emis web gp2gp clinical guidegp2gp workflow manager gp2gp has its own section within workflow...

NECS Clinical Systems Specialist Team

©Copyright NECSU Revision date: 15/05/2020

EMIS Web -

GP2GP

Clinical Guide

Author: NECS Clinical Systems Specialists Team

Telephone: 0300 555 0340 2 Email: [email protected]

Table of Contents

Contents Introduction ...................................................................................................................................... 3

GP2GP Workflow Manager .............................................................................................................. 4

Requests ...................................................................................................................................... 4

Records Received ........................................................................................................................ 5

Requests Received ...................................................................................................................... 6

Records Sent ................................................................................................................................ 6

Errors ............................................................................................................................................ 7

Registering a Patient via PDS .......................................................................................................... 8

New Patients ................................................................................................................................ 8

Returning Patients ........................................................................................................................ 8

Checking Incoming GP2GP Records ............................................................................................... 9

Filing GP2GP Records ................................................................................................................... 11

Filing a New Patient ................................................................................................................ 11

Filing a Returning Patient ........................................................................................................ 11

Filed Records with Missing Attachments .................................................................................... 13

Reject a GP2GP Transfer ........................................................................................................... 13

Dealing with Degraded Tasks ........................................................................................................ 15

Medication Authorisations .......................................................................................................... 15

Allergy Degrades ........................................................................................................................ 16

Event Degrades .......................................................................................................................... 16

Deducting Patients & Printing Records .......................................................................................... 18

Deducting a Patient .................................................................................................................... 18

Printing Documents for Deducted Patients ................................................................................. 18

Configuring GP2GP in Workflow Manager ..................................................................................... 22

Global Viewers ........................................................................................................................... 22

Task escalation settings ............................................................................................................. 23


Introduction

GP2GP allows the electronic transfer of a patient’s record between practices. This cuts down on paper and missing records but more importantly it allows for almost immediate access to a patient’s notes. Any consultations and codes/problems will be on the record straight away and medication can be available as well. Sometimes, however, data is not transferred correctly into the new record. When this happens the data becomes “Degraded” and can be dealt with via separate tasks within Workflow Manager. Degrades will be looked at later in the guide.

The registration process remains unchanged and tasks are now generated within Workflow Manager to deal with the GP2GP transfers. The Lloyd George record must still be sent when deducting your patients though.

Important Points to Note: a. EMIS Web is using GP2GP v2.2b which enables the transfer of large records. Previously, any

records that exceeded 5MB in size or had more than 99 attachments could not be transferred electronically. Currently all clinical systems should be using v2.2b.

b. You must have the appropriate RBAC rights on your smartcard to use GP2GP and this can be

arranged via the RA team for any member of staff who cannot access the GP2GP functionality, please contact the NECS IT Service Desk on 0300 555 0340.

c. Flagged PDS Records won’t transfer via GP2GP and must be handled manually. These are

records which have been marked as sensitive for various reasons or because the patient is a politician, on the witness protection scheme or a member of the royal family etc. They can also be people who have two NHS numbers and are in the process of having their records rationalised.

d. Any records that have been restricted with a confidentiality policy or have had parts of the

record restricted will lose those restrictions as part of the GP2GP transfer. This is because those policies are put in place by the practice themselves and have therefore been a local decision. It would be up to the new practice receiving the record to apply their own confidentiality polices if required.


GP2GP Workflow Manager GP2GP has its own section within Workflow Manager and is broken down into several sections. When a GP2GP transfer takes place, a task is generated and displayed within Workflow Manager. This is split into 5 Sections with subsections in each. These are: Requests, Records Received, Requests Received, Records Sent and Errors. Please see a detailed explanation below regarding each section and sub section. This section shows the requests for records you have sent to other practices.

Requests

Pending Send

Any record requests that have not been sent that are awaiting a reply from the Personal Demographics Service update. If a task is displayed in this section for longer than 24 hours contact EMIS support.

Outstanding

Record requests that have been sent to the sending organisation and are awaiting the record from the sending organisation.

Note: Tasks are displayed in this folder either because the patient’s previous organisation is using a non-GP2GP compliant system or the patient’s record is too large to transfer. If a task is displayed in this section for longer than one week contact EMIS support.

Rejections

Rejected record requests that have been rejected by the sending organisation’s system. This could be for the following reasons:

a. Patient not recognised at surgery. b. GP2GP Messaging is not enabled on this system.


c. The system’s configuration prevents it from processing this message. d. Unexpected condition.

Rejection notifications are only received if the sending organisation’s system recognises GP2GP.

Records Received

This section shows records you have received from other practices.

Unfiled / Unfiled (unknown date/time) Any EHRs that have been received from the patient’s sending organisation’s system that need integrating into the registering organisations system.

Medication Authorisation

Any received records that contain medication that requires reauthorising, or have been degraded because their code is unknown to EMIS Web.

Allergy Degrade Any received records containing clinical terms that have been recognised as allergies, but their code is unknown to EMIS Web.

Event Degrade Any received records that contain clinical terms that are unknown to EMIS Web (all items except medication and allergies).

Filed Records Shows patient’s records that have been received and filed. You must have RBAC role B0062 – Local System Administration assigned to your user account to see the Filed Records folder.


Requests Received

This section shows any Unsent Records. Click on the task to see further information about the reason GP2GP has not been sent.

Records Sent

This section shows records you have sent to other practices.

Unacknowledged Any EHRs that have been sent to the patient’s sending organisation, but have not been filed.

Integration Failure Any EHRs that have failed to be filed into the registering organisations system. If there is a technical problem with any element of the transferred record the filing of the medical record is designed to fail. This is part of the clinical safety design of a GP2GP transfer. Messages can be:

a. The system’s configuration prevents it from processing this message. b. EHR Extract received without corresponding request. c. Failed to successfully integrate EHR Extract. d. Duplicate EHR Extract received. e. Unexpected condition.

You will not receive any notifications if an integration failure occurs. Check the Integration Failure folder regularly and deduct any integration failures using GP Links.


Integration Successful Any EHRs that have been successfully filed into the requesting organisation system. This is where you can check whether the requesting system supports large messaging.

Errors

This section shows any errors that have occurred during the GP2GP process. For further information on the cause of the error, a list of error codes can be found on Emis Now / Support Centre with details of what action to take.


Registering a Patient via PDS

New Patients

1. For GP2GP to work you must be logged in with your smartcard. An important thing to

remember is that you must match the patient to the spine so that the PDS icon is blue. Note: GP2GP transfers cannot take place if the patient is not matched to the spine.

2. If PDS is unavailable or you do not have a smartcard, then it is advisable to wait until the patient can be correctly registered. If however, the registration needs to take place immediately then EMIS recommend registering the patient as a Temporary type and then changing the Patient Type later to Regular when you are logged in with your smartcard and the PDS is available.

Returning Patients

1. When re-registering a previous patient, make sure to add them as a new patient and then

locate them via that route - just re-registering them will not generate a PDS trace and therefore the GP2GP transfer can fail.

2. Always use the Add button on the registration screen and select Regular as the patient type.

This will ensure that a PDS match is triggered.

3. If the GP2GP request is successful, a Task will be received into the Unfiled folder of the

Records Received section within GP2GP in Workflow Manager.

4. If the request is unsuccessful, a task will also be received however this will be found in the folders within the Requests Sent section.


Checking Incoming GP2GP Records It is important to review the incoming record prior to filing it. This will not only ensure that it is the correct patient but additionally give the opportunity to check the content of the record to see if any data has been “degraded”. This can help when deciding how to file the incoming record which will be looked at later in this guide. Note: Degraded data is data that cannot be matched to either a clinical code or a drug code. Common items of degraded data can be old medications that have now been discontinued or allergies that were recorded as free text against a generic “allergic reaction” code. Degraded data should be reviewed by a clinician and this will be explained further within the filing section of this guide.

It is important to note that if there is a degraded allergy on the record then all prescribing is suspended until that degraded item has been dealt with. This is to stop unsafe prescribing while there is a potentially unknown allergy on the patient’s record. To review an incoming record:

1. Highlight the required patient’s task in the Unfiled folder.

2. Click the View button on the ribbon.

3. The Workflow Manager Task screen is displayed. There are two sections:

a. Previous Practice’s Record (Left-hand side): This displays the incoming record. b. This Practice’s Record (Right-hand side): This displays the patient’s current record.

Usually this will be empty as it is a new record but it may contain data if, for example, the patient was seen immediately after registration and before the GP2GP task was looked at.


It is possible to filter the patient’s record to make it easier to review the data. The following options are available in the Filter section of the ribbon:

a. Summary b. Consultations c. Medication d. Allergies e. Problems f. Other – This option lets you view:

i. Values ii. Attachments iii. Diary entries iv. Immunisations v. Investigations vi. Referrals

Note: Sometimes not all of the attachments will be sent via GP2GP and in these cases the sending practice will be prompted to print those documents and send them along with the Lloyd George paper record. When this happens a text file will replace the attachment in the record which will contain the name of the missing document and states that it was not transferrable. This will be shown in the Deducting Patients section where you will be the sending practice and you will be prompted to print off any attachments that cannot be sent via GP2GP. This is covered in the Deducting Patients section of this guide.


Filing GP2GP Records Once the record has been reviewed it can be filed by using the filing buttons on the ribbon.

To file an incoming record:



Filing a New Patient The following buttons on the Ribbon are available for filing a new patient record:

1. File as record - If you have reviewed the record and are happy with the quality of the data and

the patient is correct then you can file into the patient’s record. No degrade tasks will be created.

2. File as record with tasks - If you have reviewed the record and are happy with the quality of

the data and the patient is correct but have noticed that it includes allergy or degrade information, then you can file the patient’s record with degrade tasks. This is the best option to use as degrade tasks will be generated automatically if degraded data exists.

3. Reject record - If you are not happy with the quality of the data of it is the wrong patient then

you can select this option to reject the record.

Filing a Returning Patient The following buttons on the Ribbon are available for filing a returning patient record:


1. File incoming as record - This will replace the existing medical record held at your organisation with the incoming record. The old, existing record will be saved as an attachment in the patient’s new record.

2. Merge with existing and file - This option keeps the existing record that you already have and adds any new information recorded by the practice sending the record. Please be aware that any changes made by the sending practice to information they originally received from your organisation will not be included.

In addition, all returning patients in v2.2b are easily identified by the red banner which is displayed across the top of screen.

Note: Occasionally the date the record was originally exported from your organisation will be unknown by GP2GP, and you must manually enter an export date before you can file the record.

On the red banner, click Enter Export Date. The GP2GP export screen is displayed along with patient’s registration history.


Identify the date the patient was made inactive at your Practice (A), and enter this date in Export Date box (B). Click OK (C). The red banner will now display the export date you entered, and the filing options will become available on the toolbar. Any Degrade Tasks that have been created will be shown in their appropriate folders within the Records Received Workflow Manager section.

Filed Records with Missing Attachments

Once a GP2GP transfer has taken place it is possible to see if any attachments are missing.

1. Highlight the required patient’s task in the Filed Records folder.

2. Click Missing Attachments on the ribbon.

This will display the Missing attachments screen. From this screen you can see which attachments haven’t been transferred (if any).

Reject a GP2GP Transfer

If the record received is for the wrong patient then the transfer can be rejected.

To reject an incoming record:




3. Click the Reject Record button on the ribbon. The following warning is displayed:

4. Click Reject to complete the task.


Dealing with Degraded Tasks There are three types of Degrade tasks that can be created when filing a GP2GP record:

1. Medication Authorisation – These allow you to deal with a patient’s Current repeat medication

and any degraded medications.

2. Allergy Degrade – Allows you to add the correct Allergy codes to the record and clear the allergy degrade making prescribing possible again.

3. Event Degrade – Anything else that is not a medication or an allergy that has been degraded

can be coded from these tasks.

Medication Authorisations

When a record is transferred via GP2GP all medications are transferred into the Past screen apart from Current Repeat medications. These are listed within the Medication Authorisation task ready for a clinician to look. They can either be approved or put into the Past. Anything that is not recognised is listed as a degraded item and these can either be left as degraded or the correct drug term can be added to them.

To process a Medication Authorisation task do the following:

1. Highlight the required patient’s task in the Medication Authorisation folder.


3. To process the Current Repeats either click the Authorise or Past buttons for each

medication. 4. To process any Degrades, highlight the medication and then click the Add Drug button on

the ribbon to associate a proper medication. 5. Once finished click the Apply & Save button on the ribbon. 6. Click Yes to apply the changes and complete the task or click No if you wish to make further

changes. 7. If you authorised or ended any medication then the Reauthorise Medication screen and/or the

End Course screen will be displayed to finish those processes.


Allergy Degrades

Not all clinical systems use codes in the same way to record allergies and sometimes these allergies are not recognised as a specific code when transferring via GP2GP. These become degraded allergies and need clinical intervention to review them. Prescribing for the patient is not possible while a degraded allergy exists on their record. An alert will also be displayed when accessing the patient’s record if an allergy degrade exists. This will be cleared when the task is completed.

To process an Allergy Degrade task do the following:

1. Highlight the required patient’s task in the Allergy Degrade folder.

2. Click the View button on the ribbon. 3. Click on the degraded allergy to select it. 4. Click the Add Allergy button on the ribbon. 5. Select the required code as you would if you were adding a normal allergy. 6. Click OK. 7. Click the Mark as Viewed button on the ribbon. 8. Click Yes to apply the changes and complete the task or click No if you wish to make further

changes.

Please be aware that some allergy text could remain within consultations as all we are doing is adding the correct code at this point. In this case you may also need to edit or delete the relevant consultations to make sure the record is accurate, especially if the allergy degrade was incorrect.

Event Degrades

Anything else that could not be matched to a code and is not an allergy or a medication will be shown in here. It is important to make sure that anything that is currently clinically relevant is dealt with but it may be that some items do not need to be coded.

To process an Event Degrade task do the following:

1. Highlight the required patient’s task in the Event Degrade folder. 2. Click the View button on the ribbon. 3. Select the required event degrade.

4. Click the Add a Code button on the ribbon.


5. Search for and select the required code as you would if you were adding a code to the patient’s record.

6. Click OK. 7. Repeat this until all the required event degrades are dealt with. 8. Click the Mark as Viewed button on the ribbon. 9. Click Yes to apply the changes and complete the task or click No if you wish to make further

changes.


Deducting Patients & Printing Records The deduction process should still be followed as normal. Now though, EMIS will let you know if anything actually needs printing. Please note though, for EMIS to tell you what needs to be printed you must follow the proper deduction process. Patients must be deducted via their deduction tasks within the Deduction folder of GP Links in Workflow manager. Doing this will ensure that a task is then generated within the FP22 reminders folder and you can then start the printing process. Many practices like to print the record before deducting them but if you try to print the record while the patient is still active then EMIS Web will not associate the printing process with the GP2GP transfer and you will just get the normal options when selecting to print “Full Summary with Attachments”. Once the patient is deducted however, EMIS will let you know what needs to be printed when you select “Full Summary with Attachments”.

Deducting a Patient

To deduct a patient and print any necessary documents do the following:

1. Highlight the required patient’s deduction task in the Deductions folder located within the “GP

Links – Inbox” section of Registration in Workflow Manager. 2. Click Accept on the ribbon to accept the deduction and create a task in FP22 Reminders. 3. In the FP22 Reminders folder of the “GP Links – Medical Record Box” section click on the

relevant task to make that patient active and appear in the Precis Bar. 4. Go to the Summary page of the patient’s record. 5. Click Print on the ribbon and select “Full Summary with Attachments”.

Depending on whether the GP2GP transfer has been successful or not you will be presented with different options at this point.

Printing Documents for Deducted Patients

When printing a “Full Summary with Attachments” for a GP2GP transfer you will be presented with the following options depending on the success of the transfer. Fully integrated


When a full GP2GP transfer with all attachments has been successful, there are two screens that can be displayed, depending on whether any new attachments have been added to the record since the GP2GP transfer took place. The following screen is displayed when there have been no new attachments added to the record since the GP2GP transfer:

The following screen is displayed if new attachments have been added to the record since the GP2GP transfer:

Partially sent and fully integrated This is when a full GP2GP transfer takes place but some of the attachments were not sent. The following screen is displayed when some attachments didn’t transfer with the record and you only need to print the unsent attachments:


Partially delivered and not integrated This screen is displayed when a GP2GP transfer has only partially been delivered and has not been completed and you must print a summary with attachments.

Integration failure This screen is displayed when an unsuccessful GP2GP transfer takes place and you must print a summary with attachments.

Unacknowledged


This is displayed when a GP2GP transfer is still awaiting acknowledgement from the previous organisation. The following images show all the possible screen messages that can be displayed.

Once you have selected the required option, the “Attachments to include” screen is displayed if anything needs to be printed. This screen displays all attachments that can be printed. If required, use the “Attachments to Include” screen to make a final check of the attachments to be printed, and then click OK. Any unsent attachments are selected by default. The Practice that is registering the patient can see if there have been any unsent attachments by accessing Workflow Manager, selecting Filed Records, selecting the required patient, and then clicking Missing Attachments on the ribbon. This will display the Missing attachments screen. From this screen you can see which attachments haven’t been transferred (if any).


Configuring GP2GP in Workflow Manager You must have the appropriate access rights to access the configuration options within Workflow manager. To view the Configuration screen click the Config button on the ribbon.

Global Viewers

It is vital that anyone who will work on GP2GP is enabled as a Global Viewer for GP2GP. This is because by default, all GP2GP tasks in workflow manager will be assigned to the patient’s Usual GP. To enable a user as a global viewer:

1. Click the Config button on the ribbon. 2. Click on Global Viewers within the Organisation Options section. 3. Scroll down and highlight the GP2GP section. 4. Click the Add button to add a user to the GP2GP section.


5. Search for the user with Search button and choose Global from the Inbox View box.

6. Click OK.

Task escalation settings These should be set with appropriate times to allow senior administration staff to monitor any GP2GP tasks that are being left undone. To set the timings for these tasks:

1. Click the Config button on the ribbon. 2. Click on Task Escalation Settings within the Organisation Options section. 3. Click on GP2GP on the right hand side. 4. Click the Edit button. 5. In the Routine field, type the required number of hours. 6. In the Urgent field, type the required number of hours. 7. In the Inbox Administrators section, click the Search icon to find the required user. 8. Click OK.

9. Click OK again. If a GP2GP task is not completed within the specified number of hours, the task is escalated to administrators, who become additional owners of the task. If the task is still not actioned after a further 24 hours, the task is escalated to all users who have access to the appropriate inbox, and an escalation notification is generated. Escalation extends the ownership of a task, so that other users can process it or are at least aware that it has not been actioned.