Diabetes Year of Care

Care Planning Results Letter

(Version 2)

Implementation & User Guide

-Vision –

Produced by Carol McTurk, Head of PRIMIS Informatics, NHS Cumbria on behalf of the Year of Care programme

Vision Diabetes YOC Upgrade© v2 September 2011

Contents

Page No

1. Introduction……………………………………………………………………… 3

2. Installation & Configuration Instructions………………………………….. 3

2.1. Installing the Diabetes Care Planning Results Letter………….. 3

2.1.1. Editing macro security settings in Word……………….. 6

2.2. Installing the Diabetes YOC Information Gathering guideline… 7

2.3. Adding relevant Diabetes YOC Read codes to existing

practice guidelines………………………………………………..…. 14

3. Using the Diabetes YOC Information Gathering guideline…………..… 15

4. Creating a merged Diabetes Care Planning Results Letterfor a

patient……………………………………………………………………………. 17

5. Editing the merged Diabetes Care Planning Results Letter for a

patient…………………………………………………………………….……… 20

6. Printing the edited merged Diabetes Care Planning Results Letter

for a patient……………………………………………………………………… 21

  1. Attaching the edited merged Diabetes Care Planning Results Letter

to a patient’s record…………………………………………………………… 23

APPENDIX A - Recommended Read Codes…………………………………. 25

APPENDIX B - Edited merged Diabetes Care Planning Results Letter.... 26

  1. Introduction

The aim of this document is to support practices with the installation and use of tools to support the Diabetes Year of Care process on Vision.

Included are step by step instructions of how to install the ‘Diabetes Care Planning Results Letter’ merge document, the supporting data entry guideline and associated configuration, and how to populate the Diabetes Care Planning Results Letter for individual patients.

2. Installation & Configuration Instructions

This section details the required processes for installing the tools to support the Diabetes YOC care planning, and associated configuration.

2.1.Installing the Diabetes Care Planning Results Letter

This section explains how to import the ‘Diabetes Care Planning Results Letter’ merge document onto Vision.

The Diabetes Care Planning Results letter uses SmartTags functionality to enable appropriate patient clinical data be merged from Vision into the letter. Any PCs at the practice which will be used to generate Diabetes Care Planning Results Letters for patients need to be configured appropriately to enable the SmartTags functionality to work. Refer to section 2.1.1. of these instructions for details of how to do this.

  • Open the Diabetes Care Planning Results Letter v2.doc file from the relevant location. If your macro security settings are configured appropriately, the following box will then be displayed:

  • If the file opens without this box being displayed, your macro security settings are not configured at an appropriate level to run the SmartTag functionality required to successfully populate the Diabetes Care Planning Results Letter for patients. You need to configure your macro security setting appropriately. Refer to section 2.1.1 of these instructions for details of how to do this.
  • Click on the ‘Enable Macros’ button, as highlighted above.
  • The file will then open with the SmartTags Helper screen opened, as shown below:

  • Close the SmartTag Helper screen by clicking on the button at the top right of the SmartTag helper screen, as shown above. The screen will then appear as below:

  • Save the file to the relevant folder within Vision where existing letter templates are stored (usually within P:\wordproc\TEMPLATE). To do this, select ‘File’ from the menu bar at the top of the screen and then select ‘Save As’ from the list of options displayed, as shown below:

  • A box similar the following will then be displayed for you to select a location to save the file to:

  • Browse to select an appropriate location to save the file to and then click on the ‘Save’ button.
  • The letter template will then be saved onto the system to the selected locationand is now ready to use.
  • Click on the button at the top right of the screen to close the file.

2.1.1. Editing macro security settings in Word

This section explains how to configure the macro security settings in Word to enable the required SmartTags functionality to work.

Note: This configuration is required on all PCs used to generate populated Diabetes Care Planning Results Letters on.

  • In Word, select ‘Tools’ from the menu bar at the top of the screen, and then select ‘Macro’ from the list of options displayed, and then ‘Security’ from the next list of options displayed, as shown below:

  • A screen similar to the following will then be displayed:
  • Select the ‘Medium’ option on the ‘Security Level’ tab, as shown above, and then click on the ‘OK’ button.
  • Close down Word and return to section 2.1 of these instructions.

2.2. Installing the Diabetes YOC Information Gathering guideline

This section explains how to install the ‘Diabetes YOC Information Gathering’ data entry guideline onto Vision. The Diabetes YOC Information Gathering guideline is intended to be used at the information gathering contact to ensure that all relevant information is captured and up to date, which will then be merged into the Diabetes Care Planning Results Letter document for the patient at a later stage.

Alternatively practices can update their current diabetes data capture guideline (e.g. QOF) to include the items required for the Diabetes Care Planning Results Letter. If so, please refer to section 2.3. of these instructions and the Read code list included in Appendix A.

  • Firstly, copy the DIABYOC.htm and DIABYOC.txt files to a familiar location for you to import from later in this section of instructions.
  • Open Vision and Select Consultation Manager from the main menu:
  • Select ‘Guidelines’ from the menu bar at the top of the screen and then select ‘Select Guideline’ from the list of options displayed, as shown below:
  • The following box will then be displayed:
  • Click on the ‘Import’ button, as shown above. You will then be prompted to select the file you wish to import.
  • Browse to select the ‘DIABYOC.txt’ file from the location saved (e.g. desktop), as shown below:
  • When the ‘DIABYOC.txt’ file has been highlighted, click on the ‘Open’ button.
  • The following screen will then appear:
  • Click on the ‘Import’ button.
  • Once the guideline has been imported successfully the screen will appear as follows:
  • The guideline is now imported and needs to be added to the practice’s Local Guideline Index, to enable to guideline to be accessed easily to use.
  • Click on the (Local Index) icon at the top of the screen, as shown below:
  • The practice Local Guideline Index will then open and appear similar to the following:
  • Click on the (Maintain) icon at the top of the screen, as shown below:
  • The screen will then appear similar to the following:
  • Click on the line where you want the new guideline to appear after on the list (for the above example, click on ‘REFERRAL REPORT’ line for the new guideline to appear after this in the list).
  • Click on the (Guideline) icon from the floating tool bar, as shown below:
  • The following box will then appear:
  • Type DIABYOC into the ‘Mnemonic’ box as below:
  • Press <return>.
  • The ‘DIABYOC: Referral YOC Information Gathering’ guideline will then appear in the box as below:
  • Click to select and highlight the DIABYOC guideline from the list, as shown above, and then click on the ‘OK’ button.
  • The new ‘Diabetes YOC Information Gathering’ guideline should then appear in the Guideline Index, as shown below:
  • Click on the (Maintain) icon at the top of the screen again, which will save changes made to the Local Guideline Index.
  • Double-click on the ‘Diabetes YOC Information Gathering’ guideline from the menu to open, to test that it has been imported successfully. The guideline should appear as below:
  • The guideline is now ready to use.

2.3.Adding relevant Diabetes YOC Read codes to existing practice guidelines

Practices need to ensure that their data entry guidelines include all relevant Read codes to support the YOC care planning process. There are three main stages of this:

(a)Data gathering contact

It is essential that all required data is captured at the data gathering contact using standard Read codes to enable the ‘Diabetes Care Planning Results Letter’ document to be successfully populated at a later stage.

Practices can either use the ‘Diabetes YOC Data Gathering’ guideline available to them (using the installation instructions included in section 2.2. of this document) or edit existing Diabetes guidelines (e.g. QOF) used in their practice.

(b)Test results & generation of ‘Diabetes Care Planning Results Letter’

Once test results have been received electronically from the pathology labs and filed in a patient’s records, the ‘Diabetes Care Planning Results Letter’ can then be created for the patient concerned and sent to them in advance of their care planning consultation.

Practices should also record a standard Read code to log that the Diabetes Care Planning Results Letter has been sent to the patient.

(c)Care planning consultation

At the initial care planning consultation, appropriate standard Read codes should be used to record that the care plan has been agreed. In addition, at subsequent care planning consultations standard Read codes should be used to record details of goal achievement.

A list of the standard recommended Read codes to support the Diabetes YOC care planning process are included in Appendix A of this document.

Practices should amend their existing data entry guidelines appropriately to include the required codes and ensure those involved in the YOC care planning process fully understand their purpose

  1. Using the Diabetes YOC Information Gathering guideline

All relevant information needs to be captured at the data gathering contact, which will then populate the Diabetes Care Planning Results Letter document.

This can be done by either using the national ‘Diabetes YOC Information Gathering’ data entry guideline for Vision or by using an updated version of the practices existing diabetes guideline (e.g. QOF) which includes all required Read coded data items.

To use the Diabetes YOC Information Gathering guideline….

  • With a patient’s record open in consultation manager, open the ‘Diabetes YOC Data Gathering’ guideline. The guideline will appear as below:
  • Update the guideline as appropriate for the patient concerned and then click on the or button to exit. Recorded data will then appear in the patient’s journal.
  • The following notes may be helpful when completing the guideline:

Information Gathering Contact - Diabetes / This button should be pressed to record that the information gathering contact has been undertake. Record any other supporting information as appropriate.
Test Results / The latest HbA1c, Total Cholesterol, Albumin:creatining ratio and eGFR results for the patient are displayed in the grid for information purposes.
Bloods Taken / Click on the button to record that bloods have been taken for testing and record any relevant text in the ‘Notes’ box.
Urine Taken (ACR) / Click on the button to record that a urine sample has been taken for ACR testing and record any relevant text in the ‘Notes’ box.
BP / Double-click on ‘BP’ to record a blood pressure for the patient. Enter the systolic and diastolic values in the boxes provided plus any other supporting information as appropriate. The latest BP values are displayed in the grid for the patient.
Height / If appropriate, double-click on ‘Height’ to record a height for the patient. Add the value in the box provided plus any other supporting information as appropriate. The latest height values are displayed in the grid for the patient. Note: if a patient’s height has already been recorded (displayed to the grid) you may decide that this does not need to be measured and recorded again. The purpose of this entry on the guideline is to ensure that a BMI can be recorded, which relies on the patient having a height recorded.
Weight / Double-click on ‘Weight’ to record a weight for the patient. Enter the value (in kgs) in the box provided plus any other supporting information as appropriate. The latest weight values are displayed in the grid for the patient.
BMI / The BMI is automatically calculated and recorded when a weight value is recorded. This will be calculated based on the most recent height and weight for the patient. The latest BMI values are displayed in the grid for the patient.
Smoking / Double-click on ‘Smoking’ to record a smoking status for the patient. Tick the appropriate smoking status box (Smoker, Never smoked, or Ex-smoker) plus any other supporting information as appropriate. The latest smoking status’ are displayed in the grid for the patient.
Eyes / The date of the patient’s last digital retinopathy screening is displayed at the top of the eyes section. If this is blank or not recent, eye screening should be initiated or recent un-coded data appropriately coded. If appropriate click on the button to record that eye screening has been done plus any other supporting information (including date) as appropriate.
Right Foot Risk / The patient’s latest right foot risk is displayed. If this is blank or not recent, an appropriate risk category can be recorded for the patient. Click on the appropriate button to record plus any other supporting information as appropriate.
Left Foot Risk / The patient’s latest left foot risk is displayed. If this is blank or not recent, an appropriate risk category can be recorded for the patient. Click on the appropriate button to record plus any other supporting information as appropriate.
Depression Screening / If appropriate click on the button to record that the depression screening questions have been asked plus any other supporting information in the ‘Notes’ box. The date of the patient’s last depression screening is displayed at the top of the Depression Screening section.
  1. Creating a merged Diabetes Care Planning Results Letter for a patient

Once all relevant data has been collated and appropriately recorded for a patient (including: at their information gathering contact; any outstanding foot and eye screening; and once all test results have been received electronically from the pathology lab and filed into the patient’s record) the ‘Diabetes Care Planning Results Letter’ can be created for the patient concerned. To do this…

  • With the patient’s journal open in consultation manager, select ‘Add’ from the menu bar at the top of the screen and then select ‘Correspondence’ from the list of options displayed, as shown below:
  • The following ‘Clinical Correspondence – Add’ screen will then be displayed (either at the bottom of the journal screen or a separate window) :
  • Click on the letter button as shown above. The following box will then be displayed prompting you to select a template to open:
  • Navigate to select the ‘Diabetes Care Planning Results Letter v2.doc’ document from the location it is saved, as shown below, and then click on the ‘Open’ button.
  • A SmartTags progress message will then be displayed as the template is loading, as shown below:
  • The Diabetes Care Planning Results Letter will then open in Word pre-populated with the relevant merged data for the patient concerned. The populated form should appear similar to the following:
  • Scroll down to view the second page, which will appear similar to the following:
  1. Editing the merged Diabetes Care Planning Results Letterfor a patient

The only required editing of the merged Diabetes Care Planning Results letter for a patient is to manually add the appointment date and time at the top of the first page, as these fields do not automatically merge into the letter.

  • Add the scheduled care planning consultation appointment date and time for the patient as highlighted below:
  1. Printing the edited merged Diabetes Care Planning Results Letter for a patient

Once the necessary editing has been done for the patient (as outlined in section 5 above), the Diabetes Care Planning Results Letter can be printed off for the patient. To do this….

  • Select ‘File’ from the menu bar at the top of the screen and then select ‘Print’ from the list of options displayed, as shown below:
  • A ‘Print’ screen will then appear similar to the following for you to select your print options:
  • The form is intended as a double sided A4 sheet which folds into an A5 booklet, and so ideally should be printed double sided.

If you have a duplex printer:

Edit the print properties to print the 2 page form on one sheet (double-sided).

If you don’t have a duplex printer:

Print page 1 first, by selecting ‘Pages’ from the Page range section and then entering ‘1’ in the box, as shown below, and then press the ‘OK’ button: