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BUILDING PROTOCOLS ON EMIS

Leeds Student Medical Practice. EMIS. BUILDING PROTOCOLS ON EMIS. PROTOCOL. DESIGN. Leeds Student Medical Practice. 1. BUILDING PROTOCOLS ON EMIS. TODAY’S PRESENTATION Who am I?. Andrew Walsham IT & Data Quality Manager

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BUILDING PROTOCOLS ON EMIS

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  1. Leeds Student Medical Practice EMIS BUILDING PROTOCOLS ON EMIS PROTOCOL DESIGN

  2. Leeds Student Medical Practice 1 BUILDING PROTOCOLS ON EMIS • TODAY’S PRESENTATION • Who am I? • Andrew Walsham IT & Data Quality Manager • Formal training in computer programming and the application of small business software • Deputy Practice Manager for 2yrs (12,000 pts) • Practice Manager for 11yrs (5,500 pts) • At LSMP for the last 3yrs (30,000 pts) • Responsible for 60 PCs & 3 servers, computer training, web site & Intranet, the summarising and data entry team, and a few other things!

  3. Leeds Student Medical Practice 1 BUILDING PROTOCOLS ON EMIS • TODAY’S PRESENTATION • Who am I? • How do protocols differ from templates? • Examples: • Vaccination and immunisation • Referrals • Diabetes • The design process

  4. Leeds Student Medical Practice 2 BUILDING PROTOCOLS ON EMIS • TEMPLATES vs PROTOCOLS • Templates simply present you with a list of never-changing codes (although you can filter some out by defining gender and age) • Protocols can; incorporate templates, offer multiple choice questions, display information boxes that help users work through the protocol, print word processor documents, add and issue medication • Protocols can make decisions, for example, our NSF protocols check to see if a patient has been coded with that morbidity, before allowing you to enter data

  5. Leeds Student Medical Practice 3 BUILDING PROTOCOLS ON EMIS • TEMPLATES vs PROTOCOLS • We use templates and protocols as a tool to force users to enter the codes and data we want: for NSF, QOF, PCT reports, and to help us make progress towards paperless • DISADVANTAGE - Protocols appear to be difficult to write, this can be attributed in part to the fact that the EMIS Protocol Management module has not been developed since it was introduced ten years ago • DISADVANTAGE– Protocols are very difficult to amend unless you either: do it frequently, or, made comprehensive notes when you created the protocol

  6. Leeds Student Medical Practice 4 BUILDING PROTOCOLS ON EMIS • DEMONSTRATIONS • Vaccination and immunisation • Referrals (4 stages) • Diabetes (today’s example)

  7. Leeds Student Medical Practice 5 BUILDING PROTOCOLS ON EMIS • THE DESIGN PROCESS • PLANNING • Your first task is to draw a flowchart which shows you the various routes through the protocol

  8. Leeds Student Medical Practice 6 BUILDING PROTOCOLS ON EMIS FLOWCHART The benefit of the flowchart is that it gives you an overview to refer back to in case you get confused Check record to see if Diabetes coded If not, code it after asking for onset Template: History & Control Template: Renal Risk Template: Examination Offer to record Medication Review Offer to issue and record Flu vaccination

  9. Leeds Student Medical Practice 7 BUILDING PROTOCOLS ON EMIS THE DESIGN PROCESS TEMPLATES Your second task is to write any templates that you want to pull into your protocol Then (if relevant) ensure the Read codes selected match NSF requirements, and where necessary create new codes We created three templates so that we could acquire data in a logical structure…

  10. Leeds Student Medical Practice 8 BUILDING PROTOCOLS ON EMIS TEMPLATE 1 History & Control

  11. Leeds Student Medical Practice 9 BUILDING PROTOCOLS ON EMIS TEMPLATE 2 Renal Risk

  12. Leeds Student Medical Practice 10 BUILDING PROTOCOLS ON EMIS TEMPLATE 3 Examination

  13. Leeds Student Medical Practice 11 BUILDING PROTOCOLS ON EMIS • THE DESIGN PROCESS • Next write any information screens that will be displayed in your protocol • (EMIS key presses from the Main Menu) • AO – Advanced Options • DT – Dictionaries & Templates • C – Codes, templates, protocols • C - Protocol Management • S – Standard practice protocols • B – Manage information library • A – Add an information screen

  14. Leeds Student Medical Practice 12 BUILDING PROTOCOLS ON EMIS INFORMATION SCREENS

  15. Leeds Student Medical Practice 13 BUILDING PROTOCOLS ON EMIS THE DESIGN PROCESS STEP-BY-STEP Create a logical list of the protocol’s steps We use Word for this, as you can copy and paste common elements, and whenever you amend the protocol it is easy to amend the Word document too This stage is vital as it gives you a reference when you next need to change the protocol, or if someone else takes over the task

  16. Leeds Student Medical Practice 14 BUILDING PROTOCOLS ON EMIS • LSMP’s DIABETES PROTOCOL (Word) • Stage 1 (Is C10E recorded) Type 1 • Rule: Is C10E recorded? • If YES goto 200/300/400/500 • If NO goto 10 • Stage 10 (Is C10F recorded) Type 2 • Rule: Is C10F recorded? • If YES goto 200/300/400/500 • If NO goto 30 • Stage 30 Seek diagnosis • Display info screen: Diabetes not coded • Display “This patient is not coded, please select a diagnosis:” • Multi choice question • Select option: • Type 1 Diabetes Mellitus (stage outcome 100/200/300/400/500) • Type 2 Diabetes Mellitus (stage outcome 110/200/300/400/500) • C. None of the above (stage outcome 990/1000)

  17. Leeds Student Medical Practice 15 BUILDING PROTOCOLS ON EMIS THE PROTOCOL’S STEPS (Word) Stage 100 (record Type 1) Record: C10E, with consultation date, as problem title Stage 110 (record Type 2) Record: C10F, with consultation date, as problem title Stage 200 (call template) Display: History & Control Template: History & Control Stage 300 (call template) Display: Renal Risk Template: Renal Risk Stage 400 (call template) Display: Diabetes Examination Template: Diabetes Examination

  18. Leeds Student Medical Practice 16 BUILDING PROTOCOLS ON EMIS THE PROTOCOL’S STEPS (Word) Stage 500 (add medication review code?) Rule: Add the medication review code? If YES goto 510/600 If NO goto 600 Stage 510(add medication review code) Record: 8B3V Medication Review Done Stage 600 (record flu jab?) Rule: Do you want to give a flu jab? If YES goto 610/1000 If NO goto 1000 Stage 610 (record flu jab) Record: 65E Influenza vaccination no today’s date Acute Rx for Pasteur Merieux Inactivated Influenza Vaccine 0.5 ml asd 1 Acute Rx for Fluvirin Injection asd 1 prefilled syringes Stage 990 (you didn’t choose a code) Display “You didn’t choose a code”

  19. Leeds Student Medical Practice 17 BUILDING PROTOCOLS ON EMIS • CREATING YOUR PROTOCOL • (EMIS key presses from the Main Menu) • AO – Advanced Options • DT – Dictionaries & Templates • C – Codes, templates, protocols • C - Protocol Management • S – Standard practice protocols • A – Add or edit protocols • A – Add a new protocol • Give it a sensible name, and position it in the Access Classification • Then select it to enter the “programming” stage

  20. Leeds Student Medical Practice 18 BUILDING PROTOCOLS ON EMIS STAGE 1Diabetes Type 1 Recorded? R – Go onto the rule section of this stage A – Add a further rule A – If G – Clinical C10E A – Search recorded entries A – Search for any occurrence of this data C – No prompt if data not found H – end of rule, go to stage

  21. Leeds Student Medical Practice 19 BUILDING PROTOCOLS ON EMIS STAGE 1Diabetes Type 1 Recorded? Returns us to this screen: 1 If recorded, C10E… go to stage 2 >>EMIS inserts these numbers 2 If none of above true… go to stage 3 >>EMIS inserts these numbers S – Alter the outcome of a rule Choose rule 1 Change the outcome to 200/300/400/500 Stage XXX is not defined are you sure? Y S – Alter the outcome of a rule Choose rule 2 Change the outcome to 10 Stage 10 is not defined are you sure? Y

  22. Leeds Student Medical Practice 20 BUILDING PROTOCOLS ON EMIS STAGE 10Diabetes Type 2 Recorded? G – Go to the next stage Enter the stage number <Find> for map: 10 R – Go onto the rule section of this stage A – Add a further rule A – If G – Clinical C10F A – Search recorded entries A – Search for any occurrence of this data C – No prompt if data not found H – end of rule, go to stage

  23. Leeds Student Medical Practice 21 BUILDING PROTOCOLS ON EMIS STAGE 10Diabetes Type 2 Recorded? Returns us to this screen: 1 If recorded, C10F… go to stage 3 >>EMIS inserts these numbers 2 If none of above true… go to stage 4 >>EMIS inserts these numbers S – Alter the outcome of a rule Choose rule 1 Change the outcome to 200/300/400/500 Stage XXX is not defined are you sure? Y S – Alter the outcome of a rule Choose rule 2 Change the outcome to 30 Stage 30 is not defined are you sure? Y

  24. Leeds Student Medical Practice 22 BUILDING PROTOCOLS ON EMIS STAGE 30Choose the Diabetes type G – Go to the next stage 30, stage is not defined are you sure? Y R – Go onto the rule section of this stage A – Add a further rule G – Answer the following multi-choice question “This patient is not coded please enter a diagnosis” Option A – Type 1 Diabetes Option B – Type 2 Diabetes Option C – Return to exit Returns us to this screen:

  25. Leeds Student Medical Practice 23 BUILDING PROTOCOLS ON EMIS STAGE 30Choose the Diabetes type The following question is asked; A Type 1 Diabetes… go to stage 4 >>EMIS inserts these numbers B Type 2 Diabetes… go to stage 4 >>EMIS inserts these numbers C None of the above true… go to stage 5>>EMIS inserts these numbers S – Alter the outcome of a rule Choose rule 1, then option A Change the outcome to 100/200/300/400/500 S – Alter the outcome of a rule Choose rule 1, then option B Change the outcome to 110/200/300/400/500

  26. Leeds Student Medical Practice 24 BUILDING PROTOCOLS ON EMIS STAGE 30Choose the Diabetes type S – Alter the outcome of a rule Choose rule 2 Change the outcome to 990/1000 This last rule tells the protocol that if decide not to choose Type 1 or 2, to go to stage 990 where a polite message is displayed, and then stage 1000 which is an end point (stage 1000 doesn’t need to be coded)

  27. Leeds Student Medical Practice 25 BUILDING PROTOCOLS ON EMIS STAGE 100Code Diabetes type 1 G – Go to the next stage 100, stage is not defined are you sure? Y C – Data to be added to the clinical record C10E B – Prompt for date Free text – N Assigned as problem title – Y Gives us: Record entry Type 1 Diabetes (problem title) (date prompt)

  28. Leeds Student Medical Practice 26 BUILDING PROTOCOLS ON EMIS STAGE 110Code Diabetes type 1 G – Go to the next stage 110, stage is not defined are you sure? Y C – Data to be added to the clinical record C10F B – Prompt for date Free text – N Assigned as problem title – Y Gives us: Record entry Type 2 Diabetes (problem title) (date prompt)

  29. Leeds Student Medical Practice 27 BUILDING PROTOCOLS ON EMIS STAGE 200Call History & Control Template G – Go to the next stage 200, stage is not defined are you sure? Y A – Text information to be displayed… navigate to folder and choose History & Control information screen T – Template to be called… navigate to template layer and choose History & Control template Gives us: Following info. screen will display: History & Control Call the template Diabetic History & Control

  30. Leeds Student Medical Practice 28 BUILDING PROTOCOLS ON EMIS STAGE 300Call Renal Risk Template G – Go to the next stage 300, stage is not defined are you sure? Y A – Text information to be displayed… navigate to folder and choose Renal Risk information screen T – Template to be called… navigate to template layer and choose Renal Risk template Gives us: Following information screen will display: Renal Risk Call the template Diabetic Renal Risk

  31. Leeds Student Medical Practice 29 BUILDING PROTOCOLS ON EMIS STAGE 400Call Examination Template G – Go to the next stage 400, stage is not defined are you sure? Y A – Text information to be displayed… navigate to folder and choose Examination information screen T – Template to be called… navigate to template layer and choose Examination template Gives us: Following information screen will display: Examination Call the template Diabetic Examination

  32. Leeds Student Medical Practice 30 BUILDING PROTOCOLS ON EMIS STAGE 500Record medication review? G – Go to the next stage 500, stage is not defined are you sure? Y R – Go onto the rule section of this stage A – Add a further rule D – If the answer to the following is yes Type the question “Add the medication reviewed code?” H – End of rule, go to stage

  33. Leeds Student Medical Practice 31 BUILDING PROTOCOLS ON EMIS STAGE 500Record medication review? Returns us to this screen: 1 If the answer to “Add the medication reviewed code?” is Yes …go to stage 501 >>EMIS inserts these numbers 2 If none of the above are true… go to stage 502>>EMIS inserts etc S – Alter the outcome of a rule Choose rule 1 Change the outcome to 510/600 S – Alter the outcome of a rule Choose rule 2 Change the outcome to 600

  34. Leeds Student Medical Practice 32 BUILDING PROTOCOLS ON EMIS STAGE 510Add Medication Reviewed code G – Go to the next stage 510, stage is not defined are you sure? Y C – Data to be added to the clinical record 8B3V A – Consultation date Free text – N Assigned as problem title – N Gives us: Record entry Medication Review done on today’s date

  35. Leeds Student Medical Practice 33 BUILDING PROTOCOLS ON EMIS STAGE 600Record a flu jab? G – Go to the next stage 600, stage is not defined are you sure? Y R – Go onto the rule section of this stage A – Add a further rule D – If the answer to the following is yes Type the question “Do you want to give a flu jab?” H – End of rule, go to stage

  36. Leeds Student Medical Practice 34 BUILDING PROTOCOLS ON EMIS STAGE 600Record a flu jab? Returns us to this screen: 1 If the answer to “Do you want to give a flu jab?” is Yes… go to stage 601 >>EMIS inserts these numbers 2 If none of the above are true… go to stage 602>>EMIS inserts etc S – Alter the outcome of a rule Choose rule 1 Change the outcome to 610/1000 S – Alter the outcome of a rule Choose rule 2 Change the outcome to 1000

  37. Leeds Student Medical Practice 35 BUILDING PROTOCOLS ON EMIS STAGE 610Record a flu jab G – Go to the next stage 610, stage is not defined are you sure? Y C – Data to be added to the clinical record 65E A – Consultation date Free text – N Assigned as problem title – N M - Medication Choose the desired flu preparation, enter dose as given, and 1op as quantity C – Current

  38. Leeds Student Medical Practice 36 BUILDING PROTOCOLS ON EMIS STAGE 610Record a flu jab If you want to show additional flu preparations in the list (by another manufacturer) select M again and repeat the process but choosing a different preparation STAGE 990Politely thrown out! This stage displays a polite message when someone elected not to specify the Diabetes type G – Go to the next stage 990, stage is not defined are you sure? Y A – Text information to be displayed… navigate to folder and choose desired information screen

  39. Leeds Student Medical Practice 37 BUILDING PROTOCOLS ON EMIS THE DESIGN PROCESS - TESTING The protocol is now finished – hooray!! Exit to the main menu, swap to a test patient then test all the protocol’s permutations to make sure it is doing what you intended

  40. Leeds Student Medical Practice 38 BUILDING PROTOCOLS ON EMIS Some useful notes: You can exit at any time during the creation process, the protocol is continually saved as you construct it (but does mean you need to tell people if you are editing an existing protocol that they may be trying to use) When choosing stage numbers there are no hard and fast rules, but try to make sure there is space in case you have to add extra stages. For example, stages 2, 5, 8, 10, don’t give as much room to manoeuvre as stages 10, 20, 30, 40 Stage 1 is automatically assigned and must always exist, or the protocol will not be able to find a start point

  41. Leeds Student Medical Practice 39 BUILDING PROTOCOLS ON EMIS Some useful notes: You don’t have to create an end stage on EMIS, just point protocol stages there to ensure they don’t accidentally drop into a stage you didn’t intend visiting (our example protocol uses stage 1000 for this purpose) Don’t be afraid to steer the protocol by putting in multiple outcomes to stage rules, for example “Change the outcome to 100/200/300/400/500” Don’t try and do more than one rule in a stage, it looks like it should work, but rarely does (our referral protocol needed almost 100 different stages to work around this limitation)

  42. Leeds Student Medical Practice 40 BUILDING PROTOCOLS ON EMIS I hope this tutorial hasn’t put you off protocols forever, but has instead encouraged you to have a go yourself! Your printed copy of this presentation contains all the key presses and instructions to write the Diabetes protocol (you will need to create your own templates) Thank you for your attention andrew.walsham@nhs.net

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