SystmOne and Support for the IMT DES

1. SystmOne and Support for the IM&T DES Raj Shergill- Business Process Manager Jon Fordham- Strategic Relations Manager

2. Improving the standard of healthcare Advanced computerised infrastructure �Joined up� Health Service Information Technology leverage for healthcare professionals rather than hindrance Improving the standard of healthcare available in the UK requires more than just effective medical training and adequate resources. It also needs an advanced computerised infrastructure to aid the smooth delivery of that service to each and every patient. SystmOne helps to do just that. It assists in the creation of a �joined up� Health Service where Information Technology is leverage for healthcare professionals rather than a hindrance. Improving the standard of healthcare available in the UK requires more than just effective medical training and adequate resources. It also needs an advanced computerised infrastructure to aid the smooth delivery of that service to each and every patient. SystmOne helps to do just that. It assists in the creation of a �joined up� Health Service where Information Technology is leverage for healthcare professionals rather than a hindrance.

3. SystmOne RFA 99v 1.2 accredited Full compatibility within NHS data standards Complete and reliable functionality Easily configurable Award-winning suite of products SystmOne is an RFA 99v 1.2 accredited suite of clinical systems, guaranteeing full compatibility within NHS data standards and offering complete and reliable functionality. SystmOne is easily configurable to meet the needs of any practice: from the single-handed to the ten-partner; from the non-computerised to the paperless; and from the inner city to the rural dispensing. (1 slide) Since 1999, our award-winning suite of products have revolutionised the functionality and performance of electronic clinical recording and decision support software in primary care.SystmOne is an RFA 99v 1.2 accredited suite of clinical systems, guaranteeing full compatibility within NHS data standards and offering complete and reliable functionality. SystmOne is easily configurable to meet the needs of any practice: from the single-handed to the ten-partner; from the non-computerised to the paperless; and from the inner city to the rural dispensing. (1 slide) Since 1999, our award-winning suite of products have revolutionised the functionality and performance of electronic clinical recording and decision support software in primary care.

4. Since 2004, TPP has been working with Local Service Providers (LSP�s) to deploy SystmOne GP, Child Health, Community, Prisons as well as additional modules such as Palliative and OOH. These modules have been delivered to health care organisations as an integrated primary care solution to the NHS Connecting for Health in the North Eastern and Eastern Clusters of the NHS in England as well as the North West and West Midlands cluster.

5. Professionally Managed Service Comprehensive, proven, accurate and professionally managed data migration Data loss is zero SystmOne keeps clinical data in a safe and secure data centre, with mirrored servers in a second secure centre Disaster recovery is guaranteed i.e. in case of floods or fire Business and patient care continuity is ensured Centrally managed updates No burden on practices for backups, patches or updates or 3rd part bolt-ons SystmOne branch surgery is connected directly to N3 rather than being routed through the man site. This ensures identical performance at both sites

6. Integrating Primary Care SystmOne provides 1 patient, 1 record accessed seamlessly by the care community Full Clinical history, including scanned images, clinical development and test results is accessible without requesting paper notes All involved health care professionals view and can contribute to a detailed care history Shared knowledge between care settings eases demand management and improves patient care

7. Integration within practice Shared administration Web presence Appointments Data input challenges IM&T DES QOF Workflow Scanning Tasks SMS reminders SMS communications Email / WAP GP 2 GP Auto consultations Biometric machinery integration Touch screens and call boards Multiple sites Remote access Disconnected mode Disaster planning & recovery Training and other costs Integrated choose and book Reporting Chat rooms

8. Integration within Primary health care team District Nurse and Health Visitors Community Midwives Electronic referrals Tasks Single record structure QOF

9. Example Integrated Record between GP and Community

10. Integration with wider health care community (PCT) OOH GP provider OOH community nursing Podiatry Retinopathy Specialist nursing services (eg continence, stoma care, palliative care, heart failure, cardiac rehabilitation, respiratory (COPD)) Drug dependency services Community hospital Community Pharmacists PCT triage services PCT wide reporting Long term conditions QOF

11. Example Integrated Record between GP and OOH

12. Integration with Child Health Systems Electronic birth notifications and registration Childhood vaccinations Enter once Transfer of data

13. Integrated Vaccination Record

14. Integration with Secondary Care Pathways Palliative care Diabetes Chronic Kidney Disease Hyperthyroidism Rheumatology (especially DMARDs) Lorenzo

15. Summary Care Record Service This screenshot shows how users will be asked to ensure that information is passed to the SCR This screenshot shows how users will be asked to ensure that information is passed to the SCR

16. Integration with National Service Providers Patient demographic service Electronic Prescribing Summary Care Record Service Choose and Book GP2GP

17. Lorenzo Integration Integration with secondary care systems will be two fold � secondary care uses will be able to launch the patient�s GP system and retrieve their record to view, and the primary care users will be able to receive incoming data from secondary care and choose how it is to be used. This integration model is built and awaits testing with a secondary care installation Integration with secondary care systems will be two fold � secondary care uses will be able to launch the patient�s GP system and retrieve their record to view, and the primary care users will be able to receive incoming data from secondary care and choose how it is to be used. This integration model is built and awaits testing with a secondary care installation

18. Full Integration

19. Jessica�s Journey Future integration with provider systems will ensure that the paediatrician can access detailed care record Outpatient appointments or episodes off care will be recorded on provider PAS and integrated in to SystmOne Every Primary care physician will have a holistic view of the whole care process and detailed care record

20. Benefits to Integration Fuller Records Consistent Format Timely Information Joined up working Patient Safety

21. SystmOne and IM&T DES Modernising information management and technology in general practice � the policy perspective � Taken from the Good Practice Guidelines 2005 (v3.1) The NHS Connecting for Health program will drive policy implementation over the next few years. The major deliverables from the NHS Connecting for Health program are; An electronic booking service for hospital appointments (Choose and Book) The electronic transfer of prescriptions (ETP) The NHS Care Records Service (which extends the concept of the Electronic Patient Record across the whole health community) New IT infrastructure (N3) to support these services. All of the above 4 components are possible through SystmOne as it is fully compatible with the NHS spine and is currently being accredited as Hosted to CfH standards. We hope to obtain accreditation by March 2008 (the very latest)

22. Problems with IM&T DES within SystmOne Issue with MIQUEST reports running slow � performance improved October 2007 Error in reports when uploading to CHART (-1) � resolved September 2007

23. IM&T DES Reports  Running a Report To use the IM&T DES Report screen: Select Reporting>IM&T DES Reports from the Main Menu. Select a report from the tree. The available reports are: CCLOCS - System location report in last 28 days CCSUMS - Identification of summary flag (single) CCSUMM - Identification of summary flag (multiple) CCDALL - Identification of allergies and adverse reactions The selected report starts running automatically. All reports include active patients only. Right-click on a line in a report and select Show Missing Patients/Show Patients to view a list of the patients. The patients' details appear in the lower pane on the right of the screen. To print out a copy of the missing patient list, right-click on the list and select Print Table from the right-click menu. A copy of the report results is opened in your word processing program, ready for you to print out. To print out certain columns from the missing patient list: Right-click on the list and select Print Partial Table from the right-click menu. Select the columns whose data you want to print. Click Ok. A copy of the data is opened in your word processing program, ready for you to print out. To export a copy of the missing patient list to a spreadsheet, right-click on the list and select Send to Spreadsheet from the right-click menu. To extract report data to a .txt file: Ensure that the report you want to extract is selected from the tree, e.g.�CCSUMS. Click Extract Report. Click Yes. Note the location of the saved extract and click Ok. Running a Report To use the IM&T DES Report screen: Select Reporting>IM&T DES Reports from the Main Menu. Select a report from the tree. The available reports are: CCLOCS - System location report in last 28 days CCSUMS - Identification of summary flag (single) CCSUMM - Identification of summary flag (multiple) CCDALL - Identification of allergies and adverse reactions The selected report starts running automatically. All reports include active patients only. Right-click on a line in a report and select Show Missing Patients/Show Patients to view a list of the patients. The patients' details appear in the lower pane on the right of the screen. To print out a copy of the missing patient list, right-click on the list and select Print Table from the right-click menu. A copy of the report results is opened in your word processing program, ready for you to print out. To print out certain columns from the missing patient list: Right-click on the list and select Print Partial Table from the right-click menu. Select the columns whose data you want to print. Click Ok. A copy of the data is opened in your word processing program, ready for you to print out. To export a copy of the missing patient list to a spreadsheet, right-click on the list and select Send to Spreadsheet from the right-click menu. To extract report data to a .txt file: Ensure that the report you want to extract is selected from the tree, e.g.�CCSUMS. Click Extract Report. Click Yes. Note the location of the saved extract and click Ok.

24. CCLOCS  Allows you to report on the number of direct encounters recorded by a GP user in the last 28 days that have any of the following recorded in the Other Location field of the Event Details dialog: Surgery (face-to-face consultation) Telephone (telephone consultation) Home (home visit) Allows you to report on the number of direct encounters recorded by a GP user in the last 28 days that have any of the following recorded in the Other Location field of the Event Details dialog: Surgery (face-to-face consultation) Telephone (telephone consultation) Home (home visit)

25. CCSUMS  Allows you to report on important diagnoses that are not included in the summary. "Important diagnoses" are: Cholecystectomy Chronic Bronchitis Hypothyroidism Colectomy Rheumatoid Arthritis Breast Cancer Hypertension Ulcerative Colitis Multiple Sclerosis Parkinson's Disease Dementia Fibrosing Alveolitis Coeliac Disease Chronic Renal Failure Prostate Cancer Pacemaker Glaucoma The report shows the number of patients who have the relevant Read codes in their patient record and a separate figure for the number of patients who have the relevant Read codes in their patient summary. A patient is considered to be missing if they have an "important diagnosis" Read code in their record but that Read code is not also in the summary, i.e if they are included in the No of Patients figure but not in the No of Patients Summarised figure. Allows you to report on important diagnoses that are not included in the summary. "Important diagnoses" are: Cholecystectomy Chronic Bronchitis Hypothyroidism Colectomy Rheumatoid Arthritis Breast Cancer Hypertension Ulcerative Colitis Multiple Sclerosis Parkinson's Disease Dementia Fibrosing Alveolitis Coeliac Disease Chronic Renal Failure Prostate Cancer Pacemaker Glaucoma The report shows the number of patients who have the relevant Read codes in their patient record and a separate figure for the number of patients who have the relevant Read codes in their patient summary. A patient is considered to be missing if they have an "important diagnosis" Read code in their record but that Read code is not also in the summary, i.e if they are included in the No of Patients figure but not in the No of Patients Summarised figure.

26. CCSUMM  CCSUMM Allows you to report on important diagnoses that are not included in the summary. For pulmonary embolus, an important diagnosis is: (Pulmonary embolus) or (pulmonary infarction) [G401.] For myocardial infarction, important diagnoses are: (Myocard inf (& [ac][silent][card rupt])) or (coron thromb) [G30..] Myocard infarct: [old] or [healed] or [personal history of] [G32..] Subsequent myocardial infarction [G35..] and any children of this Read code The report shows the number of patients who have the relevant Read codes marked with an episodicity of 'New' or 'Other'. A separate figure is given for the number of patients who have relevant Read codes included in the patient summary. A patient is considered to be missing if they have an "important diagnosis" Read code in their record but that Read code is not also in the summary, i.e if they are included in the No of Patients figure but not in the No of Patients Summarised figure. CCSUMM Allows you to report on important diagnoses that are not included in the summary. For pulmonary embolus, an important diagnosis is: (Pulmonary embolus) or (pulmonary infarction) [G401.] For myocardial infarction, important diagnoses are: (Myocard inf (& [ac][silent][card rupt])) or (coron thromb) [G30..] Myocard infarct: [old] or [healed] or [personal history of] [G32..] Subsequent myocardial infarction [G35..] and any children of this Read code The report shows the number of patients who have the relevant Read codes marked with an episodicity of 'New' or 'Other'. A separate figure is given for the number of patients who have relevant Read codes included in the patient summary. A patient is considered to be missing if they have an "important diagnosis" Read code in their record but that Read code is not also in the summary, i.e if they are included in the No of Patients figure but not in the No of Patients Summarised figure.

27. CCDALL  Allows you to report on the number of patients with specific sensitivities to the following recorded: Penicillins Drugs used in infections Gastro-intestinal drugs Cardiovascular drugs Nervous system drugs Musculo-skeletal drugs To view a list of the patients who have a sensitivity to the selected type of drug, right-click on the item and select Show Patients from the right-click menu. A list of the patients is displayed in the lower pane. The name of the actual drug involved is displayed in the Drug column. Allows you to report on the number of patients with specific sensitivities to the following recorded: Penicillins Drugs used in infections Gastro-intestinal drugs Cardiovascular drugs Nervous system drugs Musculo-skeletal drugs To view a list of the patients who have a sensitivity to the selected type of drug, right-click on the item and select Show Patients from the right-click menu. A list of the patients is displayed in the lower pane. The name of the actual drug involved is displayed in the Drug column.

28. MIQUEST Overview of miquestOverview of miquest

29. Overview of main page and the treeOverview of main page and the tree

30. When a response has been authorised or rejected, it is moved to the Responses waiting to be sent tab of the Summary view. The results can then be saved as a ".csv" file on a floppy disk or on your hard drive and sent back to the enquirer. To save a set of responses in bulk: Select the relevant request set from the MIQUEST tree. Click Save All Response Files at the top of the Report Request Set Details view as appropriate. Browse to your floppy disk drive (or if you want to e-mail the files, to a folder on your hard disk) and click Open. To save responses on a floppy disk individually: Select the response from the MIQUEST tree. Insert a disk into your floppy disk drive. Right-click on the response and select Send from the right-click menu. The �icon is displayed next to the response in the tree. The following options are available when you right-click on a response on the Responses waiting to be sent tab of the Summary view: Option Description Send Save the response on a floppy disk (ensure that a disk is inserted in the drive before you click Send). Unreject Change a response that was previously rejected so that you have the opportunity to authorise it if you wish. Copy Copy the selected response. Edit Edit the contents of the selected response. Delete response Delete the selected response. Table Print Table - print a copy of the entries listed from your word processing program, e.g.�Microsoft Word. Print Partial Table - print a copy of the data from the selected columns from your word processing program, e.g.�Microsoft Word. Send to Spreadsheet - open a copy of the list in your spreadsheet program, e.g.�Microsoft Excel. When a response has been authorised or rejected, it is moved to the Responses waiting to be sent tab of the Summary view. The results can then be saved as a ".csv" file on a floppy disk or on your hard drive and sent back to the enquirer. To save a set of responses in bulk: Select the relevant request set from the MIQUEST tree. Click Save All Response Files at the top of the Report Request Set Details view as appropriate. Browse to your floppy disk drive (or if you want to e-mail the files, to a folder on your hard disk) and click Open. To save responses on a floppy disk individually: Select the response from the MIQUEST tree. Insert a disk into your floppy disk drive. Right-click on the response and select Send from the right-click menu. The �icon is displayed next to the response in the tree. The following options are available when you right-click on a response on the Responses waiting to be sent tab of the Summary view: Option Description Send Save the response on a floppy disk (ensure that a disk is inserted in the drive before you click Send). Unreject Change a response that was previously rejected so that you have the opportunity to authorise it if you wish. Copy Copy the selected response. Edit Edit the contents of the selected response. Delete response Delete the selected response. Table Print Table - print a copy of the entries listed from your word processing program, e.g.�Microsoft Word. Print Partial Table - print a copy of the data from the selected columns from your word processing program, e.g.�Microsoft Word. Send to Spreadsheet - open a copy of the list in your spreadsheet program, e.g.�Microsoft Excel.

31. Clinical Reporting Oveview of clinical reporting and how it works. Why we produced our own IM&T des reportsOveview of clinical reporting and how it works. Why we produced our own IM&T des reports

32. D2DG16 Patients on Insulins and other antidiabetics than Metformin in last 12 months without diagnosis of diabetes Overview of page and treeOverview of page and tree

33. D2DG16 Patients on Insulins and other antidiabetics than Metformin in last 12 months without diagnosis of diabetes Go through actions to aid follow up workGo through actions to aid follow up work

34. FINM1A: FEM_PREG Subset of male patients with female code recording Another example reportAnother example report

35. FINM1A: FEM_PREG Subset of male patients with female code recording How info is shown when broken downHow info is shown when broken down

36. The challenges of information sharing within the integrated record environment Coding Standards Retaining purpose of the record Ensuring the meaning of the record Accountability of the complex records Social Linkages

37. Example issues Read Code entries with conflicting free text description �Yes� and �No� coding Diagnoses entries in place of H/O codes Lack of standardisation Inappropriate use of gender specific codes

38. Completing fields unnecessarily Duplicating entries Not using templates Not sharing records Lack of awareness of other organisations data

39. Any Questions? Changes to coding at practice level has been driven by QOF and more recently by the IM&T DES. The wider community users are keen to see the benefits of coded records and the integrated record helps by avoiding duplication and variation in data entry. There are still issues around what the record may mean to different user groups -the semantic element of the record � but this should not stop integration; so too are the issues around the complexity of the record that is built. Changes to coding at practice level has been driven by QOF and more recently by the IM&T DES. The wider community users are keen to see the benefits of coded records and the integrated record helps by avoiding duplication and variation in data entry. There are still issues around what the record may mean to different user groups -the semantic element of the record � but this should not stop integration; so too are the issues around the complexity of the record that is built.