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Practices 3P Session 2 – EMIS Version
Welcome to the EMIS searching guide! This is a step-by-step guide taking you through a series of searches of your practice’s electronic database. It will help you to put the patient you visited on your first day into the context of the population that your practice serves. There will be some tasks to complete. Please make notes in your student 3P Handbook as your GP tutor will want to discuss this with you afterwards. This tutorial consists of 34 slides.
Aims • Learn how to search your practice’s electronic database • Search the practice database for a condition relating to the patient that you visited at home • Understand how the practice database and other resources can be used to provide useful information about the practice population • Understand how the profile of the practice population influences illness burden
A little bit about EMIS…. One idea shared by two clinicians from Yorkshire in the 1980s kick-started the creation of EgtonMedical Information Systems. The idea: that technology can be used to give clinicians access to complete and shared medical records, no matter where patients present for care. What followed was the development of their first clinical IT system and an ever-growing passion for making information instantly available at the point of care.
Getting started Click on the ‘EMIS ball’ at the top left of the screen Go down to ‘Reporting’ Go to Population Reporting
Click ‘Add’ then ‘Folder’ Call this folder 'Year 3 Medical Student Searches **your names**' e.g. 'Year 3 Medical Student Searches John and Sally'
Enter a name for your search. This should be the name of the condition that you will be searching for. For example, if the patient you visited at home had COPD, put 'COPD' as the name of the search. Then select 'Currently registered regular patients' .Then select 'OK’. If your patient has several conditions, just pick one for the time being.
Click here to add new rules to the search Then select ‘Create a new rule’
Select ‘Click here to choose the type of feature you would like to create’ Then select ‘Clinical Codes’
In the box in the top left, type in the condition you wish to search for and then press enter. In this case we have put in COPD. Then double click on the first option (A), indicated here by the red arrow. This is usually the most relevant code to use.
On the right, you can now see how the code you have selected fits into the coding hierarchy. You can see in this example that when we've selected the top code, it shows us all the other codes that fall within the overall code of 'Chronic obstructive pulmonary disease'.
In the box that says 'Selected codes‘ you can see all the sub-codes for your selected condition. Have a look through your list and identify anything that you think may be inappropriate to include in the search. In this example, we would want to exclude patients with 'Asthma', 'Bronchitis unspecified', 'Bronchiectasis' and 'Extrinsic allergic alveolitis' by de-selecting the box next to the condition. You may wish to look up any conditions you don't know. Then select 'OK' in the bottom right of the window.
Now you’re ready to run your search! Select ‘Save and Run’
Once the search has finished, you will see a summary at the bottom of the screen that looks like this. • It tells us the total number of patients with the particular condition that we have searched for ('Population Count'), the total number of patients on the practice register ('Parent') and the percentage of patients at the practice who have the condition that you have searched for (3% in this case). • Look online for national prevalence rates for your condition. How does the rate in your practice compare? • Write these figures down in your workbook.
Select the 'Age/Sex' tab. This gives you the age distribution of patients with the condition you have searched for. Select the 'Population Included' tab. This gives you the details for all the patients included in the search. If you want to look in more detail at individual patients included in the search, you can right click on the patient's name and select 'Summary'.
You can navigate through the patient's record by selecting the different tabs at the top. For example, you can see all their consultations by selecting 'Consultations' and all their medication by selecting 'Medications'. To return to your search, click the EMIS ball in the top left and then 'Reporting' in the drop down menu as you did at the start.
How might the practice be able to use this data to provide better care for their patients? At this stage you may wish to run some additional searches related to your condition. For example, you may want to search for the prevalence of risk factors for the condition you've searched for. If you've searched for a cardiovascular condition you may wish to search for the prevalence of smoking, diabetes or obesity in the practice population. To do this, return to the 'Reporting' page, right click in the space below your original search and then select 'Add', 'Patient' and 'Search'. Give the search a new name e.g. 'Smoking' and follow the steps above to run the search. Write the answers to any additional searches in your workbook to discuss with your GP tutor at the end of the session. What information do your extra searches provide to help explain the prevalence of the disease you searched for? E.g. do you think there is a high prevalence of COPD due to a high smoking rate?
You can also use EMIS to search for the age distribution of the practice population. Perhaps a better tool is the General Practice Profiles website provided by Public Health England. Have a look at the website here https://fingertips.phe.org.uk/profile/general-practice. On the right of the homepage, click 'START Go to the data' and search for your practice. This will provide you with an age profile of your practice by 5 year age bands which you can compare to other local practices, the region or England as a whole. Other tabs can provide information about deprivation, employment and long term health conditions. Is there any information from the General Practice Profiles website that explains the prevalence of your condition?
You may wish to run further searches on the population you have identified through your search. On the population reporting home page, right click on your previous search, then click ‘add’>’patient’>’search’.
Add a name for this part of the search in the top box, and select ‘Results from’, then select ‘OK’. In our example, we are going to search for the proportion of patients who we’ve identified with COPD who are smokers, so tick the button next to ‘Results from’ here.
Select ‘Click here to choose the type of feature you would like to create’ Then select ‘Clinical Codes’
Here we have double clicked on ‘current smokers’. Then select ‘OK’.
Now we need to add a time frame to it, otherwise it will pick up all patients with COPD who have ever been coded as smokers. Click on ‘Click here to add Criteria to this Feature’ indicated by the red arrow in the image to the right
Ensure this is set to ‘after’ 1 year before the search date. Select ‘OK’ and then ‘OK’ Select ‘Save and Run’
We now have the results of our new search at the bottom of the screen. The ‘Parent’ count is all the patients with COPD and the ‘Population Count’ is the number of patients with COPD who were coded as a smoker in the last year. You can see from the ‘%’ column that 37% of our patients with COPD are smokers.
Using these techniques you should be able to create and run any additional searches that might be of interest. You may wish to repeat this for some of your patients other medical conditions for example. If you are feeling adventurous, you might could also try searches for medication and combining this with other searches. For example, if you’ve searched for asthma, can you create a search that identifies how many patients have had more than 5 prescriptions for salbutamol in the last year? Sometimes with complex searches it can be a case of trial and error!
