Implementation of the Minor Ailment Service Produced by NES Pharmacy Using emas Software
SECTION 3 Using emas Software NHS pharmacists in Scotland can apply for a printed copy of this pack, please contact: pharmacy@nes.scot.nhs.uk
Introduction - Page 1 This section focuses on the electronic version of MAS (emas) and how it will support you in delivering this service. It takes you on a step by step journey through the processes for registration, consultation, cancellation and withdrawal, as well as how to run general housekeeping tasks. It does not describe how to operate the emas software of specific pharmacy systems. Objectives After reading this section you will be able to: outline the essential components that need to be in place to support the epharmacy Programme list the mandatory data needed for electronic registration explain the electronic processes for registration, consultation, cancellation and withdrawal using emas describe the regular housekeeping tasks that you need to undertake. This section should be read in conjunction with the training and support materials supplied by your pharmacy system supplier. There is also a laminated emas Quick Reference Guide included in this pack. Use the Guide to help you work through the steps outlined in this section. Section Contents 3.1 Background Pages 2 3.2 The Supporting IT Infrastructure Pages 3 3.3 Registering a Person Using emas Pages 4-7 3.4 The Consultation Process Pages 8-12 3.5 Withdrawing a Person Pages 13 3.6 Regular emas Housekeeping Tasks Pages 14-15 3.7 Requesting an Online Registration Status Pages 16 Section Summary and Reflection Page 17
Page 2 - Background 3.1 - Background The Supporting IT Infrastructure - Page 3 3.2 - The Supporting IT Infrastructure The epharmacy Programme is designed to help you deliver each of the core components of the new community pharmacy contract. The Programme is developing the technology to electronically support both service delivery and payment processing. It has focused initially on making an electronic version of the Minor Ailment Service (emas) available. There are a number of essential components that you need to have in place to support the epharmacy Programme. These include: an N3 network connection for communications an updated pharmacy system with new software specifically to deliver emas a digital certificate that is used to ensure secure communications from your pharmacy and to verify your pharmacy as a valid source of emas messages a dual bin laser printer. Central Patient Registration System (PRS) The central Patient Registration System (PRS) has been developed to automate the MAS patient registration processes. It allows you to register a person online through your pharmacy system via your N3 connection and the epharmacy Message Store. There are two other key components of the epharmacy programme infrastructure the epharmacy Message Store (epms) and the Central Patient Registration System (PRS). These are hosted and maintained centrally by NHSScotland. epharmacy Message Store (epms) The epharmacy Message Store provides a secure, single point of contact for all messaging for emas and future epharmacy applications. It does not open or read any of the clinical content of messages but acts as a central store which all messages pass through.
Page 4 - Registering a Person Using emas Registering a Person Using emas - Page 5 3.3 - Registering a Person Using emas Figure 5: A CP2 form with the registration details highlighted Figure 4: emas registration overview PHARMACY Pharmacy System Printer Registration Request Registration Response (with CHI) epharmacy Message Store Registration Message PRACTITIONER SERVICES Patient Registration System Image Store CHI Patient details are automatically added Pharmacy details may be automatically added If a CHI is available, it is printed on the CP2 registration form If the CHI is not known at the time of registration the DoB is placed in CHI field and 4 digits are added at the end 0008 shows a patient born in the 19th century 0009 shows a patient born in the 20th century 0000 shows a patient born in the 21th century CP2 type and sex of patient is automatically printed Individuals need to have a record on your pharmacy s medication record system (PMR) to register them electronically via the central Patient Registration System (PRS). Check that he/she has a record and if not, create a new record for that person. The minimum data you require at this stage is the person s full name, date of birth, gender, postcode and exemption status. The CHI number is not essential for registration. You may also need to complete or update a person s existing record if their circumstances have changed since you last recorded the information. Once all the mandatory data has been entered, you should then register the individual by pressing the register key on your computer. This will trigger your pharmacy system to print a CP2 registration form (see figure 5) and, at the same time, send an electronic registration message to the PRS. PRS receives the electronic message and locates the individual on the Community Health Index (CHI) database. It confirms (or otherwise) that the person has been registered at your pharmacy and supplies their CHI number in a response message. The person s record is automatically on the pharmacy system to show the new registration status and CHI number. A unique barcode is created on the CP2 registration form. The barcode number is also part of the registration message sent from the pharmacy PMR. A registration barcode number begins with the letters RE. The CP2 registration form has a unique bar code printed on each form. All registration form bar codes will start with letters RE. This bar code links the paper form with the electronic registration message sent to PRS. The details printed on the form are identical to those sent in the electronic registration request message. In most cases the message confirming the person s registration status will be received in less than a minute. Further automatic additions include: Date PS Contractor Code RPSGB Reg Number If the person s CHI number is not known at the time of registration then their date of birth is printed in the CHI number boxes on the CP2 form as described in figure 5. If the CHI number is known and recorded on their pharmacy record then it is printed onto the CP2 form at that time and is also sent in the electronic registration request message.
Page 6 - Registering a Person Using emas Registering a Person Using emas - Page 7 Registration Messages Three replies from PRS are possible registered, registration deferred or registration rejected: Registered If the reply is registered then your pharmacy system automatically updates the person s record to show that he/she is now registered with your pharmacy for MAS. This acts as the trigger for remuneration as the registration process supports an automated capitation payment system. Registration Deferred A positive registration response message may not always be received straightaway. A deferred response could result from a network communication problem or the patient not being easily identifiable on the CHI system by the PRS. This response results in the person s registration status remaining as pending. If a registration response is not received then it will be the next day (at least) before it is completed. Where messages cannot reach PRS they are batched and submitted each night. In these circumstances, and to ensure continuity of care under MAS, a consultation can still go ahead if needed. Your pharmacy system notes and records all pending registrations and the person s pending status is updated and confirmed at a later stage. Failure to send an electronic registration request does not affect the printing of the CP2 registration form and therefore both you and the person can still sign it and process it as normal. It may take up to seven days for the results of a deferred registration to be received. If you have not received a result after seven days you should contact the epharmacy Customer Services Helpdesk (0131 275 6600) Registration Rejected If the person s registration is rejected then PRS will send a message to your pharmacy system notifying you that the person has not been registered. It will still return the person s CHI number to their record. Sometimes people will register and require an immediate consultation. The system is set up to support this and allows a consultation to follow on from registration (using a separate CP2 form) even if that registration has been deferred. Signing the CP2 registration form The person (or person s representative) registering needs to sign the back of the CP2 form in the usual way, declaring their reason for exemption by crossing the appropriate box. You should carry out any point of dispensing checks if you have not already done so. You need to sign the front of the CP2 form, confirming that you have registered the person at your pharmacy for MAS. It is important for financial probity and to help Counter Fraud Services (CFS) that the individual personally (or a parent on behalf of their child, for example) signs the CP2 registration form and exemption declaration. You (or a member of your pharmacy staff) should not sign on behalf of an individual unless under very exceptional circumstances (for example the person is blind). You must make sure that you have been given clear permission to do so and you should be completely satisfied with their evidence of exemption otherwise, as the person s representative, you could be liable for any charges. Sending CP2 forms to practitioner services You include all your CP2 registration forms, bundled separately, in the exempt section of your bi-monthly submission (see section 4) and send to Practitioner Services via the normal route where they are imaged and stored. The registration has already taken place electronically and the paper is for records only. You do not have to keep copies of the CP2 forms; your pharmacy system is able to report on patients registered with you and NSS have archives of the original paper CP2 forms.
Page 8 - The Consultation Process 3.4 - The Consultation Process The Consultation Process - Page 9 Treatment Completing the consultation PHARMACY Pharmacy System Figure 6: emas consultation overview Printer Consultation Claim Claim Acknowledgement epharmacy Message Store As with registration, the consultation process is now supported electronically by software on your pharmacy system (see figure 6). The first step is to ensure the person has a valid registration status to allow a consultation to proceed. Consultations can go ahead where a person s registration status is registered, pending or lapsed. Your pharmacy system will support you by only allowing consultations to proceed where the person s registration status is appropriate. You should then go ahead with the consultation, assess the individual and his/her symptoms then consider the most appropriate course(s) of action (treatment, advice only or referral). PRACTITIONER SERVICES Payment Processing Read Barcode & Get Message The next step is to go into the consultation section of the emas software. In a similar way to using your PMR system, the individual s record should be pulled up on the screen and the outcome of the consultation recorded along with any additional information you can provide. There can be one of three outcomes: advice offered, person referred to another practitioner or, more typically, treatment prescribed. Advice given or referral Image Store If the consultation results in advice or referral only, a consultation message is sent to the epharmacy message store from where it can be accessed by Practitioner Services and a CP2 consultation form is printed. You should ask each individual to whom you provide advice only to sign the CP2 form too. If a treatment is prescribed, the medicine supplied is recorded in the person s record on your pharmacy PMR system which also produces a label with the directions as per normal dispensing procedures. The product is then dispensed and labelled. A maximum of two medicines can be prescribed on each CP2 form. If more than two medicines are prescribed more than one form is produced. The product prescribed is recorded on the CP2 consultation form along with any relevant endorsements for reimbursement purposes. When using your PMR system to select the treatment you are prescribing, you also need to consider selecting the appropriate product and pack size, as it affects the endorsement information included in the both the electronic message and the printed CP2 form. This process generates the printing of a CP2 consultation form which documents the person s details, the product prescribed, the quantity, the directions and a unique bar code for that form (see figure 7). If the CHI has not been printed on the CP2 consultation form then you should set the form aside until you have received the person s CHI through a registration update (see section 3.6). At the same time as the CP2 form is printed, an electronic claim message is sent to the epharmacy Message Store. The epharmacy Message Store confirms receipt of that message back to your pharmacy system. The claim has not been verified or passed for payment at this stage. You sign the front of the CP2 form confirming the outcome of your consultation and the person signs the back of the CP2 form annotating their exemption status. At this point, you should provide any additional counselling and advice. Sending CP2 consultation forms to practitioner services Again, you submit the CP2 consultation forms to Practitioner Services at NSS by the normal route with your bi-monthly submissions, bundling them separately from both CP2 registration forms and other prescription forms. (see section 4) On receiving the CP2 consultation forms, Practitioner Services read the unique bar code which then triggers the retrieval of the electronic message from the epharmacy message store. The information in the electronic message takes precedence over the information on the CP2 form for payment processing. Any handwritten information or amendments will not be used. It is therefore important to ensure the electronic CP2 forms are completed correctly from the start. Practitioner Services will only use the paper form if an electronic message is missing. You are reimbursed for any products supplied in the normal manner. The CP2 forms are then imaged and stored by Practitioner Services. Again you do not need to keep paper copies of the CP2 forms in your pharmacy. The information is already stored both in your pharmacy system and at Practitioner Services.
Page 10 - The Consultation Process The Consultation Process - Page 11 If a person is under 12 their age is shown in years and months Figure 7: CP2 form being used for a MAS consultation If you have given advice or referred a person to their GP, this will be indicated on the CP2 form 1. If the CHI is not returned following a registration the consultation can still go ahead 2. The CP2 consultation form will be printed as normal but the CHI will be missing. The Person signs the CP2 and can leave the pharmacy 3. Before you can send the CP2 form to Practitioner Services, you must wait until you receive the CHI in a message and hand write it onto the form Endorsing information is added to the CP2 form A maximum of two items may be printed on a CP2 form Cancelling a consultation Consultations can be cancelled - for example, if an error in the information is noticed such as incorrect endorsing. There are two possible situations that can arise, depending on whether the person is still present or not: When the person (or their representative) is still present In this case there would be no corresponding paper CP2 at Practitioner Services so the electronic message will not be used. Electronic consultation messages are only retrieved and used when the paper CP2 form has arrived at Practitioner Services. When the person (or their representative) is no longer in your pharmacy but has already signed the CP2 consultation form In this case the changes required are made by hand on the CP2 form. However, the consultation message must be cancelled on your pharmacy system otherwise the handwritten changes on the CP2 will be ignored because the electronic message always take precedence over paper. Your pharmacy system stores a copy of any message sent to epms. You therefore need to find the consultation message and follow your pharmacy system s cancellation procedure. A cancellation message is then sent to epms and a response will be received indicating that: the cancellation was successful and the hand amended CP2 form should be submitted; only the information on the amended CP2 form is used for pricing purposes as the corresponding electronic message has been cancelled or the cancellation was not successful because the message has been passed on ready for use by the payment verification systems; in this situation you must contact the epharmacy Customer Service Helpdesk (0131 275 6600) to inform them that a message has been sent in error.
Page 12 - The Consultation Process Withdrawing a Person - Page 13 3.5 - Withdrawing a Person Incomplete transactions Consultations where the CHI is not yet known If you do not have a CHI number for a person e.g. a deferred registration and a consultation has been carried out, your pharmacy system will hold the consultation message in a pending area until the CHI number is added to the person s pharmacy record via a registration update. It will then be included in the electronic claim message to Practitioner Services. The CHI number is always required to complete the consultation process. The paper CP2 consultation form will have already been printed and signed at the time of the consultation. On receipt of the CHI number you should add it to the CP2 consultation form, handwriting the information if necessary. You can then send the form to Practitioner Services in the normal way. Consultations where the registration is rejected If the registration request is rejected but the person has previously received a treatment then you should still submit the CP2 form which will mean that you will be reimbursed for the product supplied but you will not receive a capitation payment for that person. If you need to withdraw a person from MAS, enter the registration section of emas, find the person s record and press the withdrawal button on your pharmacy system. Your system will send a withdrawal message to PRS and await a reply (similar to the registration process). There are two possible outcomes - withdrawn (not registered) and deferred. Withdrawn (not registered) The person s registration is withdrawn and a corresponding message is sent back to your pharmacy system which then automatically updates the person s registration status to withdrawn (not registered). A CP2 withdrawal form is printed at the same time as your system sends the withdrawal message to PRS. These withdrawal forms should be sent to Practitioner Services. The person is not included in your capitation count from the date of the withdrawal request. Deferred A withdrawal response can be deferred in exactly the same way as a registration response. A CP2 withdrawal form is still printed and sent to Practitioner Services. The results of a deferred withdrawal will be returned to your pharmacy system via the registration update process when your pharmacy system will update the patient s registration status. Again it can take up to seven days for the result of a deferred withdrawal to be received.
Page 14 - Regular emas Housekeeping Tasks Regular emas Housekeeping Tasks - Page 15 3.6 - Regular emas Housekeeping Tasks Checking for incomplete messages There are two tasks that should be performed regulary: requesting registration updates (including deferred registration updates) checking for incomplete messages. Requesting registration updates The registration update process supplies updates on lapsed registrations*, deferred withdrawals and registered people. A registration update request should be sent to the electronic Pharmacy Message Store (epms) from your pharmacy system once a day. In reply, a message containing updates to persons registered at your pharmacy will be sent to your pharmacy system. Your computer will process these updates and apply any changes to the corresponding person s record, including any changes to registration status. Undertaking a daily update request ensures that your pharmacy system records are as up to date as possible. There are six different types of registration update messages: 1 Deferred registration response Registered or rejected to a registration request that has been deferred. 2 Deferred withdrawal response Withdrawn or rejected to a withdrawal request that has been deferred. 3 Withdrawal notification Person is no longer eligible for registration at your pharmacy e.g the person has died or the person has registered with another pharmacy. Your pharmacy system is updated and the registration status changes to withdrawn. 4 Lapsing notification When a person lapses they are no longer included in the pharmacy s capitation count. 5 Re-registering (un-lapsing) notification Confirmation of a person s un-lapsing following a consultation. Their registration status is updated to registered. 6 Registration extension notification (roll on) Confirmation of a person s twelve month registration extension following a consultation. Registration update requests can either be set to be run manually or automatically depending on your own pharmacy system. If you receive an update indicating a person s registration is lapsed, it is NOT necessary to get the person to re-register for MAS. In this case, if the person presents again and a consultation takes place, the consultation process will automatically change the status of the person back to registered as described in point 6 above. By checking for any incomplete messages on at least a weekly basis you are be able to identify any messages that are taking too long to be processed. All relevant messages that are incomplete will be displayed and relevant action taken. The two main messages that must be checked for completion are: registration request message consultation claim message. To check for these you should follow your pharmacy system supplier s process for identifying incomplete messages. If there are any registration or consultation messages incomplete after seven days then you should contact the epharmacy Customer Services Helpdesk (0131 275 6600). They will then carry out an investigation and identify the appropriate course of action. They will provide you with the information necessary to update your pharmacy system e.g. for an incomplete or a deferred registration. This will give the person s registration status, CHI number and the date and time the registration took effect. You then update your pharmacy system manually. Finally, remember to keep your supplies of CP2 forms well stocked, just like prescription labels. * (A person goes into a lapsed state if they have not accessed MAS within 12 months or have passed an age related exemption boundary see section 2.6)
Page 16 - Online Registration Status 3.7 - Requesting an Online Registration Status Section Summary and Reflection Summary Box Your pharmacy system can also send an online request to PRS to provide a person s current registration status. This online request typically only takes a few seconds so that you can wait for the response before registering and providing a consultation to the person presenting if they are not already registered at your pharmacy. If for any reason a response is not returned almost instantly then you should use your professional judgement to decide on the most appropriate course of action. Remember this is just an online query service; it will not change a status without going through the registration stage. The same minimum set of details, that are required to register a person, are required for a registration status request (person s full name, date of birth, gender and postcode). Enter these details into your pharmacy system if the patient record does not already exist. There are four possible responses to the registration request: 1 Registered The person is already registered at your pharmacy. 2 Registered elsewhere The person is registered at another pharmacy. This means that the person would need to re-register at your pharmacy. Following registration they would be withdrawn automatically from the pharmacy where they were previously registered. 3 Not registered The person is not registered at any pharmacy. This means that he/she can register at your pharmacy. 4 Unknown The person s details are not able to be matched automatically by PRS, therefore there is no information regarding their registration status. If you do not get any information back from PRS, it is at your discretion whether to proceed with registration or not. All registration status responses will include the person s CHI number where it is known. the delivery of MAS is supported by pharmacy system software called emas emas supports the electronic registration, consultation and withdrawal of people for MAS you must ensure that the electronic message is always accurate as it always takes precedence over the paper form when a consultation results in advice or referral only, a consultation message is sent to the epharmacy message store and a CP2 consultation form printed if a treatment is prescribed, the medicine supplied is recorded in the person s PMR and recorded on the CP2 form along with endorsements for reimbursement purposes registration updates cover lapsed and registered people and should be completed daily there are four possible responses to a registration status enquiry registered, registered elsewhere, not registered, or unknown checking for incomplete messages should be undertaken weekly to identify any messages that are taking too long to be processed the CHI number is not required to register a person, or to carry out a consultation, but is needed before a CP2 consultation form is submitted to Practitioner Services if anything goes wrong you can contact the epharmacy Helpdesk (0131 275 6600) or your PMR system supplier for help. Reflection Box What happens next to both the electronic messages and paper prescriptions? What do I need to do when submitting the CP2 forms to Practitioner Services? How do I complete the GP34 form for MAS forms? End of Summary Reflection
NHS Education for Scotland (Pharmacy) 3rd Floor, 2 Central Quay 89 Hydepark Street Glasgow G3 8BW Tel: (0141) 223 1600 www.nes.scot.nhs.uk