. Read Coding using Templates The instructions above show the methods for manually adding read-codes to a consultation note. By far the easiest method of adding read-codes and patient values is via a clinical Template. Templates are accessible by choosing T-Template and typing in the template name.
Once the template is completed and filed by pressing OK. The contents are added to the consultation note. NB a number of templates will be made available after commissioning. A preferred picking list of templates can be created for easy access. I Configuration, Other tab.
Adding multiple clinical notes to same consultation A consultation about more than one condition or illness can be separated to different notes by pressing N Next Problem. This will open a new blank consultation note. Consultation Problems A patient Problem can be interpreted as a read-coded diagnosis of condition or illness. The Problem heading can be used at a clinician s discretion. The Problem heading can be left blank for any consultation that is not related to a previous diagnosis, or where no new diagnosis is made. First episode diagnosis A new Problem added to the patient s record has to be manually added to the Problem heading as a readcode. NB there is currently no option to read-code a Problem from a clinical template.
Upon filing the consultation note (F8 Save), the system will now prompt the user to set the status and episode of the Problem via the Episode Management window. The system will default the episode to First Episode if the read-code is not already included in the patient s Problem list (Current or Past). NB only one First Episode can be set per read-coded Problem. The significance can be set to either Significant (a chronic condition or condition with no expected short term recovery), or Minor (a condition or illness where a clinical estimate can be applied to the duration to recovery) A Minor problem will stay current for the duration set and will automatically expire to a Minor Past problem.
Review of Current Problem The patients Problems (Current and Past) are listed under the Problem tab on the right hand panel of the Consultation window. Double clicking on a Problem under this tab will populate the Problem heading. Note that the Consultation History in bottom panel is now filtered to show the previous consultations with this Problem header.
The Episode Management will now set episode to Review as default. This is important for Problem diagnosis that will include the patient in a QOF register with condition onset criteria (e.g. Depression). EMIS Population Manager will ignore any occurrence of a previously entered QOF diagnosis code with a Review (or End) Episode. It is therefore essential for these types of diagnoses to ensure the originally entered problem code is used for all subsequent review consultations. If the code is used in any other header there is a risk that Population Manager will treat the entry of the code as a new diagnosis and prompt for any onset criteria. However, entering the code in Problem heading and setting episode as Review negates this risk.
Restart of a Past Problem As above, the patient s past problems are listed under the Problem tab. Double clicking the Problem to restart will populate the Problem heading. The Episode Management will set the Episode as a New Episode by default. End of a Current Problem It is possible to change the status of a Current Problem to Past by changing the episode to End Problem in the situation that the patient was diagnosed with a Significant Problem and subsequently recovers, or diagnosed with a Minor Problem and subsequently recovers within the Expected Duration.
Basic Prescribing A patient s Prescribing record can be loaded by pressing F9 Prescribing, clicking Prescribing on front screen, or typing PR on front screen. The prescribing record is split into two views, Current medication View and Past medication View. #
Adding a new medication New medication can be added by choosing A Add. The Add Drugs window prompts for the Name of the drug. Drugs can be searched by entering the first few characters of the drug name and pressing return. The matches to the search appear at the bottom of the screen. Blue bottles signify items that are contained in the users allocated formulary, grey bottles signify items in the EMIS drug dictionary but not in the users allocated formulary. The item to be prescribed is selected by a double click. NB entering a space before the drug name will act as a wildcard search and will return items where the searched term appears as the second or third name of the term, useful for searching for devices/dressings or on product codes. After selecting the drug any allergy or contra-indication warnings will be displayed. The dosage then needs to be set. The dosage can be selected from the drop down list or added by free text. The drop down contains default dosages for the item and dosages previously entered and migrated for the item. Free text entered dosages will be recorded and added to the drop down for future use (for all users), the system will prompt for confirmation of spelling and to record a daily quantity, it is important to record daily quantity for dosages that relate to a fixed amount.
Once dosage has been set, the quantity is required. The quantity field must be calculated on the form of the item (e.g. liquids will be prescribed in millilitres rather number of bottles). The Quantity field will only accept numerical input, there is no requirement to free text the form (e.g. 32 and not 32 capsules ). If the dosage used has a daily quantity associated to it (as described above) the system can calculate the quantity upon entering the time for the script rather than the fixed quantity (e.g.28d, 1W, 1M etc). NB migrated dosages from GPASS have no daily quantity associated so auto calculation cannot be performed. Items with these dosages will require the fixed quantity to be entered. The script type is then required, either Acute or Repeat. If set as Acute no more information is required. If set as Repeat the, system may prompt for a duration. The duration field must be set to duration for the script and must not be confused with an authorisation period. NB the system uses the duration of the script to calculate drug compliance (repeats only), however this field is only prompted for when a dosage with no daily quantity associated to it is used.
Any extra messaging can be added via the Options drop down. Drug Information is printed on RHS of the script. Pharmacy Text is printed on LHS of script (and included in epharmacy message). Instalment Dispensing Text is printed on LHS of script (and included in epharmacy message). A second drug can be added to the script by choosing Next. Issue & Print will print the script and send epharmacy message. Issue can be used for alternative method of issuing script, or to add pharmacy destination text. NB Issue method None can be used as a method to include the new item with existing items. See issuing items from current medication.
Issuing current items Items can be issued from the current view by left clicking to select, then right clicking and choosing Issue Medications, or Y Issue & Print. Amending current items Items can be amended by left clicking to select, then right clicking and choosing Alter Details, Dose / Quantity No Reason or Dose / Quantity With Reason. The option With Reason will send an epharmacy message altering the instructions on the items last message. Care should be taken when using this option! NB A Temp Dosage change can be made for the next issue of the drug only. Subsequent issue will revert to original dosage and quantity.
Cancelling Last Issue / Cancelling Medication The last issue of an item can be cancelled. This will cancel the epharmacy message for the item, but leave the item in the Current View (NB unless it was the only issue of the item where it will move to the Past View as Not Issued). The item can be cancelled and removed from Current View (to remove repeat items) to Past View by choosing Cancel Medications. This will prompt to cancel the last issue if done on same day as last issue, this will also cancel the epharmacy message and care should be taken when using this option. Changing Acute to Repeat (and Vice Versa) The prescription type can be changed by left clicking to select item, then right clicking and choosing Alter Details, Prescription Type.
Viewing Issue History The issue history of an item can be viewed by double clicking on a drug. Also available by left clicking to select, then right clicking and choosing History Detailed Review. Restarting Past View Medications Items in Past View (V Past View) can be restarted by left clicking to select the item, then right clicking and choosing Restart Drugs. Any changes to Dosage, Quantity or Type must be applied by clicking Apply Changes.
Prescribing from Consultation Mode Medication can be added or issued directly from Consultation Mode by double clicking on the Medication header. This will open Prescribing Current View. Only newly added medications initiated via the Medication header in consultation mode will be populated in the Medication header. The system is effectively making the assumption that the new item and the consultation note are linked. If a problem is coded in the Problem header, the medication and the problem will be linked. However, if the link is made in error, the option to Launch Problem Medication Linker should be ticked, and the link deleted (right click, delete).
Medications already in Current or Past View issued via Medication header will not automatically be brought into the consultation note. In other words, the system is not making an assumption that the medications and consultation are linked, e.g. Repeat items issued as an aside to the consultation. Only new added items are populated in consultation note automatically. To add existing items to the consultation note, left click to select items, then right click and choose Note Issue. NB Medication Noted for inclusion on consultation note in this manner will be linked to any Problem coded in the Problem heading, but can be manually deleted if done in error in Problem Medication Linker (as above).
SCI-Gateway Referrals SCI Gateway referrals can be added via Medical Record. This will launch SCI Gateway login prompt. Or via Consultation Mode by left clicking New Referral header, then right clicking and choosing Insert new SCI Gateway Referral. This will launch SCI Gateway login prompt.