vision anywhere windows help guide

Vision Anywhere Windows - Help Guide

Version 3.1.0

11 June 2018

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© 2018 In Practice Systems Limited

All Rights Reserved.

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No warranty of accuracy is given concerning the contents of the information contained in this publication. To the extent permitted by law, no liability (including liability to any person by reason of negligence) will be accepted by In Practice Systems Limited, its subsidiaries or employees for any direct or indirect loss or damage caused by omissions from or inaccuracies in this document.

In Practice Systems Limited reserves the right to change without notice the contents of this publication and the software to which it relates.

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In Practice Systems Limited

The Bread Factory

1a Broughton Street

London

SW8 3QJ

Website: www.visionhealth.co.uk

http://www.visionhealth.co.uk/

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Table of Contents

Preparing for Vision Anywhere .................................................... 7

Setting Up Users for Vision Anywhere for Vision Practices .......... 7

Why does this need to be done? .................................................. 7

Who needs to do this? .................................................................. 7

Do users need to use an NHS email address? ............................. 7

Can users share email addresses? .............................................. 7

What happens next? ..................................................................... 7

How do I do this? .......................................................................... 8

Logging in .................................................................................... 10

Passwords .................................................................................... 12

New Password ............................................................................ 12

Navigating the Home Screen ...................................................... 13

Encounters ................................................................................. 13

Next Appointment ....................................................................... 13

Appointments .............................................................................. 13

Downloaded Patients .................................................................. 14

Search for a Patient .................................................................... 14

Show Patient Contact Details ..................................................... 14

Other Options ............................................................................. 14

User Preferences ......................................................................... 15

Encounter Preferences ............................................................... 16

Prescribing Preferences ............................................................. 17

Preferences - Printing ................................................................. 19

Vision Anywhere Version ............................................................ 20

Selecting Patients - Overview ..................................................... 22

Search for a Patient ..................................................................... 23

Calling a Patient ........................................................................... 25

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Patient Demographics ................................................................. 26


Appointments List ....................................................................... 26

Patient Summary ........................................................................ 26

Searching for a Patient ............................................................... 27



Appointments .............................................................................. 28

Downloading Patients ................................................................. 31

Automatic Download ................................................................... 32

Downloading Patients to a Mobile Device ................................. 34

Patient Summary ......................................................................... 35

Care Reminders .......................................................................... 35

Encounters ................................................................................. 35

Medical History ........................................................................... 36

Medications ................................................................................ 36

Allergies ...................................................................................... 36

Lifestyle and Examinations ......................................................... 36

Test Results ................................................................................ 37

Immunisations............................................................................. 37

Correspondence ......................................................................... 37

Demographics............................................................................. 37

Clinical Records Browser ............................................................ 37

Navigation Menu ......................................................................... 38

Video Tutorial................................. Error! Bookmark not defined.

Allergies ....................................................................................... 39

Care Reminders ........................................................................... 40

Clinical Record Browser ............................................................. 43

Correspondence .......................................................................... 44

Encounters ................................................................................... 47

Filtering the Patient's Record ..................................................... 49

Immunisations ............................................................................. 51

Lifestyle & Examinations ............................................................ 52

Medical History ............................................................................ 54

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Detailed Medical History View .................................................... 54

Medication .................................................................................... 55

Patient Demographics ................................................................. 57

Patient Summary ........................................................................ 57

Patient Search ............................................................................ 57


Appointment List ......................................................................... 58

Problem Linkage .......................................................................... 59

Search the Patient's Record ....................................................... 60


Shared Care Setting .................................................................... 62

Test Results ................................................................................. 63

Encounters ................................................................................... 64


Adding an Encounter .................................................................. 65

Deleting an Encounter ................................................................. 67

Editing an Encounter ................................................................... 68

Leaving an Encounter Open ....................................................... 69

Adding Clinical Data .................................................................... 70

Common Observations ............................................................... 72

Common Observations and Quick Entry Forms.......................... 73

Recording Drug Allergy .............................................................. 74

Recording a Non-Drug Allergy ................................................... 76

Recording Immunisations ........................................................... 78

Editing Data .................................................................................. 80

Deleting Entries ........................................................................... 81

Voice Recognition ....................................................................... 82

Security ....................................................................................... 82

Medication .................................................................................... 83

Record Medication ....................................................................... 85


Issuing Repeat Medication ......................................................... 88

Issue a repeat ............................................................................. 88

Reauthorise Repeat Medication ................................................. 89

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Stopping Repeat Medication....................................................... 90




Appointments............................................................................... 93

Viewing Appointment Books ...................................................... 95

Accessing the shared appointments list ...................................... 95

Changing Books .......................................................................... 96

Making Appointments ................................................................. 97

Booking an Appointment from the Appointment List ................... 98


Mark Patient as Seen ................................................................... 99

Update Patient Status ................................................................ 100

Using Vision Anywhere in a Shared Care Setting ................... 101

Consent ...................................................................................... 103

Consent reasons ....................................................................... 103

Prescriptions - Shared Care ..................................................... 105

Write Back .................................................................................. 106

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Preparing for Vision Anywhere

Setting Up Users for Vision Anywhere for Vision Practices

Before users can login to Vision Anywhere, practice administrators must make sure that each required user has an email address set up in Vision Control Panel. This document details why and how you need to do this.

Why does this need to be done?

In order to access Vision Anywhere (or Practice Access) users need to have a valid user name. To ensure that each user name is unique, Vision Anywhere uses the email address stored in Vision 3 Staff Details for each user as their user name. The Vision 3 staff record is then linked to the Vision Anywhere login.

The user's email addresses together with their Vision passwords and linked staff details will be transferred into the Vision Data Hub ready to be used when Vision Anywhere is enabled for your practice.

Who needs to do this?

Your Vision 3 practice or system administrator must set this up.

Do users need to use an NHS email address?

Yes - a NHS email address is needed.

Can users share email addresses?

Every Vision Anywhere user must have their own email address in order to have a user name for Vision Anywhere, therefore you cannot use shared email addresses.

What happens next?

Once all the user details have been transferred into the Vision Data Hub, your practice can be configured to use Vision Anywhere. Depending on whether your

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patient's clinical data is already being streamed into the Vision Data Hub, there may be a delay of several weeks before Vision Anywhere is ready to use.

When your practice signed the order for Vision Anywhere, Vision asked for a contact in your practice who would act as Administrator. Once your practice has been fully configured for Vision Anywhere, the administrator, will be contacted to confirm you are ready to carry out the next step in the process.

How do I do this?

Each user who needs to use Vision Anywhere must have their email address set up in Control Panel - File Maintenance - Staff - Communications Numbers:

1. Go to Vision 3 - Control Panel - File Maintenance - Staff. 2. Right-click on the staff member and click Edit Staff. 3. Click on Add in the Communication Nos panel to open the

Communication - Add popup. 4. Enter the user's email address in the Contact box and select Email from

the Type of Contact dropdown.

Vision 3 > Control Panel > File Maintenance > Staff

5. Click OK to save and close the popup. 6. Click OK in the main staff window to save your changes. 7. Repeat this process for every user who needs access to Vision Anywhere.

User details are transferred using the GP Adaptor and the polling for staff detail changes is approximately every hour. After this short delay the user details will have been transferred and users will be able to log into Vision Anywhere with their email address as their username and their Vision 3 password.

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Note

If any staff member has more than one Vision 3 user account, ONLY the preferred user should be updated with the email address - and the password for this user should be utilised when accessing Vision Anywhere. We recommend inactivating unused staff accounts.

If the staff member is set up in more than one practice with the same email address, the user credentials ie prescriber code must be set up in each system otherwise this can cause issues.

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Logging in

1. From your Windows device, select the Vision Anywhere button.

2. The first time you login, you need to set your country. To do this select from the drop down list. Vision Anywhere will remember this setting the next time you login.

3. Select Continue. 4. Now carefully enter your user name and password.

If you are a Vision 3 user, you must have your email address entered in your staff profile in Vision Control Panel (File Maintenance - Staff - Addresses tab - Communication Numbers). This is usually done by a system administrator at your practice.

If you are using Vision Anywhere in a shared care environment, this will be set up by your system administrator.

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5. Select Sign In. 6. Select which appointments book you want to work from.

For instance, you can select your name to see appointments assigned to you or a specific appointments book ie minor surgery. You can also choose to sign in without a specific appointments book.

7. Now select Sign In to display the Vision Anywhere Home screen.

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Passwords

Vision 3 Users

Your password is your offline Vision 3 password. If you cannot remember this, the password can be reset by your practice administrator. It will take approximately 15 minutes from the reset before you can log into Vision Anywhere with your new password. Alternatively the Vision Helpline can assist with resetting this for you.

Shared Care Users

Your password will be initially set by your system administrator, who can also reset this for you. Alternatively the Vision Helpline can assist with resetting this for you.

New Password

If your password has been changed you are prompted to enter your old password to unlock any patient data stored on the device.

If you can't remember your old password, you can still sign in if you agree to delete all patient data from the device first. This warning displays regardless of patient data being on the device.

To proceed select Delete patient data.

Note - If you forget your password, any open encounters and downloaded patients are removed for security reasons.

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Navigating the Home Screen

The Home screen menus are as follows:

Encounters

Open patient encounters. Encounters that have not been closed and are therefore not synchronised.

Closed patient encounters Any encounters that are closed and are waiting to be synchronised at the next log on, when an internet connection is established.

See - Encounters on page 64.

Next Appointment

This is determined by the time on your device.

See - Appointments List on page 92.

Appointments

Displays today's booked appointments.

Past appointments (last 7 days).

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Future appointments (7 days ahead).

See - Viewing Appointment Books on page 95.

Downloaded Patients

Patients currently stored on your device for offline access.

See - Downloading Patients on page 31.

Search for a Patient

Find any of your registered patients.

Tap or click on a patient name to open the patient record.

See - Selecting Patients - Overview on page 22.

Show Patient Contact Details

View patient demographic information.

See - Patient Demographics on page 26.

Other Options If you click on your name you can access the following menu options:

Settings - Access settings and preferences for decision support and encounter settings. See - User Preferences on page 15

Sign out - Sign out of Vision Anywhere.

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User Preferences

1 - To customise your preferences select the arrow next to you name, and select Settings from the drop down menu.

2 - Select the option you want to update. See - Encounter Preferences on page 16, Prescribing Preferences on page 17 and Preferences - Printing on page 19.

Note - All settings are per user.

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Encounter Preferences

You can enable active reminders to show you that you are offline or leaving an encounter open.

Note - This is a user-specific setting. The default setting for these options is on for all users. It is important to synchronise the updated consultations, or the data will deleted after 30 days.

Use the slider On/Off options to show/hide encounter reminders when:

Closing an encounter offline - you are prompted that you are offline and the encounter will be uploaded when a connection is re-established.

Leaving an encounter - you are prompted when you leave an open encounter that it has not been closed and won't be uploaded to the patient record.

Note - Any open encounters are only stored on your device and cannot be accessed from any other setting.

See - User Preferences on page 15.

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Prescribing Preferences

The warnings for drug doubling, interactions, contraindications and precautions are defined here, and can be updated by selecting the associated drop down arrow.

The options for each section are detailed below:

Drug Doubling - item added does not double with the patient's other therapy by being in either the same drug class or having the same ingredient.

Same ingredient (default).

Same drug family.

Hide all warnings.

Drug to Drug Interactions

Show all warnings - Displays severe, major and minor interactions.

Severe and major (default) - Displays severe and major interactions.

Severe only - Displays life-threatening interactions only.

Contraindications

Patient specific only (default) - Only shows warnings that are triggered by specific clinical entries in the patient record.

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Show all warnings - Shows all warnings regardless of whether the patient has a record of the condition or not.

Hide all warnings.

Precautions

Patient specific only (default) - Only shows warnings that are triggered by specific clinical entries in the patient record.

Show all warnings - Shows all warnings regardless of whether the patient has a record of the condition or not.

Hide all warnings.

Prescriber warnings - on or off.

Note: Prescriber Warnings

You cannot access repeat prescribing functionality if the Vision 3 software at your practice has not been updated to Vision Release DLM 485.

If you are using Vision Anywhere in a shared care setting, repeat prescribing functionality is not available for EMIS registered patients and any patient who is registered at Vision 3 practice which does not have DLM 485 enabled.

Prescriber warnings are not available for EMIS patients or when offline.

Prescriber preferences are set by individual users.

See - User Preferences on page 15.

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Preferences - Printing

Configuration of printer settings for users in a Shared Care setting.

Use the drop down arrows to update.

Prescription printer

Printer tray

X and Y Margin

Printing scale

Once the settings have been applied, please perform a test print.

See - User Preferences on page 15 for other settings.

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Vision Anywhere Version

This can be checked in a number of ways depending on what operating system you are using.

Windows 7

1. From the Start menu, select Control Panel - Programs and Features. 2. Find Vision Anywhere on the list (the list can be sorted alphabetically by

clicking on the Name column). 3. The Version column on the right hand side tells you the current version of

Vision Anywhere you are running.

Windows 8

1. Click on the Settings charm (go to the bottom or top right corner of your screen, and then move your cursor up or down to access the charm).

2. The Installation and version details are displayed.

Windows 10

The app version is available from the About screen accessed from Settings and About this app.

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Selecting Patients - Overview

Note - If a patient's record is marked as sensitive and you cannot access this in Vision 3, then you are also restricted in Vision Anywhere. Federations can only access records for applied and permanent patients.

See - Search for a Patient on page 23 and Video Tutorials.

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Search for a Patient

Note - To select patients outside of your booked appointments list, you must be connected to the internet.

1. From the Vision Anywhere Home screen tap or click in the Search for a Patient box.

2. Enter the first few letters of the patient's surname and forename with a

space in between and select search button.

eg smi cli to search for Clifford Smith.

You can also search for patients by:

Date of Birth

Postcode

NHS/CHI Number

Combination of surname and year of birth

3. Matching patients are displayed along with their date of birth, age, gender and NHS/CHI number. If you are using Vision Anywhere in a shared care setting, you can see the patient's registered practice on the patient detail tile. The patient may have multiple registrations with different practices, select the entry with Permanent as the registration status.

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If a patient does not have an NHS Number, this is indicated by NHS None.

Note - Patients who were transferred out prior to your data synchronisation with Vision Anywhere cannot be accessed. Federations can only access records for applied and permanent patients.

4. You can view your returned patients as a detailed list by selecting the list

button. 5. Select the required patient to view their record and start an encounter.

See - Patient Summary on page 35 and Encounters on page 64.

Note - Web Services

Following the implementation of new web services for Vision Anywhere version 3.0, in the event of the Vision system being unavailable, patient records cannot be accessed unless previously downloaded.

If your practice system is offline, the following message displays when trying to access a patient:

“Sorry we are currently unable to access the patient’s medical record. Make sure your device is connected to the internet”

This message will be modified in a later release to reflect the exact issue.

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Calling a Patient

1. Select the patient button. 2. Choose Call this patient from the menu.

This marks the patient in consultation. 3. Tap or click on the patient name to open the Patient Summary screen.

You can then open an encounter and add data. See - Patient Summary on page 35 and Encounters on page 64.

4. To get back to your Appointments list after viewing a patient record,

select the back arrow.

Vision Anywhere will automatically update the status to seen.

This can also be done manually. See - Mark Patient as Seen on page 99.

Note - You cannot manually mark patients as waiting or in consultation from Vision Anywhere.

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Patient Demographics

Patient Demographic information can be accessed in the following ways:

Next Appointment

The Next Appointment tile displays the Patient's demographics.

Appointments List

From the Appointments list by select the Options button.

Patient Summary

From the Patient Summary screen - scroll across to the far right of the screen.

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Searching for a Patient

When searching for a patient from the Patient Search box.


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Appointments List

The Vision Anywhere Home screen automatically displays your next booked appointment and a list of appointments booked for today.

Patient records for all today's appointments are automatically downloaded to your device for offline use, when there is an active internet connection.

Next Appointment

Your next appointment is displayed with the booked time and a count down, along with patient demographic information.

The map button displays where the patient lives.

Simply tap or click to open the patient record.

Appointments

The Appointments list on the Vision Anywhere Home screen initially displays your current or next appointment session.

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The buttons to the right of the patient:

- Record downloaded for offline use Select to access patient demographic details, DNA information and patient notes, eg needs wheelchair access.

- Appointment comments Display appointment comments, eg reason for appointment.

- Patient not yet downloaded

- Special Booking Appointment booking for a non-registered patient. If you are in a shared care setting, patients from a practice without a sharing agreement are added as special bookings.

The buttons to the left of the appointments slots:

- Booked appointments slots

- Patients that have been seen

- Patients who are waiting

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- Patients who have missed their appointment (DNA)

- Dark line indicates that this appointment is overrun by a previous appointment

- Patients currently in consultation

- Appointments you are late for

- Specific appointments slots defined by your practice eg emergency appointments. Click on the slot to see description.

- Available appointment slot

Click on the Appointments> heading to see the previous and next 7 days of your appointments book.

Note - Federations can only access records for applied and permanent patients.

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Downloading Patients

Patients can be downloaded onto a mobile device for offline access.

When using the desktop version, Vision Anywhere automatically downloads the patient records in the background. This feature lets you carry on consulting in the event of any connectivity issues.

Automatic Download on page 32

Downloading Patients to a Mobile Device on page 34

Note - Any open encounters are saved to your device and cannot be accessed from any other setting. Encounters not uploaded are deleted after 30 days.

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Automatic Download

When you sign into Vision Anywhere and have an active internet connection, any patients who have appointments in your chosen book, in the next 7 days, are automatically downloaded. See - Downloading Patients to a Mobile Device on page 34.

Note - When offline care reminders and prescriber warnings are not available.

The three dots next to the patient's name indicates that the record is stored for offline use if needed.

In the event of connectivity issues click the patient's name as normal to open the record.

When the encounter is closed, a warning is displayed. See - Encounter Preferences on page 16.

The Patient Summary screen also displays a message that the Encounter is waiting to upload.

The Home screen displays a message indicating records are waiting to be uploaded.

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Note - Any encounters not uploaded are deleted after 30 days. Any open encounters are saved to your device and are not available from any other setting.

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Downloading Patients to a Mobile Device

1. From the Home screen select a patient via the Search Box. 2. Right click on the patient's name, this displays the app bar. Select Download Selected Patient Record button.

3. The downloaded patients are displayed in the Home screen, to the right of the Appointment list.

Note - Unless data is added to the record, it will be automatically deleted after 72 hours.

4. To view the record select the patient's name to access the Patient Summary screen. Data can be recorded as normal, although Care Reminders and prescriber warnings are not available when offline. 5. Log into Vision Anywhere when you have internet connectivity to upload the Encounter.

Note - Any open encounters are saved locally and cannot be accessed from any other setting. Any encounters not uploaded are deleted after 30 days.

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Patient Summary

The Patient Summary screen gives a snapshot of all the essential clinical information you need.

You can scroll or swipe across the screen to see all the headings.

Care Reminders

The screen shows a list of QOF data that needs to be recorded for the patient. Initially QOF category headings are displayed eg Cardiovascular disease. You can select the category heading to see the specific QOF indicator data that needs recording eg blood pressure and continue to record the relevant data or dissent as appropriate.

See - Care Reminders on page 40.

Encounters

New Encounter - Select to create a new encounter and add data for the selected patient.

Last Encounter - Displays the date, type, data recorded and clinician for the selected patient's last encounter.

Encounters in progress - Displays open/unsynchronised encounters for the selected patient.

Encounters Heading - Select to see all previous encounters/consultations.

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Medical History

Significant Diagnoses - Priority 1 & 2 medical histories and Problem headers.

Significant Operations - Priority 1 medical histories in Read chapter 7.

Medical History> Heading - Select to see all medical history entries.

See - Medical History on page 54.

Medications

Active Repeats - All active repeat medication.

Acutes - Last 2 years of acute medication.

Medication> Heading - Select to see all medication entries.

See - Medication on page 55.

Allergies

All the patients recorded drug and non-drug allergies.

If the patient has allergies recorded the Known Allergies alert is displayed in the patient information banner at the top of the screen.

See - Allergies on page 39.

Lifestyle and Examinations

Last recorded lifestyle and examination entry displayed in tile format for easy viewing.

Lifestyle and Examinations> Heading - Select to see all entries in list format.

See - Lifestyle & Examinations on page 52.

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Test Results

Last 3 months of test results.

Test Results> Heading - Select to see all entries in the last 2 years.

See - Test Results on page 63.

Immunisations

All recorded immunisations.

Immunisation> Heading - Select to view all entries.

See - Immunisations on page 51.

Correspondence

Displays the last 3 months correspondence.

Correspondence> Heading - Select to view all correspondence entries.

See - Correspondence on page 44.

Note - Correspondence entries are currently only available for practices who also use Vision Anywhere alongside Vision 3.

Demographics

Displays the patients registered and usual GP, the patient's address and telephone number. From here you can also navigate to a map, email or telephone the patient direct.


Clinical Records Browser

Accessed by right clicking in the Patient Summary.

Tap the arrow on the Patient Summary to view the Clinical Records Browser which shows all entries on the patient record in chronological order.

See - Clinical Record Browser on page 43.

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Navigation Menu

Right click anywhere on the Patient Summary screen to access:

Home - Takes you back to the Vision Anywhere Home screen.

Appointments - Takes you to your detailed appointment list for the next 7 days. You can book a follow-up appointment from here if required.

Patient Summary Categories - Click on the arrow to all the categories mentioned above plus a Clinical Records Browser which displays all recorded patient data in reverse chronological order.

Refresh - Updates the patient record with any changes made outside of Vision Anywhere since the patient was selected.

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Allergies

If the patient has allergies recorded the Known Allergies button is displayed on the patient information bar.

The allergies are detailed in the Patient Summary, and accessed by scrolling or swiping to the right.

The main Allergies screen is accessed from the heading. You can filter on the allergy type. See - Filtering the Patient's Record on page 49.

To record an Allergy see - Recording Drug Allergy on page 74 or Recording a Non-Drug Allergy on page 76.

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Care Reminders

The screen shows a list of QOF data that needs to be recorded for the patient.

Initially QOF category headings are displayed eg Cardiovascular disease or smoking status.

Click the category heading to see the specific QOF indicator data that needs recording eg blood pressure and continue to record the relevant data or dissent as appropriate.

1. From the Home screen, select a patient. 2. The Patient Summary screen displays the list of QoF Registers and a

count of any outstanding QoF reminders.

3. Select the disease area you wish to update. 4. Click on the arrow next to the indicator, the following options are displayed

depending on the indicator type select as required:

Select a Clinical Term - Click the drop down list and choose the relevant clinical term. All terms in the list are QOF compliant.

Record an Exception for this Register - Click the drop down list and choose the relevant exception term.

Prescribe - The standard prescribe form is displayed for completion.

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5. The related data entry screen launches populated with the associated read code.

6. The reminder is then cleared from the section heading.

7. The Patient Summary screen is updated immediately to reflect the changes.

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Note - Care Reminders

These are only available when:

Vision Anywhere is used alongside Vision 3.

Minimum Vision 3 version of DLM485.

When online with Vision Anywhere.

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Clinical Record Browser

The Clinical Record Browser gives a chronological view of all items in the patient's record.

1. From the Patient Summary screen, right click or long press to access the app bar.

2. Select the arrow next to Patient Summary to display a drop down menu.

3. Select Clinical Record Browser.

4. The record is displayed and can also be filtered. See Filtering the Patient's

Record on page 49

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Correspondence

The Correspondence heading in the Patient Summary screen displays a summary of correspondence within the last 3 months.

Select the Correspondence header to display all the documents sent or received in the last 2 years.

Correspondence can be sent or received, and includes:

Referrals

Clinical Letters

DocMan Letters

Photos

The correspondence can also be filtered. See - Filtering the Patient's Record on page 49.

Note - Correspondence entries are currently only available when online, and to practices who use Vision Anywhere alongside Vision 3.

To view an item:

1. Tap the correspondence item.

2. The letter summary displays, along with any linked problem. See - Problem Linkage on page 59.

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3. Select the letter to view. The letter displays.

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See - Patient Summary on page 35.

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Encounters

The Encounter section of Patient Summary displays details of the last encounter.

Selecting the Encounters heading displays the patient's Encounter history.

This is similar to the Consultations tab in Vision 3.

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The encounters can also be filtered. See - Filtering the Patient's Record on page 49. For details of the content recorded in the Encounter see - Clinical Record Browser on page 43.

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Filtering the Patient's Record

You can filter the data in Vision Anywhere to display specific items such as blood pressure and smoking. You can also add date filters onto all of the views.

1. Select the Options button in the lower right corner of the screen.

Or right click on the screen to display the app bars.

2. Select the Filter button. 3. Choose which items you want to view.

Note - The categories change depending on which part of the record you are currently using.

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This table tells you what categories are available for the patient record screens.

View Date Filter Filter Categories

Clinical Record Browser Yes Encounters - Medical History - Medication

Allergies - Lifestyle and Examinations Test Results - Immunisations

Correspondence - Other

Encounters Yes None

Medical History Yes Problems – Diagnoses – Procedures Family History – Referrals

Requests - Other

Allergies Yes Drug allergies - Non-drug allergies

Lifestyle and

Examinations

Yes Blood pressure - Height and Weight Peak flow – Pulse - Pulse Oximetry

Respiratory Rate – Temperature Visual Acuity – Alcohol – Smoking

All Examinations - All Lifestyle

Test Results Yes None

Immunisations Yes None

Correspondence Yes Incoming correspondence Outgoing correspondence

Note - If you are in the Medical History view and remove the tick next to problems, you will still see the problem term in the view as the clinical term exists outside of the problem.

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Immunisations

The Immunisations heading in the Patient Summary screen displays vaccination information.

Selecting the Immunisation header displays the full vaccination history.

The Immunisation view can also be filtered. See - Filtering the Patient's Record on page 49.

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Lifestyle & Examinations

The Patient Summary screen displays tiles, showing the latest entry for each category.

Select the Lifestyle & Examinations header to list all items in a chronological order.

Lifestyle and Examinations view covers the following categories:

Blood pressure

Height and Weight

Peak flow

Pulse

Pulse Oximetry

Respiratory Rate

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Temperature

Visual Acuity

Alcohol

Smoking

Refining the View

Use the Search Bar to look for entries. See - Search the Patient's Record on page 60.

Apply Filters to display specific items. See - Filtering the Patient's Record on page 49.

Lifestyle and Examination entries may be linked to a Problem. See - Problem Linkage on page 59.

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Medical History

The Medical History heading in the Patient Summary screen shows the patient's Significant Diagnoses populated from problem headings, priority 1 and priority 2 diagnosis codes.

Any operations from Read Chapter 7 with a priority 1 are shown under the Significant Procedure section.

Detailed Medical History View

Selecting the Medical History displays all the medical history.

The problem entries are displayed first, to show you significant items.

Refining the View

Use the Search Bar to look for entries. See - Search the Patient's Record on page 60.

Apply Filters to display specific items including Diagnoses, Procedures and Referrals. See - Filtering the Patient's Record on page 49

Medical History entries can be linked to a Problem. See - Problem Linkage on page 59.

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Medication

From the Patient Summary screen you can scroll or swipe across the screen, to see the patient's active repeat medication and recent acutes.

Select the Medications heading for further detail.

From this screen you can access:

Active Repeats - default view.

Acutes - all acute medication issues in the last 2 years.

Overview - all acute and repeat medication issued in the last 3 months.

Issue Repeat Medication. See - Issuing Repeat Medication on page 88.

Reauthorise Repeat Medication. See - Reauthorise Repeat Medication on page 89.

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Inactivate Repeats. See - Stopping Repeat Medication on page 90.

Problem Linkage - if the medication is linked to a problem. See - Problem Linkage on page 59.

The Acute view shows all acute scripts issued in the last 2 years.

The Overview screen details active repeats and acutes issued in the last 3 months.

Hints & Tips

You can also use the Search Bar to look for medication. See - Search the Patient's Record on page 60.

Medication may have been linked to a Problem. See - Problem Linkage on page 59.

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Patient Demographics

Patient Summary

From the far right side of the Patient Summary screen you can see the patient's demographic details, and plot their address in Google Maps.

Patient Search

The demographic information is also available when searching for a patient, by right clicking and selecting Show Patient Contact Details button.

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Next Appointment

The Next Appointment tile displays the Patient's demographics.

Appointment List

The data can also be accessed from the Appointment list by clicking the

Options button next to the patient's name.

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Problem Linkage

Problem orientation shows items that are linked to a condition, to provide a full overview of the management and treatment for the condition. The problems are also displayed as a header in the Medical History view.

Clicking onto a Problem will show the related items.

If items such as Medication or Test Results are linked to a problem, this is indicated alongside the entry. If selected the problem details are displayed.

Note - EMIS Data

EMIS creates a problem automatically when a history item is recorded, these are displayed as a significant Medical History.

The free text related to the entry isn't shown as part of the problem heading, as this is stored separately in the patient's record. You will need to scroll down the Medical History view to access this.

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Search the Patient's Record

Vision Anywhere has the facility for a free text search of the patient's record, to quickly return specific information.

1. From the Patient Summary or Encounter screen, enter the term you want to find in the Search Box.

2. Select the Search button.

Any coded entries or free text entries display.

The search facility works on all parts of the record, including drug names and test results.

3. Select the Arrow button to return to the previous screen.

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See - Filtering the Patient's Record on page 49.

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Shared Care Setting

If you are using Vision Anywhere in a shared care setting, the patient's record cannot be accessed until you record a consent status.

In the event of the patient refusing consent, and wanting a consultation the Record a consultation without consent option is available.

The patient consent options are defined by your organisation. However the most common consent status are:-

General Practice Registration - the patient is registered with your practice.

Patient has given Consent

If a patient has dissented to share their record with the service, when a consent reason is chosen, the message "Please note that the patient has withdrawn consent from this service" displays.

Select "Record a consultation without consent" to proceed.

See - Using Vision Anywhere in a Shared Care Setting on page 101 and Consent on page 103.

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Test Results

The Patient Summary screen shows any test results in the last 3 months.

Select the Test Results header to display all the patient's test results in the last 2 years. These are displayed in a chronological order, any problem linkage is also displayed.

You can filter the results to a specific time frame, select the app bar and choose date range. See - Filtering the Patient's Record on page 49.

Note - EMIS Data

In EMIS when results are sent to the practice they are filed automatically.

However, when an action or comment is added to a result, it is filed again into the patient's record.

The record contains two entries, both of these display in Vision Anywhere, the most recent entry shows the comments, and the earlier original entry shows the actual results.

Scrolling down will show the actual result values.

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Encounters

Encounters are the equivalent of Consultations in Vision 3. They are used to define and group data added during a consultation, for example acute medication, diagnosis and symptoms are contained together within one encounter.

This makes it easy to see what was recorded during current and previous patient consultations.

Points to note:

To add data to the patient record, you must first start an encounter - otherwise the patient record is view only (with the exception of issuing medication).

When starting an encounter, you need to select the type of encounter you are having with the patient eg Surgery Consultation, Home Visit etc.

You must remember to close your encounter when you have finished adding data so that it can be synchronised with the patient record.

Encounters that are left open for 30 days, or encounters that are closed but you have not logged into the app while device is connected to the internet for 30 days are automatically removed from Vision Anywhere.

Open encounters are wiped from your device if you forget your password.

Open Encounters are stored locally on your workstation/device and cannot be accessed when you login in elsewhere.

Note - Please ensure that all required encounters are saved and closed before switching devices or changing workstation.

You can see a list of all previous encounters by selecting the Encounters menu in the Patient Summary screen.

To disable encounter warning messages see Encounter Preferences on page 16.

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Adding an Encounter

1. Open a patient record. See - Selecting Patients - Overview on page 22. 2. From the Patient Summary screen select New Encounter

button.

The Current Encounter screen displays.

3. You can now add data to the encounter. See - Adding Clinical Data on page 70.

4. Acute Visit is the default encounter type. To change this simply select the menu and choose the appropriate encounter type.

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5. Select the Close this Encounter button to save and send the data back to the practice system.

The patient record can be searched during the Encounter. See - Search the Patient's Record on page 60.

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Deleting an Encounter

Note - You can only delete previous encounters if they have not been closed and synchronised with the patient record ie if you have opened it from the saved encounter list or you want to delete the current encounter you are working on.

To delete an encounter:

1. From the Current Encounter screen select Delete. 2. You are prompted that deleting the encounter will also delete everything

that has been added to it. 3. Select Yes. 4. The encounter is now removed from Vision Anywhere.

Note - When working in a shared care setting, if you have printed a medication you cannot delete the encounter it is contained in.

See also - Deleting Entries on page 81.

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Editing an Encounter

You can only edit previous encounters if they have not been closed and synchronised with the patient record.

To edit an encounter:

1. Go to the Encounters list on the Vision Anywhere Home screen. 2. Select the required encounter. 3. The patient record opens and the Patient Summary screen displays,

simply select the encounter in progress to continue adding to the patient record:

4. You can now continue to add data to the encounter. 5. Close the encounter when finished so that it is uploaded to the patient

record when you are online.

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Leaving an Encounter Open

1. If you want to come back to an encounter later and not synchronise it with the main patient record just yet, simply navigate away from the Current Encounter screen eg click the back button.

2. Depending on your preferences settings, you may be prompted that the encounter is still open and has not been added to the patient record, click Continue.

Note - When working in a shared care setting, if you have printed a medication you cannot leave an encounter open. You are forced to close the encounter so that the medication details are immediately synchronised with the main patient record.

3. Your encounter is now parked on the Vision Anywhere Home screen under the Encounters menu.

4. You can now continue to select another patient or exit Vision Anywhere.

Note - Open Encounters are stored on your device for 30 days, and cannot be accessed from any other setting. Any open / offline encounters are deleted after 30 days or if you forget your password.


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Adding Clinical Data

1. Open a patient record. See - Selecting Patients - Overview on page 22. 2. To record data an Encounter must be open. See - Adding an Encounter

on page 65.

3. Enter the keyword in the dynamic data entry bar.

You can record a drug, immunisation or clinical term using this bar.

Three characters are needed, items are returned as you type.

A single letter will trigger a common observation quick entry. See - Common Observations on page 72.

You can search the record during an Encounter. See Search the Patient's Record on page 60.

4. Select the term from the list. The relevant data entry form displays. If searching for a clinical term the most likely form to display is medical history, however if results match on a term with a specific form, this is automatically displayed with the associated data selection boxes eg the immunisation add form has stage and batch number boxes.

5. Complete the form as required.

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Description - The chosen clinical term. You can change by searching an appropriate term if required.

Priority - The default priority is 3 but you can select from 0-9.

Episode type - Select from none, first ever, new event, continuing or other.

Notes - Enter supporting free text information as required.

6. Select the Save button to add the entry to the current encounter.

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Common Observations

Quick data add functions have been built into Vision Anywhere to add commonly recorded items.

1. Open an Encounter. See - Encounters on page 64. 2. Enter a single letter into the dynamic data entry bar.

The relevant quick entry forms display.

3. Alternatively enter a numeric value, which is matched to the correct area. Here the entry has been automatically recognised as a blood pressure.

If there is more than one possible area for the value, all suggestions will be displayed.

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4. Select the entry to add this to the Encounter.

Common Observations and Quick Entry Forms.

There are Common Observations forms for the following areas.

Alcohol Allergy

Ankle Brachial Pressure Blood Pressure

Head Circumference Height

Jugular Venus Pressure Oxygen Saturation

Peak Flow Postural Drop

Pulse Rate Respiratory rate

Temperature Visual Acuity

Waist Circumference Weight

Weight Loss

Quick Entry forms are also triggered by a single letter.

These are available for:

Immunisations

Test Request

Test Results

Smoking

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Recording Drug Allergy

Vision Anywhere supports the recording of both drug and non-drug allergies.

1. Open an Encounter. 2. Enter 'a' in the dynamic data entry bar to trigger the allergy forms.

3. Select the Drug Allergy item. The add Drug Allergy form displays.

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4. Search for the clinical term for the reaction. 5. Record drug name by entering the drug or browsing the drug dictionary. 6. Use the drop down arrows to record:

Reaction Type

Certainty

Severity 7. Enter any comments in the Notes field.

8. Select the Save to finish.

See - Recording a Non-Drug Allergy on page 76.

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Recording a Non-Drug Allergy

Vision Anywhere supports the recording of both drug and non-drug allergies.

1. Open an Encounter. 2. Enter 'a' in the dynamic data entry bar to trigger the allergy forms.

3. Select the Non-drug allergy item. The add Non-Drug Allergy form displays.

4. Enter the allergy details.

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5. Using the drop down arrows record:

Reaction Type

Certainty

Severity 6. Enter any comments in the Notes field.

7. Select the Save button to finish.

See - Recording Drug Allergy on page 74.

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Recording Immunisations

1. Open a patient record. See - Selecting Patients - Overview on page 22. 2. To record data an Encounter must be open. See - Adding an Encounter

on page 65. 3. Enter the keyword in the dynamic data entry bar.

You can enter 'inf vac'. to trigger Influenza vaccinations.

4. Select the vaccination. 5. Enter vaccination details.

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If there is more than one vaccination option start typing to make your selection.

6. Select Save button to finish. 7. Vaccination is saved into the Encounter.

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Editing Data

You can only edit data that has been added during the current open encounter or those stored in the encounters in progress list (ie saved consultations which have not yet been synchronised with the patient record).

To edit data:

1. From the current open encounter right click or long press on the item.

2. Select Edit from the menu bar at the bottom of the screen.

3. You can now update the entry as required.

4. Press Save to save the changes.

See - Deleting Entries on page 81.

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Deleting Entries

You can only delete data that has been added during the current open encounter or those stored in the encounters in progress list (ie saved consultations which have not yet been synchronised with the patient record).

To delete data:

1. From the current open encounter right click or long press on the item.

2. Select Delete from the menu bar at the bottom of the screen.

3. A prompt displays, select Yes to proceed.

4. The entry is deleted.

Note - If the Encounter has been closed any changes need to be made in the practice clinical system.

See - Editing Data on page 80.

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Voice Recognition

Voice Recognition can be used to record data when consulting with Vision Anywhere.

Security

The dictated information is sent to servers for conversion. The information lodged in the service is a disjointed set of data entries that are not patient-identifiable.

The exception being if the GP mentions any personally identifiable information e.g. a full name or contact data.

Note - Do not include personally identifiable information when using voice dictation.

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Medication

From the Patient Summary screen you can scroll or swipe across the screen, to see the patient's active repeat medication and recent acutes.

Select the Medications heading for further detail.

The initial view shows active repeats, and options to access acute issues, inactive repeats, overview of current medication and repeat management.

The Acute view shows all acute scripts issued in the last 2 years.

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The Overview screen gives a view of active repeats and acutes issued in the last 3 months.

Note:

You can also use the Search Bar to look for medication. See - Search the Patient's Record on page 60.

Medication may have been linked to a Problem. See - Problem Linkage on page 59.

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Record Medication

The dynamic data entry bar can be used to select a drug. A combination of drug name and strength can be used to refine the selection.

1. Enter part of the drug name, additional data can be added to reduce the number of results ie - ibu 400.

Note - a minimum of 3 characters are needed to return matches.

2. The following symbols next to the drug indicate:

- Branded drug

- Discontinued drug

- Toxicity alert

- Controlled drug 3. Select drug from the list, which launches the Medication Add form.

Alternatively select the Add Medication button which displays the form and allows you to enter the drug name directly.

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Drug Name - If not already populated from the data entry bar, enter the keyword for the item you require. An intelligent search displays as you type showing matching results from the Gemscript drug dictionary. Select the required drug.

Decision Support / Prescriber Warnings - Warnings in the form of drug doubling, contraindications, precautions. drug and topical interactions and are displayed on the right of the screen when the item is selected.

- Drug Doubling

- Severe Contraindications

- Major Contraindication

- Precautions Select the warning to see the reason. Entries with no buttons are generic warnings. Prescriber warnings displayed depend on your Prescribing Preferences settings. See - Prescribing Preferences on page 17.

Note - If you are an existing Vision user your prescriber preferences are not automatically imported and need to be configured in settings.

You must have an internet connection for prescriber warnings to display. If you do not have an internet connection a warning displays "Decision support is not available".

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Drug Class - You can search for a drug using the drug class

option next to the drug name box .Once you have selected a drug, the drug class displays. Some drugs can belong to more than one drug class, however this cannot be changed in Vision Anywhere at the moment.

Dosage and Frequency - The defaults are populated for you from the Gemscript drug dictionary. Practice default dosages are not currently integrated.

Preparation - Completed in conjunction with the selected drug.

Quantity - Select from the available quantities or enter directly.

Repeat prescription - If you would like the item to be added as a repeat, enter the number of repeats required in the box. You can optionally complete the Repeat Until date and tick the create an acute box which adds a separate acute prescription to the record. Tick Sync with existing repeats to link the medication issue frequency and repeat until date, with the existing schedule. See - Repeat Synchronisation Overview.

4. Select Save to add the item to the patient record. You may see a summary of the Decision Support Warnings.

5. Select Prescribe. The item(s) are now added to your current encounter.

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Issuing Repeat Medication

The Medication screen allows you to issue and reauthorise repeat medication. These are not printed, only issued.

Issue a repeat

1. From the Patient Summary screen select the Medication header. 2. Select Issue Scripts and all the active repeats are automatically selected

for issue. 3. Select Exclude to remove any drugs that are not needed.

4. Select the issue button. 5. As the prescriptions are being issued a message is displayed on the top of

the screen.

Note - The repeat prescriptions are not printed, and show in Vision 3 as unprinted medication.

See - Reauthorise Repeat Medication on page 89 and Stopping Repeat Medication on page 90.

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Reauthorise Repeat Medication

To reauthorise an individual repeat master:

1. From the Patient Summary screen select the Medication heading. 2. Select a drug to display the history.

3. To authorise the medication select the reauthorise button. 4. Select Save to reauthorise.

5. The medication is reauthorised, and available to issue.

The reauthorise all repeat medication, see - Synchronise Repeats.

See - Issuing Repeat Medication on page 88 and Repeat Synchronisation Overview.

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Stopping Repeat Medication

1. From the Patient Summary screen select the Medication heading. 2. Select a drug to display the history.

3. Select the button to stop the medication. 4. Choose the reason for stopping via the drop down arrow.

5. Record comments in the Notes box. 6. Select Stop Now. 7. The medication is inactivated.

Restart Medication

1. From the Patient Summary screen select the Medication heading. 2. Select Inactive Repeats.

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3. Select the drug you wish to restart. The history displays.

4. Select the Restart button. The Restart Repeat screen displays.

5. Select Reason for Restarting from the drop down list.

6. Enter any comments in the Notes field. 7. Press Save.

The Repeat Medication History updates. 8. The drug is now available for reauthorisation / issue.

See - Medication on page 83.

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Appointments List

The Vision Anywhere Home screen automatically displays your next booked appointment and a list of appointments in today's next session. Patient records for all today's appointments are automatically downloaded to your device for offline use, when there is an active internet connection.

Next Appointment

Your next appointment is displayed with the booked time and a count down,

along with patient demographic information. The map button displays where the patient lives.

Simply click to open the patient record.

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Appointments

The Appointments list on the Vision Anywhere front screen initially displays your current or next appointment session.

The following also display:

Booked appointment time

Patient name and title

- Patient record has downloaded. Select to access demographic details, DNA information and patient notes eg needs wheelchair access

- Appointment comments eg reason for appointment

- Patient not yet downloaded.

- Where a patient does not have a valid NHS/CHI number there record cannot be downloaded, therefore no symbol is displayed.

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- Special Booking Appointment booking for a non-registered patient. If you are in a shared care setting, patients from a practice without a sharing agreement are added as special bookings.

The buttons to the left of the appointments slots show:

- Booked appointments slots

- Patients that have been seen

- Patients who are waiting

- Patients who have missed their appointment (DNA)

- Patients currently in consultation

- Appointments you are late for

- Specific appointments slots defined by your practice eg emergency appointments. Click on the slot to see description.

- Available appointment slot

Click on the Appointments> heading to see the previous 7 days and next 7 days of your appointments book.

See - Update Patient Status on page 100.

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Viewing Appointment Books

The appointments for the book selected on signing in displays from the Vision Anywhere Home screen.

Click on the Appointments> heading to see the last and next 7 days.

Accessing the shared appointments list

When you login to Vision Anywhere, you must select the appropriate service type ie your practice or shared care organisation and the relevant appointments list.

See - Changing Books on page 96.

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Changing Books

When you initially login to Vision Anywhere you are asked which appointments book you would like to use with your session.

Select the relevant one to use in conjunction with your login. If you are already logged in and want to change the appointments book, you must logout, re-login and select the required appointments book.

See - Logging in on page 10.

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Making Appointments

1. Search for a patient. See - Selecting Patients - Overview on page 22. 2. When the patient is displayed right click on the patient to select and

activate the app bars.

3. Select Book Appointment. 4. The free slot search screen displays which allows you to filter on time /

day / session / slot type.

5. Search will then find any matching slots, choose the slot and save.

6. A message displays confirming the booking.

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Booking an Appointment from the Appointment List

1. Select the area to the left of the booked appointment. This can either be blank or have an icon depending on if the patient is waiting or has been seen.

2. Select Book an appointment for this patient from the drop down menu, and the free slot search displays.

Note -The appointment refresh rate is currently 5 minutes. Selecting the app bars will let you manually refresh if required.

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Mark Patient as Seen

Patients are automatically marked as seen when you close the consultation. You can manually mark the patient as seen:

1. Click on the status button for the patient you have seen. 2. Select Update status - this patient has been seen.

3. The status changes from to .

See - Update Patient Status on page 100.

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Update Patient Status

You must manually mark a patient as in consultation from your appointments list:

1. Click on the status button for the patient you are about to consult with. 2. Select Call this patient.

3. The status changes from to .

Note - The patient must be marked as arrived in your appointments system before you can change their status to "in consultation" in Vision Anywhere.

See - Mark Patient as Seen on page 99.

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Using Vision Anywhere in a Shared Care Setting

Most Vision Anywhere functionality is the same whether you are accessing your practice's registered patients or are working as part of a shared care organisation. The following functionality is specific to shared care access:

Logging in - When you login to Vision Anywhere, you have the option of selecting your local practice or your shared care service. You can subsequently select the relevant shared appointment list.

Registration Status - Vision Anywhere includes patients with the permanent and applied status, although this is dependant on your sharing agreement.

Patient Consent - This must be recorded in order to access the patient's record. See - Consent on page 103.

Patient Selection - When manually searching for a patient, you can see which practice they are registered at. You can also select patients at EMIS practices if they are part of your shared care organisation.

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Acute Printing/Re-printing - In a shared care setting and if using Windows 7, you can print and reprint acute prescriptions. The print option is available from the Current Encounter view after prescribing.

Repeat Medication Management - Full repeat medication management is available for Vision registered patients if the Vision version for all practices in the organisation is DLM 485 or above. If one practice is on a lesser version, basic repeat lists are displayed for all patients.

EMIS Patients - Full repeat medication management, decision support, access to care reminders and correspondence is not currently available when you have an EMIS patient selected.

Windows 7 Minimum Specification

Processor 1.33 GHz

RAM 2 GB RAM

OS Windows 7 SP1, 32-bit and 64-bit

Disk space 10 GB

See also - Video Tutorials.

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Consent

When Vision Anywhere is used in a Shared Care Service a consent model is implemented to ensure that a legitimate relationship exists with a patient, before their record can be viewed.

Consent reasons

The clinician must record patient consent, i.e. confirm that the patient has given permission to access their record by selecting the most appropriate option from the following list:

General practice registration - when the patient is actually registered to the clinician's home practice.

Expressed patient consent to access - patient has given consent.

Self-claimed relationship - when it's in the best interest of patient OR court order OR public interest.

External access - when user is not a GP/hub user and are accessing the patient out-with the service e.g. an auditor.

Patient had given consent - patient has given consent.

Emergency consent - emergency access for urgent treatment when patient is incapacitated.

If a patient has dissented to share their record with the service, when a consent reason is chosen, the message "Please note that the patient has withdrawn consent from this service" displays.

Select "Record a consultation without consent" to proceed.

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See - Using Vision Anywhere in a Shared Care Setting on page 101

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Prescriptions - Shared Care

Any medication prescribed in a Shared Care setting displays the Prescribed out of Practice flag next to the item in Vision 3.

When the entry is viewed, the source displays as "By GP in another practice". If the medication was printed, the date is also recorded.

For EMIS sites see - Write Back on page 106.

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Write Back

Once information has been added into Vision Anywhere and the encounter is closed, it is then automatically sent back to the patient's record in either Vision or EMIS.

Any consultations recorded in a shared care setting have "Dr Federated User" as the clinician and the read code 9kh0 Attended extended hours clinic - ESA is entered into the patient's notes.

Vision Practices

The encounter header is sent into Mail Manager, and the consultation automatically coded into the patient's record.

The consultation details display in the journal as normal.

EMIS Practices

The coded clinical data is automatically filed into the patient record, however due to a limitation on the EMIS API any medication prescribed is degraded - and therefore needs to be added by the practice staff.

An email alert is also generated to advise the practice that an encounter has been recorded in the shared care setting.

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