MEDICAL RECEPTION STATION SANDHURST
PROTOCOL FOR USE OF EMIS PRIMARY HEALTH CARE INFORMATION SYSTEM (PHCIS)
INTRODUCTION
1.The aim of this protocol is to direct how the EMIS PHCIS is used at MRS RMAS. The protocol complements the EMIS training package provided by the Defence Medical Services Training Centre (DMSTC) and should be read in conjunction with the user guides produced by DMSTC. This protocol is installed on all practice computers as an icon on the Desktop. Amendments, especially Read codes, will only be made by the SMO.
2.All users are to receive EMIS training, including locums and temporary nursing staff who are to be instructed in the use of the system by the Practice Manager (System Administrator). This guide provides basic guidance for use of the system.
HEALTH AND SAFETY
3.The Practice Manager is nominated as the MRS Health and Safety officer. He is to conduct Risk Assessments in accordance with MOD and Academy policies.
4.All new users of the EMIS system are to have a Display Screen Equipment (DSE) Work Station assessment carried out and MOD Form 1054 completed. All safety information is to be displayed either attached to or near that workstation.
LEVEL OF ACCESS
5.The following levels of access are to be applied:
a.The Practice Manager is designated System Administrator (SA) and is to have Level 6 access, as is the Senior Medical Officer (SMO), who is the System Manager.
b.The Receptionist is the Appointments Manager and requires Level 5 access.
c.The Dispenser is required to access stock control and so requires Level 5 also.
d.Doctors other than the SMO, physiotherapists, all nurses and all CMTs are to have Level 4 access.
e.Permanent clerical staff other than the Receptionist are to have Level 4 access.
f.Temporary clerical staff are to be given Level 3 access.
LOGGING ON AND LOGGING OFF
6.All users not familiar with the system are to be provided with a User Guide by the Practice Manager (SA). The following is a brief guide to logging on:
Step / Action / Remarks1 / Switch on computer
2 / Ctrl, Del, Return to log on
3 / Type in password
4 / Press RETURN
5 / Type in WORK at UCI prompt
6 / Type in your user code then RETURN / Usually your initials
7 / Type in password, then RETURN / Unique to user. Practice Manager (SA) is to ensure passwords changed at the beginning of each term
8 / At end of session type CU to change user, or CD to close down
REGISTERING PATIENTS
7.All patients must be registered on the computer, whether as temporary or permanent. There will be many occasions when patients consult before their full medical record has arrived; this is catered for by the system. Those registering patients must do so in accordance with the EMIS guide produced by DMSTC. Addresses are to be entered for military staff as follows:
House name/No / Course number (e.g. CC 013) or PS or DSStreet / Company name in full then Coy (e.g. Alamein Coy) for cadets; 44 Sqn, GDC, Ac HQ, or MRS for permanent staff; leave blank for Directing Staff. Army Medical Directorate entered as AMD.
Village/station / RMAS, FASC or CTC
Town / Camberley
Tel No / Home telephone number or other contact number is essential
.
APPOINTMENT SCHEDULES
8.The Receptionist as Appointments Manager is to generate sessions as directed by the SMO or deputy. The Cadets’ Medical Officer as Deputy SMO is responsible for producing the doctors’ rota and so will usually produce this information for medical officers. Matron will produce the information for the Treatment Room (and nurse run clinics) and the Superintendent Physiotherapist for the physiotherapists.
9.Appointments.
a.As a default setting, all appointments are 10 minutes in length. Appointments are made by typing AP when in the main “Patient Management” menu and selecting the appropriate session holder.
b.The Duty MO for the session is to have alternate appointments categorised as urgent only. This will be annotated in text as URGENT. These slots can only be filled by nurses or CMTs after they have assessed the patient; they are not available to the Receptionist. Sick Parade slots are similarly indicated as such. These have to be cancelled by the nurse or CMT making the appointment, and then the patient’s name booked in. If the medical officer or other session holder is unavailable for that particular time, then these appointments will be BLOCKED (------) (type B).
c.Double appointments (i.e. 20 minutes for the patient, rather than 10) may be made by any user, but must be annotated as such by double appt being entered in text in the 10 minute slot immediately following that in which the patient’s name appears (type T then type text). When booking appointments, all patients should be asked if they would like to make a regular 10 minute appointment, or whether they feel a longer appointment will be necessary.
d.Cervical smears, Y list reviews and medicals (except boxing medicals, which are 10 minute appointments) are as a default always double appts. In this situation, type T and enter y list review, PULHHEEMS, etc. Medical Board appointments are always 40 minutes. 30 mins are needed for minor ops and IUD fittings. IUD fittings must also be booked into the Practice Sister’s appts; minor ops must be booked in treatment room appointments as well as the doctor concerned.
e.Other appointments may also be blocked, usually by the Receptionist at the request of the clinician holding that session. In this situation dotted lines will appear in that slot. Such appointments may only be unblocked with the permission of that session holder.
f.The Receptionist, doctors, nurses and CMTs may make appointments directly in the physiotherapists’ sessions. Note that there are three physiotherapists, named as session holders (use linked screens). As for all patients, blocked appts must NOT be unblocked except by the physio. Referral forms are not required, provided full details are on the consultation notes. Enter as a Referral: Referral to Physiotherapist Read Code 8H77.
10.The appointment schedules are to be backed up by the Receptionist on disc at the end of each working day Monday to Friday, discs rotating on a weekly basis.
DATA ENTRY
/ TOP TIP:When entering data in more than one screen press F3 to transfer function
11.MR Page.
a.The Medical Record (MR) page is to be used for all entries when the patient is not consulting (i.e. results, reports from consultants etc). It is especially important that ALLERGIES are entered (from MR screen, type B)[1], plus other essential information including for example Hepatitis B risk.
b.Results of xrays, blood tests etc are to be entered by typing V for Values and Investigations and then A for Add. Then chose the appropriate line (e.g. Z for CK – creatine kinase level). ECGs will also be recorded here.
c.Immunisations are entered via MR screen by typing I for Immunisations[2]. Choices are listed; type T for Template then D for Service Immunisations..
d.Reports from consultants must always have been seen by a medical officer. The data will then be entered onto EMIS by nursing staff as indicated by the doctor. Space in the MR sector is limited to two lines of text, and so only essential information will be recorded (highlighted by the doctor). The original will be filed in the patient’s notes; when hardware becomes available the letter will be scanned into EMIS. The clinical information is to be entered by typing E for Diseases and Operations and then A for Add data. The problem is then added via Read Codes as described below, with further text as highlighted by the MO. Where invited to add as a problem, do so. The MO will have indicated if the problem is Significant or not.
e.Nurses carrying out new civilian patient registrations (all new patients other than cadets should be offered a new patient check with the nurse) must generate the beginnings of a summary on this first contact. This can be amended once the patient’s records arrive. Similarly, the medical officers carrying out initial medicals will complete details on the military (blue) summary card. This must be entered on the computer when this is generated later that day by nursing or data entry staff. Any entry on the summary card is Significant. Clinical data from new notes and registration medicals for both military and civilians is entered from the MR screen via H for Health Screen. The most recent immunisations must also be entered.
f.Administrative contacts are made via the MR page. Generally the entry will be headed Administration (Read Code 9…..).
12.CM Page.
a.The Consultation Mode (type CM from the main screen) is to be used by doctors, nurses and medics for all patient contacts, including telephone advice. It must NOT be used for entering results, reports etc as this will generate a consultation statistic (i.e. make our consultation rate appear much higher than it actually is).
b.During sessions, clinicians will have the appointments page selected (type AP). As the patient arrives at Reception, the cursor must be moved to that patient’s name on the appt list and A typed. When the session holder calls the patient in they are then to enter S on their appointment list. Pressing RETURN will then bring that patient’s notes onto the screen. When the patient leaves type L .
c.When invited to select the Place of consultation, the default setting should be MRS RMA Sandhurst for doctors’ consulting rooms. Press F4 to chose the place that you are consulting (e.g. Treatment Room) if this does not appear as default.
d.All terminals should as a default be configured to show the Brief Summary on entering CM. Summaries are updated via the MR screen.
e.To enter CM from MR, select C for Consultations and then A for Add. The Problem Title will be highlighted. Press RETURN and define the problem by entering a Read Code from the list below. No other codes are acceptable.
/ TOP TIP:When reviewing a patient with an ongoing problem, select L - Patient’s Problem List. The list of problem titles already used will be displayed. For a new problem, type D – Problem Titles. This leads to the MRS RMAS list of Read Codes. When in Additional typing J brings you to Morbidity Index for entering Additional codes
f.In order that injuries can be attributed to the activities that caused them, the doctor must enter the relevant code in the Additional field as described in para 16 below, but only once (usually the first occasion they present). Patients seen for review must have the Read Code Patient reviewed entered as an Additional field. On y list recommendation Read Code Medical evaluation for rehab is entered as an Additional field. This is most easily entered by typing J for Morbidity index; choices are listed.
g.If the patient has a further problem type N - next problem.
h.The consultation must be saved by pressing F8 - File, F5 - swap patient, or F10 - Appointments. These keys may ONLY be pressed when on the CM screen. For military patients you will then be prompted to detail fitness for duty. Press F8 to exit.
13.Coding – responsibilities of doctors, nurses and medics.
a.If patients are seen by nurses or medics and then immediately referred to a medical officer (i.e. the usual procedure during Sick Parade) then the “Problem Title” must be competed by the nurse/medic as seen by practice nurse Read Code 9N22, or by CMTs as Combat Medical Technician Read Code TRISCO22. The medical officer will then complete the problem title, disposal etc. Details of the condition are typed in as free test in history. The Light Duties screen which will be displayed on typing F8 to file can be bypassed in this case by typing F9.
b.If the patient is given treatment by the nurse or medic, and/or is seen later that day, the following day or later, then the nurse or medic must enter the code for problem as below (plus days light duties etc). In this situation the Light Duties screen which will be displayed on typing F8 to file, is completed as appropriate. If the problem is to be entered by the nurse then usually it will be entered as Minor unless the nurse or CMT considers that it is definitely Significant.
c.For recording procedures such as taking blood, stay in CM but enter X for Xray/lab requests and then one of the choices listed, e.g. W for Blood sample sent to lab. Similarly, if an X ray is requested type X for Xray/lab requests then X for Xray.
d.In summary, if the medical officer sees the patient in the same session as the nurse or CMT then this is in effect one consultation. If the doctor sees them later, then there are two consultations.
14.Read Codes. Read Codes are to be used during consultations, or as Problems on the MR page, entering one of the following choices as “Problem Title”. The aim is to ensure that for Service personnel there is consistency in data entry. This is in order to maximise the accuracy of morbidity returns, and to ensure accuracy when undertaking searches and audits. The Read Codes used in the practice will need to be reconsidered from time to time, but only via amendments to this EMIS Protocol by the SMO.
J97 / Description / Read Code / RemarksINFECTIOUS AND TROPICAL DISEASE
1 / Intestinal infectious diseases / A0 / Incl diarrhoea and vomiting when likely to be infective or due to food poisoning1 / Typhoid and paratyphoid fever / A01 / Proven cases
2 / Genitourinary symptoms / 1A / Sexually transmitted diseases, epididymo-orchitis and pelvic inflammatory dis (not thrush)
3 / Temperature symptoms / 165 / If cause not known – Pyrexia of Unknown Origin (PUO)
3 / Bacterial Meningitis / F00
3 / Tuberculosis / A1
3 / Malaria / A84
3 / Leptospirosis risk exposure / 65PC
3 / Infectious mononucleosis / A75
3 / Rubella / A56
- / Rubella antib present - immune / 4393
- / Rubella a/b low – not immune / 4395
3 / Other infectious and parasitic disease / AD / If notified also enter Read Code 9G1 in Additional field
- / Foreign travel advice / 67E
PSYCHIATRIC PROBLEMS
4 / Alcohol problem drinking / E23-2 / Alcohol abuse
4 / Suspected drug abuse / 1J1 / Incl CDT positive
5 / Overdose of drug / SL-5 / Self harm by overdose
5 / Suicide+self-inflict.in.-SII / TK / Other self harm
51 / Stress reaction causing mixed disturbance of emotion/conduct / E284 / Stress reaction, including marital discord, bereavement and situational anxiety
5 / Mental state / 6652 / All other psychiatric conditions including depression (exact symptoms free text)
EYES AND ENT PROBLEMS
6 / Acute and subacute iridocyclitis / F440 / Incl repeated episodes6 / Glaucoma / F45
6 / Closed fracture zygoma / S0241 / Enter in Additional field the cause of injury.
6 / Eye symptoms / 1B8 / All other eye disorders incl conjunctivitis and corneal FB
7 / Otitis media NOS / F52z
7 / Impedance audiometry / 3136 / Audiometry review
7 / Allergic rhinitis / H17 / Hay fever
7 / ENT symptoms / 1C-1 / Other disorders of ENT including sore throat and acute or chronic tonsillitis
RESPIRATORY SYSTEM
81 / Acute nasopharyngitis / H00 / URTI – colds82 / Acute lower respiratory tract infection / H062 / LRTI – significant coughs esp with sputum; bronchiolitis in babies and pneumonia
82 / Influenza like illness / H27z-2 / Severe cases only (bedded down)
82 / Influenza / H27 / Only those proven on serology as influenza
82 / Asthma / H33 / Incl occupational asthma
82 / Pneumothorax / H52
- / Croup / H044 / Children and babies
82 / Lung cancer / B22z-1
82 / Other resp system diseases / H5
DIGESTIVE SYSTEM
9 / Tooth symptoms / 1919 / Oral cavity, salivary glands and jaw diseases / J0 / Including # jaw (add injury mechanism in Additional field)
11 / Jaundice - symptom / 1675-1
11 / Cirrhosis and chronic liver disease / J61
11 / Other liver disorders / J63 / Incl porphyria
- / Hepatitis B surface antig +ve / 43B4 / Hepatitis risk
- / Hepatitis B immune / 43B2
11 / Epigastric pain / 1972 / Incl dyspepsia and reflux
11 / Acute pancreatitis / J670 / When diagnosed
11 / Abdominal pain / 1969 / Incl low abdo pain. Enter associated vomiting as free text
11 / Gastric ulcer / J11
11 / Duodenal ulcer / J12
11 / BMI 25 – 29 overweight / 22K4 / BMI to be recorded
11 / Obesity / C380 / BMI > 30
11 / Emergency appendicectomy / 7700-1 / All appendicectomies
11 / Cholecystectomy / 7810-1 / Incl laparoscopic
11 / Inguinal hernia / J30 / Incl repair operations
11 / Femoral hernia / J31 / Incl repair operations
11 / Neoplasm of unspecified nature of digestive system / BA00 / All GIT cancers
11 / Constipation / 19C
11 / Haemorrhoids / G84
11 / Inflammatory Bowel Disease / J4-2 / Crohn’s Disease and Ulcerative Colitis
11 / Digestive system diseases NOS / Jz / All other gastro-intestinal problems incl irritable bowel syndrome and vomiting when cause not likely to be infective
CERVICAL NEOPLASIA SCREENING
- / Cervical neoplasia screen / 6859 / Smear recall (use template; In CM type T then O then C)- / Ca cervix screen - up to date / 6856 / Smear up to date
- / Ca cervix screen - offered / 6852 / Smear offered
- / Ca cervix screen – not wanted / 6853 / Smear declined (incl NSA)
- / No smear – benign hysterectomy / 685H
- / Cervical smear status unknown / 685E
- / Cervical smear non responder / 6857-1
- / Cervical smear taken / 7E2A2
- / Cervical smear: negative / 4K22 / Cervical smear negative
- / Ca cervix screen – no result yet / 685A / When smear taken elsewhere
- / Ca cervix screen – wanted / 6854 / Smear to be taken elsewhere
- / Ca cervix screen abnormal / 685C
OBSTETRICS AND GYNAECOLOGY
12 / General contraceptive advice / 611 / Including condoms and caps12 / Post-coital contraception / 61A
12 / Oral contraceptive / 614 / As template
12 / Depot contraceptive / 61B
12 / IUD contraception / 615-2
12 / Sterilisation counselling / 6775
12 / Pregnancy care / 62-3 / All obstetric care
12 / Cancer of ovary / B440-1
12 / Fertility problem / 1AZ2
12 / Gynaecological history / 15 / All other gynae problems including miscarriage and TOP
SKIN DISEASE
131 / Atopic dermatitis/eczema / M111 / Incl occupational eczema132 / Blisters / SD-3
132 / Acne / M2610
132 / Psoriasis unspecified / M1610
132 / Pilonidal sinus/cyst / M06
132 / Cutaneous cellulitis / M08
132 / Impetigo / M05
132 / Pruritus / M18
132 / Fungal infection of skin / AB0-1 / Incl athlete’s foot and ringworm
132 / Fungal nail infection / AB01-3
132 / Other local infections of skin and subcutaneous tissue infections / M07 / Other skin infections including warts, scabies and head lice
132 / Suspected skin cancer / 1J0G
132 / Other skin and subcutaneous tissue disorders / M2 / Other skin problems including non specific rashes, lipomas and sebaceous cysts
MUSCULO-SKELETAL PROBLEMS AND INJURIES