Vision+ User Guidehelp.visionhealth.co.uk/PDFs/VisionPlus/VisionPlus User... · 2019. 11. 11. · 9...

Copyright © INPS Ltd 2014

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Vision 3

Vision+ User Guide

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Contents

What's New 9 DLM 457 (08/04/2014) 9 SIS 10245 (26/03/2014) 10 DLM 451 (15/01/2013) 12

Introduction to Vision+ 13

Overview 14

"Real Time" Alerts 15

Simple Data Entry Tools 16

Templates 17 Additional Templates - Download Web Files 19

Inbuilt Calculators and Questionnaires 21

Vision+ Recall Management 21

Vision+ Reports 22

Getting Started With Vision+ 23

Installation and Vision+ Versioning 23

Accessing Vision+ 25

Initial Set-up 27 Forward Dating Explained 28 Vision User Rights to Vision+ 30

Clinical Audit and Vision+ 30

Mail Gateway and Vision+ 30

Multiple Consultation Managers and Vision+ 30

Vision+ Alert Indicator Screen 31

Viewing the Alert Indicator Screen 31

Navigating the Alert Indicator Screen 32

Colour-Coding of Contract Indicators 33

Toolbar 34

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Using the Right Click Menu 35

Hide and Re-Invoke the Alert Indicator Screen 35

Moving the Alert Indicator Window 35

Re-sizing the Alert Indicator Window 36

Vision+ Data Entry 37

Read Code Data Entry in Vision+ 37

Adding Current Exception Read codes 39

Expired Exception Read codes 39

Entering Additional Codes 40

Recording Measurements and Values 40 Recording BMI Values 41 Recording Blood Pressure Values 41 Recording Smoking Status 42

Using the Notes Summary Data Entry Screen 43 Indicators screen 43 Registers screen 44

Assessment Forms & Risk Calculators 45 Questionnaires 46 ASSIGN CVD Risk Calculator 47 CHADS2 - AF Stroke Risk Calculator 50 eGFR Calculator 53 Framingham CHD/CVD Risk Calculator 56 JBS 2 CVD Risk Calculator 58 QRISK2 CVD Risk Calculator 60 Peak Expiratory Flow Rate (PEFR) 62 ABPI Calculator 64

Add to Register 66

Extra Indicators 68

Prevalence Searches 69

Register Checks 69

Vision+ Contract Templates 71 Overview of the Contract Template Screen 72 Summary - Viewing or Adding data to a Template 73 Using Contract Templates 74

Toolbar 76 Default Date 76 History Tab 76 Status Bar 77 Contract Icon 77 Undo Last Entry 77 Undo All Entries 78

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Tabs 78 Next Tab and Previous Tab Buttons 78 Next and Previous Buttons 79 Viewing Details of Contract Information 80 Listing and Graphing Historical data 81 Viewing All Templates 82

Alternative methods of Opening a Contract Template 82

Practice Reports 83

Overview - Practice Reports 83

Accessing the Practice Reports Tools 83

Using Patient Target Lists 84 Patient Target Lists 85 How Patient List Information is calculated 85

Working with Data within the Patient Target Lists 86 Recording Information Using Patient Lists 86 Printing a List of Patients on a Patient List 86 Looking at Other Indicators for Patients in the Patient Lists 86 Opening a Patients notes from the Patient List 86 Producing Recall Letters Using Mail Merge Tools 86 Designing Patient Recall Letter Templates 87 Create a New Recall Letter Template 88 Edit or Delete Letter Templates 89 Important Information about Letter Templates 89 Running a Mail Merge from Patient Target Lists 89 Multi-Disease Registers 91 Important Information about Influenza Recalls 92 Managing the Recall Status using Letter Levels 96 Targeting High-Value Patients for Recall 97 Recalling Patients by Phone 97 Adding Codes to Multiple Patient Records 98 Read code Data Entry Screen for Non-Contract codes 99

Last Run button 100

High Value Patients 100

Contract Manager 102 The Contract Manager Screen 102 Updating Contract Manager 103 Navigating Through the Different Contract Domains 103 Working with Data on the Contract Manager Screen 104

Viewing Contract Point Statistics 104 Using the Points Screen 105

Entering Manual Point Information 105 Adjusting Point Aspirations 105 Opting out of Clinical Categories 106 Specifying Payment and Prevalence Information 107 Generating a Points Report from Contract Manager 108 Generating a Percentage Report from Contract Manager 109 Updating and Displaying Yearly Results 110 Printing Information on the Contract Manager Screen 110

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Exporting Information to a CSV File 110 Shrinking / Enlarging the graphs 111

Data Extract 112

Vision+ Scheduler 113

Configuration and Settings 115

Using the Settings Screen 115 Options Tab 116

Roles 116 Indicators 116

Forward Dating 117 Advanced Tab 118 Scheduler 119 Order Tab 121 Protocols Tab 122 Reset Position Button 122

Security Access to Vision+ 122

Changing the Appearance of Vision+ 122

Creating and Modifying Vision+ Templates 123

Accessing the Vision+ Template Designer 123

Customise an Existing QOF Template 125

Create a New User-Defined Template 125

Replacing an Existing QOF Template 125

Opening Existing User-Defined Templates 126

Working with Indicators in the Template Designer 127 Adding a Header or Footer Image to a Template 127 Creating a Menu Image for the Template 127 Adding Multiple Pages to Your Template 128 Changing the Appearance of Page Markers 128 Adding New Codeset Rows to the Template 128 Adding Existing QOF Indicators to the Template 130 Adding a Read code Row to the Template 131 Adding Blood Pressure Rows to the Template 133 Adding BMI Rows to the Template 133 Adding Smoking Rows to the Template 134 Adding a BNF History Row to the Template 135 Adding an Image Row to the Template 135 Adding a Text Row to the Template 136 Adding a URL Row to the Template 136 Adding Attachment Rows to the Template 137 Adding Read code Group Rows to the Template 137 Adding a Calculator Row to the Template 140 Inserting a Row into the Template 141 Deleting a Row on the Template 141 Changing the Position of Rows on the Template 141

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Saving the Changes to Your New Template 141

Changing the Status of Templates 142

Logic Tools 142

Indicator Logic Tool 143

Rule Logic Tool 145

Rule Logic Exception Tool 146

Additional Templates - Download Web Files 147

INDEX 149

9

What's New

DLM 457 (08/04/2014)

England, Wales and Northern Ireland

Vision+ Changes - As per our recent announcement on the INPS

blog, we have made some changes to the way Vision+ is accessed. This

is so that we can continue the rollout of scheduled DLM releases and

properly address the intermittent freezing and crashing in Vision+ that a

minority of practices are experiencing. On receipt of DLM 457, you will

notice that the Vision+ menus have been removed from the Vision front

screen and there is a new Vision+ floating toolbar in Consultation

Manager. We are hoping to reinstate the Vision+ menus in the near

future. All Vision+ functionality remains unchanged but please read the following topics to familiarise yourself with this and other minor changes:

- Vision+ In Consultation Manager - Vision+ icon and menu in

Consultation Manager is now replaced with a Vision+ floating toolbar

where you can access all your Vision+ patient

functionality. See Accessing Vision+ (page 25).

- Vision+ Module Access - The Vision+ menus have been removed

from the Vision front screen ribbons. Vision+ modules are now

accessed by right clicking on the Vision+ button in the Windows

Notification Area. Your individual Vision+ settings are now only

accessible from here. You can also access the Vision+ patient menu

from here if you have a patient selected in Consultation Manager. See

Accessing Vision+ (page 25).

- Vision+ Versioning - Vision+ Versioning details have changed. See

Installation and Vision+ Versioning (page 23).

- Vision+ Security Settings - From DLM 457, access to Vision+ is no

longer determined by Control Panel - Security settings, all Vision users

can access all the Vision+ modules. See Security Access to Vision+.

(page 122)

Scotland

Vision+ Integration - DLM 457 introduces a new free of charge

QOF management and practice protocol tool called Vision+. This exciting

new update to Vision includes real-time alerts for additional QOF points,

practice-based protocols and a simple but powerful recall and reporting facility.

When a patient record is open in Consultation Manager, Vision+ shows

missing or incorrect contract information and provides intelligent

templates for fast data recording. There are also additional reporting

facilities to help with QOF and protocol management.

Note - Unless specifically stated in these release notes, all other

aspects of Vision+ Functionality remain unchanged.

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Practices can also create their own protocols that alert users to missing

information during consultations alongside the existing QOF related

alerts.

Some practices in Scotland may already be familiar with the functionality

that Vision+ offers, however, please see Getting Started With Vision+

(page 23) to recap or familiarise yourself with how Vision+ works within

Vision.

Clinical Audit QOF Reminders - For practices in Scotland on

receipt of DLM 457, your QOF reminders in Clinical audit will be disabled.

This is because Vision+ will now be the principal tool for QOF alerts and

data entry.

SIS 10245 (26/03/2014)

Version 27 QOF Business Rules - SIS 10245 brings a new

version of the Business Rules v27 for Vision+. This supersedes the

previous version 26.0. To check the changes in the Business rules refer to the Clinical Audit on-screen help.

Undo All Entries - There is a new Undo All option available when

adding data to Templates. This allows you to remove all Read code

entries that have been added since accessing the template. See Undo All Entries (page 78).

Scheduler - Vision+ now includes an option to schedule the

generation of QOF lists, Contract Manager and Data Extracts within

Practice Reports. The scheduler is available for practices with their own server (LAN) practices. See Scheduler (page 118).

ABPI Calculator - Vision+ now includes an Ankle Brachial Pressure

Index (ABPI) calculator. See ABPI Calculator (page 64).

Warfarin Dosage System - The Warfarin reports have been

updated for practices using the existing Vision+ Warfarin Pathway and Anticoagulation Reports.

Records with End Dates - Patients with an End Date recorded on

the History or Problem Structured Data Areas (SDA) are no longer

counted by Vision+ as being on a Register. See Add to Register (page 66).

Latest, First and New - Vision+ has been updated so that it now

applies the appropriate business rules and takes into account the patient's latest or earliest record.

Skins - The 'Skins' option within the Vision+ Settings has been

removed so that it is no longer possible to change the appearance of

Vision+. The default setting is ‘Office2010Silver’. If you have changed

the 'Skins' setting you will automatically revert back to the default setting.

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Scot-PASQ Calculator - The Scot-PASQ calculator can now be

selected from the Alert Popup window or from the Calculator section of

Vision+.

Patient Synchronisation - When Vision+ was installed a full

synchronisation was performed which synchronised all the patients on

Vision, including those patients who are Transferred Out. If a

synchronisation is required again (as advised by the Helpdesk), it will

only include patients who have Transferred Out within the past 2 years. On installation, SIS10245 will perform a resynchronisation.

CVD Primary Prevention (CVD PP001) - Vision+ now only looks

at the latest entry when looking for patients with a new diagnosis of Hypertension.

Alert Popup Display problems - Some users with admin rights

have experienced intermittent problems with the Vision+ alert popup displaying then instantly disappearing. This is now resolved.

Contract Manager - Some larger practices had an error message

when running Update Results in Contract Manager. This has been resolved in SIS 10245.

Temporary Patients - Temporary patients who are registered and

removed (eg Transferred Out) on the same day, are no longer included in the Vision+ Recalls.

Discontinued Read codes - Discontinued Read codes are no longer included in Contract Manager, Alerts and Practice Reports.

Vision + Scotland Only

The following changes are implemented for practices in Scotland:

CVD Primary Prevention (CVD PP003) - The Contract Manager

report now includes patients with a new diagnosis of Hypertension after

the 1st April 2009 given advice on increasing activity using the Scot-PASQ (68L, 38Q5) after 1st April 2013.

Target Threshold change for CVD Primary Prevention (CVD

PP003) - The higher target threshold has been updated to the correct value of 90%.

Medicine Management (MED003) - Medicine Management is

now looking back 12 months instead of 15 months.

Note - Temporary patients registered and deducted on the same date are usually test patients who are used for training purposes

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DLM 451 (15/01/2013)

Oxford Calculator - The Oxford Hip and Knee calculators now only calculate the score once all questions have been selected. See .

ASSIGN CVD Score - The Vision+ ASSIGN calculator score has

been updated so that it now matches the latest algorithm from the ASSIGN Score website (version 1.5, October 2013).

Read Dictionary Quarter 3 - Vision+ has been updated to

incorporate the Quarter 3 2013 Medical Read Codes Release of the Read dictionary.

Pinning Vision+ Alerts - The Vision+ alert screen can no longer

be pinned to task bar on Windows 2008/7 clients. Note this will not remove existing pins, they must be manually unpinned.

Vision+ Error Reporting - The contents of Vision+ error dialog

box has been updated so that it no longer contains patient demographic information.

Vision + Letter Template Folder - For hosted practices, Vision+

mail merge now points to the correct letter template folder (p:\visionplus).

Various behind the scenes fixes are also included in this release.

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Introduction to Vision+ Vision+ is an integrated QOF Management Tool which is free of charge to all Vision

users. Vision+ functionality includes real-time alerts for additional QOF points,

practice-based protocols and a simple but powerful reporting and recall facility.

When a patient record is open in Consultation Manager, Vision+ shows missing or

incorrect contract information and provides intelligent templates for fast data

recording. There are also additional reporting facilities to help with QOF management.

Practices can also create their own protocols that alert users to missing information

during consultations alongside the existing QOF related alerts.

Vision+ comprises the following changes and additions to Vision modules:

Consultation Manager Menu and Toolbars - The Vision+ toolbar and

menu option takes you directly to the Vision+ functions. The Vision+

options consist of a Contract Indicator Alert screen which provides colour

coded timely alerts that capture the patient's QOF requirements at a

glance. There are also some easy to use data entry tools that allow you to

record key terms quickly and efficiently. QOF Templates can be used to

help record information in a structured format. Calculators and Questionnaires are available to help manage patient care.

See Vision+ Alert Indicator Screen (page 37) and Vision+ Data Entry

(page 37).

Practice Reports - The Vision+ Practice Reports module consists of

numerous reporting tools that enable you to run patient target lists and

setup a recall programme. There is also a contract management option that enables you to monitor your points and targets.

See Practice Reports (page 83).

Configurations and Settings - The Vision+ Settings module allows you to customise Vision+ to suit your individual needs.

See Configuration and Settings (page 115)

Editing and Creating Vision+ Templates - You can edit existing

QOF templates or create your own data entry templates using the Vision+ Template Designer module.

See Overview - Creating and Modifying Vision+ Templates (page 123)

Download Web Files - The Download Web Files module allows you to

download other practice and local health board protocol templates. Available templates may vary.

See Download Web Files (page 19)

Mail Gateway - Mail Gateway includes Vision+ synchronisation. This

keeps the Vision+ database up to date with the patient data changes.

You will not see any visible change in Mail Gateway but for Vision+ to work properly, Mail Gateway should be open at all times.

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Overview Vision+ is a free of charge QOF management and practice protocol tool which is part

of your core Vision modules. Vision+ provides an immediate way of capturing

essential QOF data using real time alerts and templates. Vision+ also brings a

comprehensive reporting site which includes a recall management programme and

QOF Reporting Tools.

The following topics outline the changes and provide an overview of the new

functionality. Once the Vision+ installation has completed, you will see the new

modules and icons and can start using Vision+ straight away.

New icons in Consultation Manager

New Vision+ menu option in Consultation Manager

New Vision+ Module Access in Windows Notification Area

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"Real Time" Alerts When a patient record is opened, Vision+ provides colour coded timely alerts that

capture the patient's QOF or other practice protocol requirements at a glance.

Alert Screen

Individual data items can be entered directly into the patient's journal from the alert

screen. Once recorded, the alert is instantly updated to display the remaining

outstanding alerts. The alerts can also be printed and taken on house calls.

Smoking data entry screen

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Simple Data Entry Tools One of the other major features of Vision+ is the ability to record key items of

information quickly and efficiently using intuitive data entry tools.

For example you can quickly access Contract codes from the Alerts screen in

Consultation Manager:

Choosing a Data Entry Screen

Simply choose the Read term and click OK to enter data.

Data Entry Screens

17

Templates In addition, Contract and Clinical Templates provide step-by-step protocols and links

to other templates and screens.

Contract Templates

By a single click you can view a patient's historical data and graph it.

Templates

You can also edit existing QOF templates or create your own data entry templates

using the Vision+ Template Designer module.

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Additional Templates - Download Web Files

Vision+ has access to a number of additional templates that can be used to improve

patient care, creating a single template that holds all the relevant information and will

also allow the user to input information from the template. These templates are

similar to the QOF templates, but contain non-QOF information such as NICE

guidelines and Local Enhanced Services. It is up to the practice to download the ones

that they choose to use.

To access downloadable files:

1. Log into Vision, right click on the Vision+ icon in the Windows Notification

area and select Download Web Files from the menu.

Download Web Files

Note - You may not have access to all templates. This depends on

your health board, where you are in the country and if you have purchased additional templates.

Note - To access Download Web Files, you must not have a patient

selected in Consultation Manager else the patient-specific menu displays.

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2. A list of files available for download and files already downloaded is displayed.

Download Web Files

Group Name - details the name of the download

Web Version - tells you the version of the download available to import

Local Version - tells you the version of the download you currently have

installed on your system

Status - tells you the status of the download

Download - tick the box to select a download to import

Delete - tick the box to select a download to delete

3. Select the file(s) you wish to download by ticking the box in the download

column.

4. Then click Download. You do not need to log out of Vision whilst the files are

downloading.

5. A splash screen will appear showing the progress of the download.

6. The status column quickly shows which templates have already been

downloaded to the system, and which templates have a new version that may

be downloaded. Template Version numbers can be compared between the

Web Version and Local Version to see if a more recent version is available for

download from the web. To remove a template from the system simply click to

place a Tick in the Delete column alongside all the templates you wish to

remove, then select Delete from the Toolbar.

Note - Templates that have been downloaded by the practice are

available to all users providing that Disable User Defined Indicators is not checked in Configuration and Settings.

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Inbuilt Calculators and Questionnaires There are numerous integrated calculators and questionnaires available within

Vision+ to assist with the management of patient care. These are easily accessed

from the Vision+ menu on the floating toolbar in Consultation Manager.

In Built Calculators and Questionnaires

Vision+ Recall Management A simple, comprehensive recall programme is built into the new Reporting module.

The recalls can be per disease area or there is a facility to merge co-morbidity cohorts

in order to facilitate streamlining of letter invites.

Recalls

Vision+ will keep a track of the number of letters sent to the patient and it will

automatically update the invite status and record an entry in the patient's journal.

The Vision+ recall functionality uses history entries rather than Vision recall

entries.

22

Vision+ Reports Contract Manager is also part of the new Reporting Tools. This is an essential tool for

monitoring your practice QOF performance over the year. It can be used to track

aspirations, help plan monthly workloads, compare year on year performance and

show your practice prevalence and provide you with financial information.

Contract Manager

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Getting Started With Vision+ The following topics give some useful information regarding the installation of Vision+

and using it alongside existing Vision modules:

Installation and Vision+ Versioning Vision+ is automatically enabled for all Vision users. You will know that this has

happened as you will see Vision+ alerts in Consultation Manager and a new floating

toolbar in Consultation Manager and a Vision+ icon in the Windows

Notification Area see Vision+ Modules (page 25). However, you can also check

the Vision+ versioning from the Vision front screen About Vision window:

1. Login to Vision.

2. From the front screen click Help - About Vision....

3. The Vision+ Details section tells you the version of Vision+ you have installed

and the database status.

Version - Details the version number of Vision+ which is installed on your

system.

Database - Standalone

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You will be informed when new QOF versions are available in Vision+ via the usual

release notifications and web release guides.

Help - About Vision

25

Accessing Vision+ You can access Vision+ functionality in the following Vision areas:

Consultation Manager

1. When you select a Patient in Consultation Manager, the Vision+ floating toolbar

and any relevant alerts for the selected patient are displayed:

Vision+ Floating Toolbar in Consultation Manager

2. Click to access the Vision + patient centric menu. This displays:

Vision+ Menu in Consultation Manager

QOF Templates - are designed to collect QOF information in a

step-by-step protocol based format. They are the same as Contract

Indicator Alerts in that they show "real time" data and use the same colour coding scheme.

Clinical Templates - provide step-by-step protocols for general data

entry and disease management.

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Add to Register - allows you to quickly add patients to a QOF disease register.

Calculators - there are a variety of calculators and questionnaires to

help manage patient care.

Warfarin Monitor (if enabled at your practice) - is a powerful tool for monitoring INR results and advising on the dosing regime.

3. Click to re-invoke the Vision+ Alerts screen if you have previously closed

it.

Patient Mode - Vision+ Patient-centric Menu

The Vision+ menu for patient specific functionality is also available from the Vision+

icon on the Windows Notification Tray when you have a patient selected in

Consultation Manager.

Patient Mode Vision+ Menu from Window's Notification Tray

Vision+ Modules

1. Whilst logged into Vision, right click on the Vision+ icon in the Windows

Notification Tray.

2. Select the required module from the Practice Mode menu. You can select from:

Vision+ Practice Mode

Practice Reports - for recalls, patient correspondence and

QOF/non-QOF reporting.

Note - You can reposition the floating toolbar anywhere you want

within the Consultation Manager window. Vision remembers where you

last positioned the floating toolbar for when you next login.

Note - If you want to access the Vision+ modular menu options

whilst in Consultation Manager, make sure you don't have a patient

selected, otherwise patient-centric menu displays. See Vision+

Changes in Consultation Manager.

27

Template Designer - for creating or editing existing templates.

Download Web Files - for downloading other Vision templates.

Settings - for configuring individual user settings (there is no global

configuration). This is no longer accessible from within Consultation Manager.

3. The required Vision+ module opens for you to use.

Initial Set-up Once you have Vision+ installed on your system, you can start using all the modules

straightaway. However, there are some configuration options for Vision + which we

advise you to to review beforehand:

Within the Settings screen, there are configuration options which allow

each user to customise how Vision+ works for their individual Vision

account. Initially all users are set-up with a GP role profile which sets

predefined options for that role but you may want to change this to

Nurse, Admin or create custom Vision+ settings. See Configurations and

Settings in the Vision+ Quick Reference Guides (page 30) for further details.

Also within the Settings screen there is a forward dating option which

determines the baseline date for the alerts and reports within your

individual Vision account. The default is set to today which means in QOF

terms that alerts and reports reflect today's data rather than projecting

back from the end of the QOF year, so you may wish to change this. See Forward Dating (page 28).

Note - For the above two points, there are currently no global

settings to configure individual Vision+ preferences. You must login as each user to do this.

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Forward Dating Explained

The Forward Dating Tab within the Settings screen provides three different options for

forward dating of indicators. These options will change the information that you see

displayed in the Contract Indicators, Contract Templates and Patient Target Lists (the

reference date is clearly shown on these screens). By default the Alert Indicator

screen defaults to None (today’s date) every QOF start date. The diagram below

attempts to explain the timeframes you may initially require for forward dating.

1. To access the Vision+ Settings screen, right click on the Vision+ Icon in

the Windows Notification Area and select Settings.

Access to Vision+Settings

Note - To access the Settings module, you must not have a patient

open in Consultation Manager.

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2. The Settings Configuration screen is displayed.

Forward Dating Tab

3. To change the forward dating, select from the following options:

None – Only those indicators requiring completion as of today's date will

be shown. This is the default setting when Vision+ is installed on your system.

Forward Date – Will also show those indicators that have already been

completed as of today's date, but will need to be re-recorded before a

specified reference date. You can set this date using the date picker or by typing in a date.

Rolling Days – Will also show those indicators that have already been

completed as of today's date, but will need to be re-recorded within a

specific number of days ahead. You can set the number of days using the Days field.

If you choose the Forward Date or Rolling Days option, you also are able

to select the Show Inactive Triggers checkbox to display those items

that will need recording in the future, but cannot be recorded within the

specified time period. Depending on which option you have selected, the

indicators will appear in different colours in the other screens. For more

information on the colour-coding of indicators, see Colour Coding for

Contract Indicators.

4. Click OK to save.

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Vision User Rights to Vision+

All Vision users have full access rights to all Vision+ functionality.

For practices in England, additional RBAC roles are not required to use Vision+.

You may also notice that you have an inactive user in the security module called

VPLUS. This is used for maintenance purposes and should not be amended or deleted.

It will not appear on any practice reports or lists.

Clinical Audit and Vision+ All functionality within Clinical Audit and QOF Guidelines remains unchanged with the

introduction of Vision+, apart from QOF reminders which are automatically disabled

once Vision+ is installed.

As Vision+ offers dynamic, up to the minute alerts on patient data, direct access to

intuitive templates, real time reporting and simple yet effective recall management, it

is intended to be the principal tool for QOF and practice protocols in Vision. We

encourage you to take advantage of this new functionality. However, you can

reactivate Clinical Audit reminders and use them alongside Vision+ alerts until you get

used to the different screens. QOF Clinical Audits and guidelines will continued to be

maintained until further notice.

As Clinical Audit will still manage and transmit your end or year QOF reports, it is

important that you keep check on how it is running and maintain your regular system

management for this.

Mail Gateway and Vision+

Important - Please note that the Mail Gateway must be running for Vision+

services to run correctly. Whilst you are not able to close the Mail Gateway per se, the

Mail Gateway program will close if the machine it is running on is turned off.

Task exclusion times should only be set for times when your backup is running

overnight, not during the day. If these services are not running during the day,

Vision+ functionality will not work as expected and other messages will be delayed.

Multiple Consultation Managers and Vision+ Please be aware that when opening multiple Consultation Managers, Vision+

functionality is only available in the most recently opened instance of Consultation

Manager. As you close extra instances of Consultation Manager, Vision+ functionality

becomes active in the most recent remaining Consultation Manager screens and alerts

display for the relevant patient if they are selected.

Note - To disable the Vision+ alerts in Consultation Manager for a

particular user, go to the users Vision+ settings in their Consultation

Manager screen (this can also be accessed from the Management Tools

menu on the Vision front screen) and tick Disable Auto Popup. See

Configuration and Settings in Vision+ Quick Reference Guides (page

30).

31

Vision+ Alert Indicator Screen The Alert Indicator screen is displayed when you select a patient in Consultation

Manager. The screen shows a list of items that need to be recorded for the patient.

Each set of indicators is grouped into QOF, Enhanced Services and Extra Indicators

(eg annual reviews).

Viewing the Alert Indicator Screen 1. In Consultation Manager, select the patient and open a consultation.

2. After analysing the patient's data the Alert Indicator screen appears.

Alert Indicator Screen

3. The screen shows a list of criteria relevant to the patient, and displays:

Category Headings - QOF Categories eg Cardiovascular disease primary prevention

Contract Indicators - QOF Indicators eg Lifestyle advice required

Any other alerts for Vision+ protocols that your practice is using.

4. To collapse the heading click the collapse icon and to expand the heading

click the expand icon.

5. You can double click on any indicator line to enter data. See Data Entry (page

37).

Note - The Alert Indicator window does not display in Consultation

Manager if you are working in the new Practice Reports module in

Reporting as some parts of Vision+ require exclusive access to the

database. In order to see the Alert screen you need to exit Practice

Reports. As this is a user specific setting it does not affect anyone else in the practice.

Note - All categories are expanded by default to show the indicators

within them.

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Navigating the Alert Indicator Screen At the top of the Alert Indicator window is the patient's name and QOF date. The date

can be set as the Reference date eg QOF year end, today's date or a future date. For

more information on how to change the date, refer to Configuration and Settings

On-screen help (page 115).

Alert Indicator Screen - Patient Name and QOF Date

33

Colour-Coding of Contract Indicators The lines on the alert screen often display different colours. If you have changed any

settings on the Forward Dating tab in the Settings screen, future information is

displayed in addition to the indicators that you can currently record. For more

information on changing the settings, refer to the Configuration and Settings

on-screen help.

The following colour-coding conventions are used to show contract information:

Colour Type of Indicator

Bold green text represents a Category where there are no

current outstanding indicators or within a template where an

indicator has been completed.

Black text represents information that requires completion

now. Following the QOF business rule set, these are either

outside the time constraints, or have never been recorded.

Indicators in bold blue text mean that you have recorded the

information but you need to do it again as it falls outside the

time frame.

Light blue text is information that cannot be recorded until

specific criteria is met, eg within a set period for the year, or a

specific age is reached within the year. These indicators are for

information purposes and are not removed if data is recorded

when outside the criteria.

A red flag indicates a category has been exception coded in the

current QOF year.

An orange flag category or indicator signifies that a previous

exception code has expired.

Information in bold grey text means that the category does not

currently apply to the patient, eg where a patient is not part of

a register.

34

Toolbar The Toolbar is located along the top of the Alert Indicator screen and is used to access

the various functions eg contract codes, exception codes, depression questionnaire,

BP measurements, etc. If you highlight an Indicator the relevant icons on the toolbar

become enabled or disabled depending on whether they are available for use.

The table below describes the function for each icon on the Alert Indicator screen:

Icon Function

Displays the Contract Read Code Data Entry screen to enter Read codes

Displays the Contract template of the currently highlighted category

Displays the Indicator logic screen of the highlighted indicator

Displays the Smoking data entry screen

Displays the Rule logic screen for the highlighted indicator

Displays the BMI data entry screen

Displays the Read code data entry screen to enter Exception Read codes

Displays the Read code data entry screen to enter Expiring Exception

Read codes

Displays the Read code data entry screen to enter additional Read codes

Displays the Blood pressure data entry screen

Displays the Rule logic exception screen for the highlighted indicator

Displays the Depression questionnaire

Displays the GPPAQ questionnaire

Print preview the contract indicators displayed

Print the contract indicators displayed

Training Tip - Hover the cursor over the Toolbar for a description

of their function.

35

Using the Right Click Menu If you right click on an Indicator line a menu appears showing the options available for

that particular Indicator. The menu is essentially the same as that shown on the

toolbar (page 34).

Right click menu

Hide and Re-Invoke the Alert Indicator Screen The Alert Indicator screen always stays on top of the consultation screen.

1. To close the window click the close icon.

Closing the Alert Indicator Screen

2. To re-invoke the screen choose the Show QOF Indicators icon on the

Vision+ floating toolbar.

Moving the Alert Indicator Window By default, Alert Indicators appear in the bottom right hand corner of your screen. To

move the alert window to another part of the screen, simply drag and drop it to the

preferred position. Vision+ remembers your preferences so that you don't have to

keep changing the position each time you use it.

36

Re-sizing the Alert Indicator Window To re-size the Alert Indicator window, move your mouse pointer over the border of the

box. The mouse pointer will change to a Resize cursor.

Resize cursors

Click and hold with the left mouse button and drag the border until you are happy with

the preferred size. Release the mouse button to keep the new size.

Note - The size of the window is saved as your personal preference

and only changes if you resize the window again.

37

Vision+ Data Entry One of the main features of Vision+ is the ability to record key items of information

quickly and efficiently using intuitive data entry screens. These same data entry

screens are frequently used throughout Vision+. This section explains the most

commonly used screens and how to add data.

Read Code Data Entry in Vision+ The Read Code Data Entry screen is the most used tool in Vision+. From this screen

you can list and select individual or multiple Read codes. To access the Read code

Data Entry screen:

1. From Consultation Manager, select a patient and open a Consultation.

2. If your practice uses problems, open or create the relevant problem.

3. The alerts screen is displayed showing data that is missing from the patient

record (see Alert Indicators (page 31)).

Alert Indicator Screen

4. From the alerts screen either:

Double click on the indicator line

Highlight the Indicator line and choose the Contract icon on the

toolbar

Right click and choose Contract

Note - In order to add data you must have a patient open and a

consultation started.

Note - Do not use the Read Code Data Entry Screen to record

measurements such as BP, weight and height and smoking as they have their own data entry screens with specific boxes to enter values.

38

5. The Read Codeset screen is displayed.

Read Code Data Entry screen

6. In the Apply column, select the Read code you wish to use. You can also make

selections from the other columns:

Priority - Select from the

drop down list. If left blank

the Priority will be the same

as your default setting.

Where the entry does not

require a Priority eg tests,

this box is ignored and not

written back to the patient's journal.

Episode - Select the Episode

type from the drop down list.

If not selected the Episode

defaults to the same as that

in your setup. Where the

entry does not require an

Episode type eg tests, this

box is ignored and not

written back to the journal.

The default Episode type is blank.

Date Recorded - A date can

be entered or a calendar

appears if you choose from the drop down list.

Read Code - This is QOF

compliant and shows the

commonly used contract

codes. It is for information

only and cannot be changed.

Description - This is for

information only and cannot be changed.

Value - This box is for data

requiring numeric values. If

not required e.g. for history

entries this box should be ignored.

Comments - Optional freetext

comments can be accessed

from a pre-defined list.

Alternatively, you can start

typing freetext comments.

Comments

Button - Click on the

Comments button to setup a

pre-defined list. To enter a new

comment start typing. If you

press return you move to a

new line as if you are creating a

new comment. Click OK to save the changes.

Show More

Button - The QOF Read code

list is quite exhaustive which is

why the Read code list displays

the most commonly used

codes. Clicking Show More

allows you to expand the Read

selection.

7. Click OK to enter the data on the patient record. The alert for the missing data

is now removed from the alert screen.

Note - The Apply column is automatically ticked if you change any

of the other columns.

39

Adding Current Exception Read codes Exception codes are used when you want to exclude a patient from QOF. To enter an

Exception code:

1. From the Vision+ Alerts screen in Consultation Manager, highlight the

indicator line or the category heading you wish to exclude the patient from and

either:

Click the Exception code icon

Right click on the relevant line and select the Exception option

2. The Exception code screen is displayed.

Exception Code screen

3. Tick the box in the apply column for the required exception and click OK to

save the changes.

4. Where a patient is exempt from a full clinical domain, the whole category title

appears in red eg .

Expired Exception Read codes Previously used Exception codes for the selected patient are represented with an

Orange flag icon. If you hover the mouse over the exception icon it displays the

Exception Read code along with the date of the previous exception entry.

1. To add another exception code select the icon or right click and choose either:

Orange flag icon - Previously selected Exception code

Red flag icon - Choose a new Exception code

Exception Code icons

40

2. The Exception code screen is displayed.

Exception Code Screen

3. The previous Exception code is already selected, either click OK to save the

changes or choose another code.

4. Where a patient is exempt from a full clinical domain, the whole category title

appears in Orange.

Entering Additional Codes Additional Read codes are used to help monitor patient annual reviews.

They are displayed on the Alert Indicator screen under the heading Extra Indicators

and can be accessed by:

Double clicking on the line(s) below Extra Indicators

Highlight the indicator line and choose the Additional icon.

Right click and choose Additional from the menu.

The Read Code Data Entry screen is displayed, choose the Read code and click OK.

Note - Additional codes are used internally by the practice to

improve patient care and do not count towards QOF. Extra Indicators is

a user specific setting.

Recording Measurements and Values To help with recording of data, Vision+ has some additional screens that make it easy

to record everyday information such as Blood Pressure and BMI as well as various

calculators. These user friendly screens simply require the values to be entered and

the Vision+ will automatically add the appropriate Read codes for you.

Note about thyroid entering results - at the moment Vision+

allows you to enter alphabetical characters in the thyroid value box.

This will not save on the patient record. Please be sure to enter numerical values only.

41

Recording BMI Values

The BMI Data Entry screen is used to quickly input the height and weight values.

Vision+ will then calculate the BMI for you and record the appropriate Read code into

the patient's journal.

1. In Consultation Manager, from the Vision+ alert screen, highlight the indicator

and choose the BMI icon or right click and choose BMI.

2. The BMI form displays, select either Metric or Imperial.

3. Type the Height and Weight values or select by using the drop down list.

4. The BMI is calculated automatically and is stored in the weight SDA in Vision as

usual.

5. Enter the date or choose from the calendar.

6. The default Read code is 22K, but can be changed by using the drop down list.

7. Click OK to save the changes on the patient record.

BMI

Recording Blood Pressure Values

The Blood Pressure data entry screen can be used to quickly record the blood pressure

values.

1. Highlight the indicator line and either double click or choose the Blood Pressure

icon.

2. Enter the Systolic and Diastolic readings.

3. Record the date of the blood pressure or use the drop down list to choose from

the calendar.

42


BP

Recording Smoking Status

1. To record a smoking status, highlight the indicator and either double click, right

click or choose the smoking icon on the toolbar.

2. Select a smoking Read code and optionally enter a quantity.

3. Record the smoking date or choose from a calendar.

4. If the patient is a smoker or ex-smoker record the smoking cessation advice

and optionally enter a second cessation code.

5. Enter the date of cessation date or choose from a calendar.


Smoking

Note - When the smoking entry is added to the patient record, the

date started and date stopped boxes are not currently populated.

43

Using the Notes Summary Data Entry Screen The Notes Summary screen is an unique template that helps you summarise patient

records. It can be used to quickly input significant medical conditions and add new

patients to registers. The screen is split into two sections:

Indicators - Indicators are used to record measurements and QOF

information

Registers - Registers are used to quickly place a patient on a register

1. To access the Notes Summary screen, in the alerts screen, click on the Notes

not summarised indicator line which is listed below the Records and

Information section on the Alerts screen.

2. You can then either:

Double click on the indicator line

Right click and choose Notes Summary

Choose the Notes Summary icon from the toolbar.

Indicators screen

The Indicator screen enables you to record readings and measurements. You can also

choose which Read code you want to use to indicate that you have summarised the

clinical record.

Indicators Notes Summary Screen

You can use the drop down arrow icon to see a summary of any previous

readings. If you want to enter a new measurement, click one of the icons at the end

of the row to open the relevant Data Entry screen. For more information on the icons,

refer to the On-screen help.

Note - To view Popup Alert Indicators for the Notes Summary, the

Notes Summary setting must be enabled in the Settings screen. See Using the Settings Screen (page 115).

44

Registers screen

The Registers screen is used to quickly place a patient on your QOF register with the

appropriate Read code.

To view and record information use the toolbar to the right hand side of each line.

Register screen

When you have finished summarising the patient clinical record, click OK and the

entries are written back to the patient's journal.

45

Assessment Forms & Risk Calculators Vision+ has additional tools and utilities which make it even more useful when

capturing data for the contract as well as forms and calculators that help your practice

improve patient care. These forms and calculators are extremely intuitive and reduce

the clinicians workload by simplifying the process. They can be accessed by clicking on

Calculators from the Vision+ menu on the floating toolbar menu, and selecting from

the relevant group.

Calculator from Vision+ Floating Toolbar Menu

Alternatively, you can choose it from the Vision+ icon in the Windows Notification

Area (you must have a patient selected).

Calculator from Vision+ Icon in Windows Notification Area

The calculators are divided into five categories so that the correct calculator can be

quickly located.

46

Questionnaires

Many questionnaires are available to help the clinician assess the patient. The

answers provided by the patient allow the clinician to quantify and scale severity, and

then add the result along with the relevant Read code onto the patients record. The

questionnaires all work in the same way, following a published algorithm to convert

the answers given into a score. The Clinician can either turn the computer monitor to

face the patient and allow them to make their own selections, or the clinician can ask

the patient and record the answers given.

Questionnaires currently available are:

Asthma Control Test (ACT)

Alcohol Use Disorders

Identification Test

(AUDIT)

Depression

Fast Alcohol Screening Tool (FAST)

General Health

Questionnaire (GHQ12)

Mini Mental Health State

RCP3 Asthma Assessment

COPD Assessment Test (CAT)

CHADS2 score

for Atrial

Fibrillation

Stroke Risk

and Smoking Pack Years

General Practice Physical

Activity Questionnaire

(GPPAQ)

The following explains how to complete a questionnaire. The Audit questionnaire has

been used in the example below:

1. Select a patient in Consultation Manager.

2. From the Vision+ menu on the floating toolbar, select Calculators and choose

the required questionnaire:

Questionnaires

47

3. Once you have selected the required questionnaire, work through the

questions with the patient by clicking on the relevant answers.

4. When each page has been completed click then next page.

5. When all the questions have been answered the calculated score is supplied in

the bottom right-hand corner of the screen.

6. Select the Read code to be entered into the patients record from the Read

code drop down menu (the calculated score is added onto the Read code

selected).

7. Enter the Date or choose from a calendar.

8. If you want to add a priority, select it from the Priority drop down box.

9. Click on OK to save the Read code and Risk percentage.

Audit Questionnaire

ASSIGN CVD Risk Calculator

The ASSIGN CVD Risk Calculator can identify people free of cardiovascular disease

most likely to develop it over ten years. 'High risk' (score 20 or more) implies it

necessary for risk-lowering medication and/or other medical help. ASSIGN is the

cardiovascular risk score chosen for use by SIGN (Scottish Intercollegiate Guidelines

Network) and Scottish Government Health Directorates.

In order for the risk to be assessed, the calculator needs information on blood

pressure, cholesterol, and the number of cigarettes smoked per day. Without this

information the calculator cannot work out the risk. If one or more of these pieces of

data are not available then clicking on the relevant Mean button will use the Average

48

results for the patient’s age and sex as defined by ASSIGN (these values are NOT

recorded within the patient record).

Accessing the ASSIGN Calculator

1. From Consultation Manager, click on the Vision+ icon on the floating toolbar

and select Calculators - Cardiovascular - ASSIGN.

Accessing the Assign Calculator

49

2. The ASSIGN calculator is displayed:

Assign Risk Score

3. Missing patient data can be entered or updated by clicking on the relevant Add

Data icon at the base of the screen. If the data is not available then the

relevant Mean button can be used instead. The most recent data entry is

shown in the History column. Historical data other than the most recent can be

viewed by clicking on the history drop down icon.

4. If relevant, tick the Family History of Stroke/CHD and the risk score will be

amended as per the ASSIGN algorithm. Note that Diabetes diagnosis is not

taken into consideration.

5. When all the data is entered the risk in 10 years is displayed along with the

relevant Read code.


50

CHADS2 - AF Stroke Risk Calculator

CHADS2 is a method of calculating stroke risk in patients with atrial fibrillation. The

patient is allocated points based on their previous medical history in the following

areas:

Congestive Heart Failure

Hypertension

Age

Diabetes Mellitus

Strokes or TIA

The CHADS2 risk score is calculated using the following data:

Condition Criteria Points

C Congestive Heart Failure Any Read code starting G580% 1

H Hypertension Any Read code of G2% 1

A Age Over 75 years old 1

D Diabetes Mellitus Any Read code of C10% 1

S2 Prior stroke or TIA Any Read code of G6% 2

This results in a CHADS2 score of between 0 and 6 which translates to the annual risk

of stroke shown in the table below:

51

CHADS2 Score Stroke Risk %

0 1.9

1 2.8

2 4.0

3 5.9

4 8.5

5 12.5

6 18.2

Accessing the CHADS2 Calculator


and select Calculators - Cardiovascular - CHADS2:

Accessing CHADS2

52

2. The CHADS2 Calculator is displayed for you to use:

CHADS2 Calculator

53

eGFR Calculator

The eGFR Calculator is a tool used to measure kidney function, and is part of the

Chronic Kidney Disease requirements. The calculator incorporates two different

protocols and you can use either method.

The Sex, Age and any previously recorded Creatinine levels for the patient are

displayed (you can also type in the Creatinine result, but this is NOT recorded within

the patient record). You can then choose the Equation type – either Abbreviated

MDRD or Cockcroft and Gault. If you choose the former type, you will need to specify

the Race of the patient.

Accessing the eGFR Calculator


and select Calculators - Others - eGFR:

Accessing th eGRF Calculator

2. The eGFR Calculator is displayed for you to use:

54

eGFR calculator

55

If you choose the latter Equation type, the eGFR Calculator screen will change to the

one below.

eGFR Calculator - Equation

The Cockcroft and Gault Equation uses the patient's weight as part of the calculation

and this is picked up from previously entered data (you can also type in the weight

measurement, but this is not recorded within the patient record).

The eGFR value and recommended CKD Stage is displayed in the Result box.

1. Do one of the following:

Click the more icoon to choose an appropriate Read code for the CKD register if the result is Stage 3, 4 or 5.

Click the Exceptions button if the result is Stage 1, or 2, or if you

want to exception code this patient for any other reason.

2. Click OK.

56

Framingham CHD/CVD Risk Calculator

The Framingham CHD/CVD Risk Calculator is based on the Framingham index and

uses existing data such as Age/Sex, Blood Pressure, Cholesterol, Smoking Status,

Diabetes, and ECG readings to calculate a predicted risk.

The screen is split into 2 sections:

The upper section of the screen is used to display the data that has already

been collected by the calculator from the patients records. There are also some options that you can use to modify the calculation.

The lower part of the screen can be used to view historical information, or can

be used to input the relevant data. Use the drop down icon to see historical

data, or use the more icon to enter a Read code.

To access the screen and record information:


and select Calculators - Cardiovascular - Framingham CHD or CVD.

Accessing the Frammingham Calculator

57

2. The Framingham screen is displayed:

Framingham CHD

3. In the Blood pressure box, choose either the Systolic or Diastolic option to base

the calculation on that value.

4. In the period box, choose either the 10 years or 5 years option to base the

calculation on that time period.

5. Select the Read code to be entered into the patients record from the Read code

drop down menu (The calculated risk is added onto the Read code selected).

6. Enter the Date or choose from a calendar.

7. If you want to add a priority, select it from the Priority drop down box.

8. Click OK.

58

JBS 2 CVD Risk Calculator

The JBS 2 CVD Risk Calculator is based on the Joint British Soieties guidelines for the

prevention of CVD. It uses existing data such as Age/Sex, Blood Pressure, Cholesterol

and Smoking Status to calculate a predicted risk.

The lower part of the screen displays historical information, or can be used to capture

relevant data. Any data that has already been collected by the calculator will be

automatically pre-populated. If there is any data missing then it will be displayed in

Green and 'No Data Recorded' will be in the history column.

The data is recorded as below:


and select Calculators - Cardiovascular - JBS 2 CVD.

Accessing the JBS2 Calculator

59

2. The JBS 2 CVD screen is displayed:

JBS 2 CVD Risk Calculator

3. Use the drop down icon to see historical data.

4. You can Use the Contract icon to enter a Read code, or the BP icon in

the case of a blood pressure.

5. The information that is relevant is shown in the Patient Values area of the

screen. This can be altered to give a 'What If" scenario.

Note - Any 'What If' changes to values are not recorded within the

patient record.

6. The CVD Risk prediction is then plotted on the graph and using the legend you

can see the CVD Risk over the next ten years.

7. In the Read code box, select the Read code to be added from the drop down list

.

8. Enter a Date or choose from the calendar.

9. Click OK.

60

QRISK2 CVD Risk Calculator

QRISK2 is a cardiovascular risk score developed by Julia Hippisley-Cox at the

University of Nottingham.

QRISK2 (the most recent version of QRISK) is a prediction algorithm for

cardiovascular disease (CVD) that uses traditional risk factors (age, systolic blood

pressure, smoking status and ratio of total serum cholesterol to high-density

lipoprotein cholesterol) together with body mass index, ethnicity, measures of

deprivation, family history, chronic kidney disease, rheumatoid arthritis, atrial

fibrillation, diabetes and antihypertensive treatment. A QRISK over 20 (20% risk of

CVD event over the next ten years) indicates that primary prevention with lipid

lowering therapy (such as statins) should be initiated.

To access and complete the QRISK2 screen:


and select Calculators - Cardiovascular - QRISK2.

Accessing the QRISK2 Calculator

61

2. The QRISK2 calculator is displayed. Any relevant data from the patient record

is populated.

QRisk2 Score

3. Missing patient data can be entered or updated by clicking on the relevant tick

box, Add Data icon or list selection. Older data can be viewed from the

history drop down list.

4. To record the score, please make sure you have selected Read code -

38DP.QRISK2 CVD 10 year risk score.

5. When all the data is entered, select calculate.


62

Peak Expiratory Flow Rate (PEFR)

The PEFR Calculator can be used from the QOF tools. The PEFR calculates the patients

Peak Expiratory Flow Rate as a percentage of the target flow rate based on standard

data for that age and height.

To use the PEFR Calculator, do the following:


and select Calculators - Respiratory - PEFR.

Accessing the PEFR Form

63

2. The PEFR screen is displayed:

Peak Flow Rate

3. Enter the patients PEFR by typing it into the box or using the up and down

arrows.

4. The Height and Age should be displayed but can be altered/added as necessary

(please note that this change is NOT recorded within the patient record).

5. The Percentage predicted is then displayed.

6. Read codes can be selected from the drop down boxes and the Event Date can

be altered if necessary by clicking on the down arrow and selecting a date on

the calendar, or by typing the date directly into the box.

7. Click on OK to save the data.

64

ABPI Calculator

The Ankle Brachial Index (ABI) is the systolic pressure at the ankle, divided by the

systolic pressure at the arm. It has been shown to be a specific and sensitive metric

for the diagnosis of Peripheral Arterial Disease (PAD). Additionally, the ABI has been

shown to predict mortality and adverse cardiovascular events independent of

traditional CV risk factors.

To access the calculator:


and select Calculators - Other - ABPI.

Accessing the ABPI Calculator

ABPI Calculator

65

2. The ABPI calculator is displayed.

ABPI Calculator

3. Select either Dorsalis pedis or Posterior tibial.

4. Record the relevant blood pressures.

5. The Read codes and score are displayed at the base of the screen. Click OK to

record the data.

66

Add to Register You can quickly add patients to a QOF register using the Vision+ Add to Register

option.

1. From Consultation Manager, select Add To Register from the Vision+ menu

on the floating toolbar or right click on the Vision+ Icon in the Windows

Notification Area:.

Vision+ Menu on the Floating Toolbar

Add to Register from Vision+ Icon in the Notification Area

2. Choose the required register from the menu.

67

3. The Read Code Data Entry screen is displayed with QOF compliant Read codes.

Add to Register - Data Entry Screen

4. Choose the Read code by selecting Apply. You can also enter a priority and

notes.

5. When adding a patient to a register that also requires therapy recording to

count for QOF, a list of applicable therapy items is displayed below the Read

code list. You have the following choices:

If you want to add therapy – Tick the Apply box. If the drug is to be

prescribed as an acute prescription select Acute, if this box is not selected the drug is recorded as a Repeat.

If you have already recorded relevant therapy in Consultation

Manager – You can ignore this list.

Add to Register - Drugs

6. Relevant Vision prescribing support is displayed; click OK to save the data.

Note - Some QOF Categories require a drug to be present in

addition to the Diagnostic Read codes in order for the patient to appear on the register.

68

Patients who have an end date entered in history or problems in Consultation Manager

are automatically removed from the Vision+ register.

Extra Indicators Vision+ provides Extra Indicators which are used by the practice for recall purposes.

Extra Indicators help the practice monitor the QOF disease category recalls. These

Extra Indicators allow call/recall for the purposes of monitoring, assessments, annual

reviews etc. If the category already has a review as part of the QOF then that one

should be used. As with other templates, Popup Alert Indicators are available, and

patients can be sent letters from the Practice Reports screen.

Extra Indicators

In addition the template can be accessed just like any other QOF template. This is

done from the QOF templates list on the main Vision+ menu on the floating toolbar

or via the Vision+ icon in the Windows Notification Area . The data

can be input through the standard Read code data entry screen.

Note - To view popup alert indicators for the extra indicators, the

Extra Indicators setting must be enabled in the Settings screen.

69

Prevalence Searches Vision+ provides a number of data tidy searches which allow the practice to maintain

accurate disease registers. Prevalence Searches look for patients who have been

potentially overlooked and should be on a QOF disease register. If the patient should

be on a QOF disease register then the clinician can add the relevant Read code by

clicking on the Contract icon in the usual way from from the Read code data entry

screen. If the patient should not be on the QOF disease register then they remain on

the Prevalence Searches list. All the usual functionality associated with patient lists

are available. As with all other templates, the popup alert indicator will appear

advising the clinician of the Prevalence Search.

An example of a Prevalence Search are patients with Asthma related Read codes who

do not have an Asthma diagnosis. It may be that the patient has a History of Asthma

Read code but no Diagnosis Read code, and they may need one adding on to their

record. This can then easily be done through Vision+.

Register Checks Another data tidy search that Vision+ provides is the Register Checks. Register

Checks display a list of patients who may have fallen off a Register due to some

reason.

An example of a Register Check is a patient who has an Epilepsy diagnosis Read code

but has not been prescribed Epilepsy drugs in the last year. For a patient to be on the

Epilepsy disease register they are required to have an Epilepsy diagnosis Read code

and to have been prescribed Epilepsy drugs within the previous year. The patient

therefore may have been overlooked, or may not be taking their Epilepsy drug.

As with other templates, popup alert indicators are available, and patients can be sent

letters from the Practice Reports module.

Note - To view Popup Alert Indicators for the Prevalence Searches,

the Prevalence Searches setting must be enabled in the Settings

screen.

71

Vision+ Contract Templates Contract Templates are designed to collect QOF information in a step-by-step protocol

based format. They are the same as Contract Indicator Alerts in that they show "real

time" data and use the same colour coding scheme.

Contract Templates

72

Overview of the Contract Template Screen

Below is an example of a Contract Template Screen.

Note - The Template screens vary depending on the disease area

highlighted eg some Templates have questionnaires on the toolbar.

Contract Template screen

73

Summary - Viewing or Adding data to a Template

To add data to a Template, highlight the line and choose one of the following Data

Entry icons at the end of the line:

Icon Function Icon Function

Previous Entry - This

blue icon indicates that

the patient does not have any previous records.

Smoking - Selecting this icon

launches the smoking data

entry screen and allows you to

record the patient's smoking status.

Previous Entries - When

the row contains more

than one relevant Read

code, a drop down arrow

appears in red to alert you

that more Read codes are

available than the one

currently being displayed.

Where numeric data is

recorded a graph is also visible.

Blood Pressure - Selecting this

icon displays the blood pressure

data entry screen and allows you

to record a patient's blood

pressure details.

Contract Read Code -

The Contract icon takes

you to the Read code Data

Entry Screen where Read

codes can be chosen from

a predefined list of

relevant contract Read

codes.

BMI - Choosing this icon

displays the BMI data entry

screen and allows you to record

a patient's BMI status.

Exception - Choosing

this icon allows you to

enter an exception code from Read code list.

CHADS - This icon provides

quick access to the CHADS

calculator screen.

Rule Logic Exception -

Choosing this icon displays

the rule logic exception

screen for the highlighted

indicator

Depression Questionnaire -

This icon provides quick access

to the Depression Questionnaire.

Rule Logic - This displays

the logic screen for that

highlighted indicator.

Undo - The Undo Last Entry icon

deletes the Read code previously

entered on that line during the

current session. If multiple Read

codes are added then the most

recently added one is deleted

first. If no Read codes are

available to be deleted this icon

is greyed out.

GPPAQ - This icon provides

access to the Physical

Activity Questionnaire.

Undo All Entries - The Undo All

option allows you to remove all

entries added to a Template.

74

Using Contract Templates

The QOF Templates can either be selected by:

Highlighting any line on the alert indicator screen and choosing the Show

Template icon or right clicking and choosing Show Template. This option takes you directly to the clinical or public health domains.

Alert Indicator - Contract Template

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Alternatively, you can choose QOF Templates from the Vision+ menu on the

floating toolbar or from the Vision+ icon in the Windows

Notification area. This gives you the option to view all Templates or select a specific one.

Vision+ Menu on the Floating Toolbar

Vision+ Menu from the Windows Notification Area

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Toolbar

The Toolbar is used to access the various functions e.g. contract codes, depression

questionnaire, BP measurements, etc. By highlighting a line the relevant icons on the

toolbar become enabled or disabled depending on whether they are available for use.

Most of the icons on the toolbar are duplicates of those that appear alongside each

category. This means that you can also access them by clicking on the icon alongside

the relevant line. The exception to this is the Indicator logic icon which always displays

on the toolbar but not against the line.

Contract Template Toolbar

Default Date

The default date can be altered by either typing the date into the box or selecting a

date from the drop down calendar . Any Read codes entered

within Vision+ will then assume the default date. Consultation Dates within

Consultation Manager are not applied to Vision+ data entry and vice versa. Any Read

codes added before changing the default date will be unaffected. The default date is

set to the current date by default.

History Tab

The History icon is located at the end of the line and is used to display historical

data for the particular indicator or category selected.

History

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Only the most recent Read code is displayed in the history column. If the row contains

none or one relevant Read code, a blue arrow key icon is displayed. If the row

contains more than one relevant Read code, the drop down arrow appears in red

to alert you to the fact that more Read codes can be viewed.

Historical Data

To close the history screen click the icon. The window can also be resized by

clicking and dragging the resize icon .

The following options are also available when viewing a patient's history:

To the left of the history icon is the history column which shows the most

recently dated relevant Read code. When the cursor rests over the

history column a popup window displays the entire history line, which is useful if it exceeds the width of the history column.

To the left of the history column is the indicator name column which

shows the names of the indicators.

Status Bar

The status bar located at the bottom of the screen displays the history of the currently

highlighted line along with the date and any relevant values.

Contract Icon

The Contract

icon takes you to the Read code data entry screen where Read codes can be chosen

from a predefined list of relevant contract Read codes.

Undo Last Entry

The undo last entry icon deletes the Read code previously entered on that line

during the current session within the current template. If multiple Read codes are

added then the most recently added one is deleted first. If the undo last entry button

is used again it proceeds to remove the Read codes in the reverse order to which they

were added. If no Read codes are available to be deleted then the icon will be greyed

out .

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Undo All Entries

Some Vision+ templates have data entry screens that only show the Read codes

selected once the data is saved in the patient's record. Other data entry screens show

the data in the template as soon as it is selected. This has caused confusion when

using the "undo last entry" option because you have to click through multiple

entries (some of which are not visible), before the data is removed. The Undo All

option removes all entries, regardless of whether they are visible or not.

Vision+ Templates - Undo All Entries

Tabs

Tabs are used to break down templates into smaller and easily manageable portions

(If necessary). Select the tab you wish to view by clicking on it, or alternatively use

the previous and next buttons to move systematically through them. The history tab

is always present and is used to quickly view the history of all GMS contract relevant

data present in the patient’s notes.

Next Tab and Previous Tab Buttons

The next tab button moves forward to the next tab in the series. The previous tab

button moves back to the previous tab in the series.

Previous and Next Tab

Note - Undo last entry can still be used to remove individual

entries.

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Next and Previous Buttons

You can use the next and previous buttons to move to the next or

previous linked template. This is particularly helpful when a patient is on multiple

registers and you need to move from one template to another.

Next and Previous options

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Viewing Details of Contract Information

At times, you may find it useful to be able to see what clinical information is recorded

for a patient. From the contract templates, you can click the history tab along the top

and see a categorised view of different types of information. Displayed within the

history tab are Read codes, Active Repeats, Acutes, Inactive Acute/Repeats, and

Additional Information.

Viewing Details of Contract Information

For example, if you are unsure of when the blood pressure readings have been

recorded for a patient, you can use the Expand and Collapse icons to view this

information. You can also quickly see from this screen, which staff member has

recorded the data.

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Listing and Graphing Historical data

The latest record is always displayed on the Template screen but you can look at

historical data and where appropriate graph the information. The red icon at the

end of the row indicates you can view more entries. A blue arrow icon signifies

that there is only one record.

Graph

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Viewing All Templates

Using the All Template option you can view all QOF Categories.

To access all templates in Consultation Manager, click on the Vision+ menu in the

floating toolbar or right click on the Vision+ icon in the Windows

notification area, select QOF Templates and select All Templates. You can now

view the QOF categories.

All Templates

Alternative methods of Opening a Contract Template You can also open up a contract template screen from the Patient List screen. Right

click on a patient's name and choose Show Template.

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Practice Reports

Overview - Practice Reports An essential element of the GMS Contract lies within the management of patient

recalls, monitoring of point targets, and the ability to produce statistical, up-to-date

reports.

Contract Administration tools have been designed to help facilitate the management

aspect of the GMS Contract and assist practices with achieving the required targets.

You can be sure that the information you see in target lists, recall management, point

totals, and payment details is a true reflection of the status of the practice.

Accessing the Practice Reports Tools The Practice Reports module can only be opened if you have Consultation Manager

and other Vision+ modules closed.

To access the Practice Reports module:

1. Login to Vision.

2. From the Windows Notification Area, right click on the Vision+ Icon and

select Practice Reports.

Accessing Vision+ Practice Reports

Note - To access Practice Reports, you must not have a patient

selected in Consultation Manager else the patient-specific menu displays.

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3. The Practice Reports module opens by default on the QOF page.

4. Click on the required report to run it. When the report has run, it appears on

a new tab, enabling you to select the Home tab to run a new patient list or

design Patient Recall Letter Templates (page 87). When a new patient list is

run it replaces any previously run ones.

Using Patient Target Lists One of the most useful features of the Practice Reports tool is the Patient Target Lists.

Based on your 'live' data, these lists can readily provide you with your clinical

registers, 'tidy-up' lists and targets for patients with missing indicators, and can be

run off whenever you need them.

You can use them to update patient information, see which patients have more value

than others, create and manage recall letters, view point totals for the category, and

see which staff members are contributing towards the points.

To view the Patient Target Lists click a Category option for the list that you want to

work with.

Note - You can schedule the All QOF Report to run on a set date

and/or time. See Vision+ Scheduler (page 113).

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Patient Target Lists

When a report is run, the Patient List screen is displayed showing the results. The

example below shows the Cervical Screening report:

How Patient List Information is calculated

For Patient Lists that are run from Practice Reports, information is calculated using the

current date as a reference and should reflect what is shown within the popup alerts

screens (which is different to the default Patient Lists available from within Contract

Manager). The same colour-coding is applied to patients within the list.

If you access the Patient List from within Contract Manager, information is calculated

using 31 March 2014 as the reference date with any exceptions taken into account.

You also have the advantage of being able to see both positive lists (completed

indicators), as well as negative lists (missing indicators).

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Working with Data within the Patient Target Lists

Recording Information Using Patient Lists

Just like the Contract Indicators and Templates, the Patient Lists also allow you to

quickly record information using the data entry tools.

You can use the toolbar buttons at the top of the screen to add Contract codes,

Exception codes, additional information and the relevant Template. And because of

the 'real-time' aspect of the software, any information you record will update the

patient's medical record straight away and disappear from your list.

Printing a List of Patients on a Patient List

You can print the list of patients who appear on a Patient List to obtain a hard copy.

This can be useful for handouts or allocating tasks to other members of staff.

A copy of the current screen view can be printed by clicking on the Print button on the

Toolbar, or to view it first click on Print Preview on the Toolbar ( ). It is

necessary to expand ( ) or collapse ( ) the Category headings and descriptions

before printing as the printed copy is an exact view of how it appears on the screen.

Looking at Other Indicators for Patients in the Patient Lists

For any of the patients who appear within the GMS Contract Patient Lists screen, you

can quickly see any other indicators that need to be completed. Simply right-click on

any patient name and from the popup menu and choose Show Indicators ( ).

See

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