Tees SystmOne Template - PRIMIS

Tees process: proformawww.PrimaryCareInformatics.co.uk

Will the data items be stored in thesame New Journal view?By making the selectionas shown, the data itemwill show in the normaldefault view within theNew JournalDefault position?Consistency?This option should beselected as appropriateto avoid the risk of auser assuming that ifthey cannot see thedata item it was notapplicable for thepatientwww.PrimaryCareInformatics.co.uk

Have appropriate fields been used?www.PrimaryCareInformatics.co.uk

Have appropriate codes been used?www.PrimaryCareInformatics.co.ukYes/No codes should be usedwith caution•If a code exists to record adata item, it should be used•If a code does not exist and asuitable alternative cannot befound, it may be consideredacceptable to utilise the Yes/Nooptions next to an appropriatelyworded prompt – this is only ofbenefit within the single patientrecord and should only beviewable with the appropriateuse of filters•Care should always be used toensure that a No is never usedwhere it may negate the meaningof another code

Have appropriate codes been used?Although intended to beentered into a child’srecord, these codes sitwithin the obstetricsRead code hierarchywww.PrimaryCareInformatics.co.uk

Have appropriate codes been used?www.PrimaryCareInformatics.co.uk

Are appropriate codes available?• Creme egg (Ub0W2)• Fire in spacecraft on launchpad (X711K)• Wears odd socks (Ua2Cr)• Wears clothes of all one colour (Ua1Yo)• Fish fingers (Ub0OA)• O/E - red nose (2FM00)www.PrimaryCareInformatics.co.uk

Have appropriate codes beenidentified?• Referral to GP (8H62.)• Referral to general practitioner (Y9948)• Health education - exercise (6798.)• Health ed. - exercise (Y7077)• Mixed anxiety and depressive disorder (X00Sb)•Anxiety with depression (Y5448)• Attends stop smoking monitoring (9OO1.)• Attends stop smoking monitor. (Y5515)www.PrimaryCareInformatics.co.uk

Has the back-dating option been usedappropriately?Often appropriatebut use can bemisunderstoodOften EDs betteroptionwww.PrimaryCareInformatics.co.uk

Has system functionality been usedwhere most appropriate?www.PrimaryCareInformatics.co.uk

What if a Podiatrist recorded adiagnosis i of Diabetes everytime apatient came for a diabetic footcheck?www.PrimaryCareInformatics.co.uk

What if a Heart Failure servicerecorded d an MI?www.PrimaryCareInformatics.co.uk

What is the impact on the sharedrecord?This approach will givethe user theopportunity to selectand enter/re-enterdiagnostic dataWhat is the impact onthe clinical record?Consider the impact onQOF• Register• Data duplication• Time based criteriawww.PrimaryCareInformatics.co.uk

www.PrimaryCareInformatics.co.ukOh Dear!!

Oh Dear!!www.PrimaryCareInformatics.co.uk?Multiple Yes/No entriesrecorded in the Journaland also, because of theway the template wascreated, these itemsalso show in thesummary view which willthen be visible to, butunalterable by, all otherusers

Oh Dear!!?www.PrimaryCareInformatics.co.uk

www.PrimaryCareInformatics.co.ukOh Dearer!!• Yes/No codes in use – although, inthis case, these are used as ‘nonstandardqualifiers’ the opportunityexists to negate the meaning of theoriginal code• Immunisations being recorded asRead codes, the implication beingthat they will not be recorded inthe correct area of the record• Free text associated to 2different fields• Back dating available for somevaccinations but not others• The code ‘X74VC’ has beenincluded with the indication thatthis means the Hep B course hasbeen completed whereas the codeis actually a single vaccination• Some field widths too narrow sofull option cannot be viewed• Field entitled ‘Hepatitis Status’includes the data item displayedwhich is actually a numericmeasurement but without thefacility to record this

Problems• Easy availability to ‘poor’ templates• Simplicity of template development• Over – confidence• Lack of appropriate training• Non-standardisation of approach across multipleorganisations• Range of necessary skills•Codes• Resources (dealing with priority demands, ongoingmaintenance, monitoring)• Inability to ‘fix’ to prevent unwanted nt editing‘A little l knowledge is a dangerous thing’www.PrimaryCareInformatics.co.uk

Inability to ‘fix’ to prevent unwantededitingChangesmade byservice userswww.PrimaryCareInformatics.co.uk• Template created, hazardreviewed and published by TPCI•Since had several amendmentsmade by the service – now up toversion 9•If the template is now exportedand then imported into a newenvironment it will still containthe hazard review endorsementsheet but will have lost all therelevant amendment historywhich has taken place since thattime

The Challenge…keep the faith!Thank you for yourtime and attentionwww.PrimaryCareInformatics.co.uk