Referral Issues Using EMIS LV
Contents
1. This is used to send any laboratory link results such as blood tests with a Choose and Book referral Feedback from providers alerted this programme office to a problem Results under the investigations tab are being recorded twice in Choose and Book See example screen shot below which shows the information highlighted within the blue box duplicated in the red box underneath Investigations tab Duplicated information 3 NHS Choose and Book Microsoft Internet Explorer Olve Jackie Pamela Service Provider Clnician A choose and book Appointment Summary fC A tment Serum TSH level Details Original text Serum TSH level Referral Letter Details Clinically relevant date date 28 08 2008 Investigations Priority Conditions Routine a Battery Serum TSH level 102 34 mu l Clinically relevant date 28 08 2008 Observation date 29 08 2008 Above high reference limit Normal Range from 0 35 1 Original Value 0 35 Original Unit mu L to 5 1 Original Value 5 Origina Serum TSH level 102 34 mu L Clinically relevant date 28 08 2008 Observation date 29 08 2008 Above high reference limit Normal Range from 0 35 1 Original Value 0 35 Original Unit mu L to 51 Original Value 5 Original Unit mu L Plasma glucose level Original text Plasma glucose level Clinically relevant date date 28 08 2008 Priority Routine Battery Plasma glucose level 5 3 mmol L Clinically relevant date 26 08 2008 O2. Choose and Book screen is immediately closed before it fully opens Attaching a scanned document to a referral that is more than 12 months old Referral letter not attached Full details of the tests including screen shots can be found in the next section Version 1 4 Page 7 Surrey Results Test 1 EMIS LV Prescribed Work Flow In order to achieve a successful electronic referral the following steps must be adhered to Search for a Patient Select F5 and search for a patient as normal Consultation Mode Select CM for consultation mode and record details as normal Referral At the point when the GP decides to refer the patient select R to begin the referral process P Template ent Comment explanation Summary History Additional Brief summary Examination Date doctor place Next problem Medication X ray lab requests View sections Mentor Referral Lab results l ndividual Problem Quick keys lt File gt lt Pgup gt lt sF2 Mentor gt Choose and Book Select the referral method In this case we are using Choose and Book Referral Method B Choose amp Book Version 1 4 Page 8 NHS Surrey Read Code Enter the relevant 8H referral read codes Note the prescribed work flow requires both a high level chapter 8 read code followed by a low level chapter 8 read code Each read code selected must have three bytes for the process to be successful For example Referral to Physician is 8H4 High Leve
3. Clicking on the filename gives the impression of a blank document with only a single character that looks like a small square The content of the document is not displayed oe The referring practice will not be aware of anything wrong unless they are first contacted by the Provider EMIS are aware of the issue and it currently sits within their development department under Software Bug ID 27743 Version 1 4 Page 25 Surrey End of Document X Z a Z Version 1 4 Page 26
4. No UBRN retrieved The result will be e No UBRN in EMIS Consultation e No UBRN in EMIS RF screen e One UBRN in Choose and Book Test 10 Attaching a Scanned Document that is Older than 12 Months In this scenario the user attempted to upload a scanned document to the patient s UBRN However when the electronic referral letter screen opened this document did not appear as an option In fact all the documents that were available for uploading to the UBRN were under 12 months old Version 1 4 Page 14 Surrey Test 11 Referral Letter Not Attached A patient booking their appointment at their chosen provider opens the door for that provider to view the referral letter as soon as it is attached The referral letter will be printed and presented to the relevant Consultant or viewed on line to make the decision to accept or reject The Consultant is able to do this because there is now a legitimate relationship Where a user at the GP practice is going through the process of attaching a referral letter to a UBRN the referral letter must be ticked prior to clicking send However in a busy practice setting where this step is omitted EMIS LV allows Choose and Book to think that the letter has been attached In the Activity work list the Referral Status will change from Not Sent to Not Reviewed See example screen shots below Electronic Referral Letter UBRN 000090022391 Date of Referral 7 8 2006 Urgency Referrer MR MA
5. when using Choose and Book integrated with EMIS LV Three of the main issues are highlighted below Issue 1 Documents Scanned with Docman PCTI A number of practices using Docman PCTI to scan external documents into patient records are currently experiencing a problem when attaching these documents to a Choose and Book referral Docman PCTI saves scanned documents with an XX2 file extension which should be stripped out by the EMIS LV software so that it is saved in patient records as a TIF file The EMIS software that is responsible for this function has a bug in it The screen shot below clearly shows the XX2 file extension that appears within the Electronic Referral Letter screen Electronic Referral Letter UBRN Date of Referrak 9 4 2009 Urgency Routine Referrer Dr Ivan Ratnayake Reason Term Read Code Cardiological referral Provider Unit Speciality Consultant Referral Problem Non Free Text Narative Consultations Problems Medication FamilyNistory Investigations Values Social Attachments Date Description EBS Compatible only A 09 04 2009 IR AD ref to Cardiology CO EDICS rtf gt 01 04 2009 Result Epsom General Hospit l Cardiology ECG Result 26 3 2009 D7_00091810 TI XX2 O 26 03 2009 IR AD ref to Orthotics via orthopaedics C O EDICS rtf Version 1 4 Page 20 INHS Surrey To date this programme office has seen the fault in four surgeries and this has been logged with the f
6. INHS Surrey Referral Issues Using EMIS LV This document highlights the problems that can occur when deviating from the prescribed work flow using EMIS LV integration software with Choose and Book It also provides a record of on going technical issues that users may experience when referring patients or attaching referral letters Workarounds are provided where applicable Surrey PCT Choose and Book Programme Office Version 1 4 Page 1 Surrey Contents Management Summary sates eet nctewbbieiwastsabasnetdarnenkiietdanbnetwochbieessuabcuimeubhiulldwabtoucebbentone 3 Part One EMIS LV Workflow Problems cccceeeeeeeeeeeeeeeeeceeeeeeeeeesesnneeeeeeeeeees 4 IMrOdUCHOM ioina ea aa 5 ACi Laroo 0 010 iY APMAA n 6 RESUMS oono d a aaeeei aaae e TEER 8 REE a E A EEEE E ET ETE ATEA 8 TESE 2 oe EEE EE E E E E EE OE A E E 11 TEST anae een ee A ea AE at sce cere se cee ee eet EEE 11 TSE a a a a a a 12 TESS acae A EE 12 TESCO ea E E eeeeemsame 13 KESET masea te ce sas ire mc nee E E EE A A eaceceneeteeees 13 VESEO meneri are A A T A A A 13 TESTO ane teeter ied cece S E E E E A E 14 TeSt TO e a e e E renee er errs 14 TESEI Tietia aa aa a aaaea araea 15 Part Two NHS Surrey Response to EMIS LV Problems ccccceeeeeeeeeeeeeeeeeees 17 Development Change Requests ccccccceeeeeseeseceeeeeeeeeeeeeesaaeeeeeeeeeeeeesnnaeeeeeeeees 18 Part Three EMIS LV Technical ISSUCS cccce
7. MIS does not allow the option to edit the consultation in order to change it to a Choose and Book referral A message will appear stating Referral has already been entered on this date The user is able to cancel the existing entry although EMIS does not recognise this and therefore prevents any further modification to this referral This was reported to EMIS under ECR 4947864 There is now a software bug ID27279 to fix the problem In the interim period EMIS suggest the following workaround e Click F1 to exit the consultation e Select Y to cancel the existing entry e Click F8 to file the deleted referral this allows the user to add a new referral Version 1 4 Page 24 Surrey Issue 5 Incorrect Encryption of Referral Letter This is an intermittent issue where documents that are uploaded to a Choose and Book referral are not being encrypted successfully Referral information is omitted from the message sent to Choose and Book However the filename as shown in the example below is clearly visible to the Service Provider Appointment Requ st Details Referral Details Referral Letter Details Referral Letter Created Date Time 23 01 2009 10 12 am Requested Action Not Specified Priority Routine Referred By Name Investigations Conditions Organisation Name Organisation Address Organisation Phone Requested Action Comments Referrer Attachments File Name File Description Gynae rtf
8. RTIN GIBBON Reason Term Read Code Admit surgical emergency unsProvider Unit Speciality Consultant Referral Problem None Free Text Narative Medication Social Attachments Date Description EBS Compatible only C 17 07 2006 ENT Referral 0706 rtf Select the attachments to send Default Selections On Send Cancel Here the referral letter has not been ticked prior to clicking send There is no warning preventing the user from proceeding Following clicking send the Referral Status in Choose and Book will change from Not Sent to Not Reviewed This informs the user that a referral letter has been sent Version 1 4 Page 15 INHS Surrey This error will be picked up by the provider when the patient has booked an appointment When the provider clicks on the UBRN the screen will show that no referral letter has been attached even though it displays Referral Letter Details in the left hand column and no file name s appear below Referral Attachments Appointment Details Referral Details Referral Letter Details Please review the attachment s before you action this referral Referral Letter Created Date Tin Requested Actior Priorit IE Urgarasation rnone Requester hior amenents UE J This leaves the provider with two options e The provider must take the time to contact the referring practice to resolve e The provider may reject the referral This creates additional work load and can affect
9. Referral Repeated In this scenario the GP completes the prescribed work flow correctly up to the point of launching Choose and Book from the Consultation screen The GP is unsure of the next step and minimises EMIS LV to launch Choose and Book from the desk top EMIS and Choose and Book are no longer integrated They are working as two separate systems The GP searches for the patient clicks on Refer Advise and completes the mandatory fields required in Choose and Book This creates a referral from the web based Choose and Book system The GP then closes Choose and Book and returns to EMIS The GP is forced to press any key in order to continue This results in Choose and Book launching from EMIS LV The GP then completes the remainder of the prescribed work flow closing Choose and Book at the end and filing the consultation This second referral is created from the integrated system The result will be e One UBRN in EMIS Consultation which relates to the second referral e One UBRN in EMIS RF screen which relates to the second referral e Two UBRNs in Choose and Book Test 8 Web Based Choose and Book Launched Once and then Closed following a Second Launch This is a repeat of test 7 up to the point of clicking any key to continue This launches Choose and Book but in this scenario the GP closes the Choose and Book screen without completing any fields The consultation is then filed Note that the results are the same whether the user wait
10. Referring Select this document from the GP System Supplier Integrated User Manuals This offers you full details of the national work flow and is divided between narrative and screen shots e EMIS LV Quick Guide Referring Clinicians Select this document from the End User Quick Guides This offers you a handy desk aid with simple step by step pointers In many cases GP practices have developed in collaboration with the NHS Surrey Choose and Book programme office local guides that take account of existing practice work flows and local pathways These local guides must however still conform to the prescribed work flow by EMIS LV The NHS Surrey Choose and Book programme office feel that users of EMIS LV integrated with Choose and Book are occasionally able to deviate from the set work flow with ease This causes problems during the referral process Version 1 4 Page 5 Surrey Methodology Initially a series of tests were conducted at three different GP practices using EMIS LV integrated with Choose and Book Two test days were conducted jointly by Mike Bernstein from NHS Surrey and Jan Malin EMIS LV Programme Manager for South East The third test was conducted by Mike Bernstein in order to clarify results and produce this report It was not possible to replicate operational conditions during these tests There were no time constraints to contend with or patient expectations to manage On each day the first test was the presc
11. act 8H9 K No follow up arranged 8HA lt PgDn gt Selecting Option A will bypass the low level chapter 8 read code screen and take the user straight to the Consultation screen Here the GP clicks Return to launch Choose and Book The result will be e No UBRN in EMIS Consultation e No UBRN in EMIS RF screen e UBRN created in Choose and Book Version 1 4 Page 11 INHS Surrey Test 4 Low Level Chapter 8 Read Code Not Selected In this scenario the GP completes the work flow up to the point of the high level chapter 8 read code screen Here the GP correctly selects a three byte read code but then fails to navigate further down the hierarchy and select a low lever read code from the next screen Instead the GP clicks Return and completes the remainder of the process The result will be e No UBRN in EMIS Consultation e No UBRN in EMIS RF screen e UBRN created in Choose and Book Test 5 Two Referrals in the Same Consultation using N for Next Problem Occasionally a GP will be required to refer a patient for two separate problems within the same consultation EMIS should allow a GP to simply move onto the next problem without the need to create a new consultation Despite this need EMIS offer no guidance in their End User Manual or Quick Reference Guide In this scenario a GP completes the prescribed work flow apart from the final step of filing the consultation When the Choose and Book screen is closed the GP is broug
12. bservation date 29 08 2008 Normal Range from 3 1 Original Value 3 Original Unit mmol L to 11 1 Original Value 11 Original Unit mmol L Plasma glucose level 5 3 mmol L Clinically relevant date 28 08 2008 Update Person Add Cinkcal Information Add Addional Requeements C This site is secured using 128 bX SSL encryption Trusted stes start GH EC J mal Read mc AB NHS Choose and Boo Practice Detals ED Microsoft Excel SEIER E As you can see from the above example the trusts are experiencing printing off a large number of pages containing duplicate results Version 1 4 Page 22 Surrey This issue has been reported to the following interested parties e EMIS Software Bug ID 25701 e NSD 301784 It is understood that the Message Implementations Manual MIM provided by CfH specifies the structure of the message and how Choose and Book displays this information based on that structure MIM s have been previously agreed between CfH and EMIS following compliance testing some time ago It is hoped that EMIS and CfH are now re visiting the MIM s All users are anxiously awaiting a response on how to manage this issue until a fix can be agreed and the timescale for the fix Version 1 4 Page 23 INHS Surrey Issue 3 Attaching Scanned Documents One of the benefits of using the integrated system is that it is a fast and simple process when attaching documents to a referral However EMIS has expe
13. eeeeeeeeeeeeeeeeeeeeeeeeeeseeneeeeeeeeees 19 Issue 1 Documents Scanned with Docman PCT cccceeeeeeeeeeeeeeeeeeeeetneeeeeeeees 20 Issue 2 Duplications of Investigations cceceeeeeeeeeeeeeeeeeeneeeeeeeeeeeeeeeeenneeeeeeeees 22 Issue 3 Attaching Scanned Documents cceceeeeeeeeeeeeeeeeeeeeeeeeeeeeenenteeeeeeeess 24 Issue 4 Editing an Existing Consultation to Refer by Choose and Book 24 Issue 5 Incorrect Encryption of Referral Letter ssssssssssessessssessesseeeees 25 Version 1 4 Page 2 Surrey Management Summary This report was commissioned by the NHS Surrey Choose and Book Programme Manager Its purpose is to raise awareness to weaknesses in the EMIS prescribed work flow and current technical issues that affect operational effectiveness Referring a patient in today s modern NHS can be extremely complicated There are many variations in care path and decisions have to be made within a brief consultation In contrast the EMIS LV system integrated with Choose and Book only requires a standard sequential approach The only variation is the clinical decisions required to meet the needs of the patient A referring GP will often fall at the first hurdle where this simple sequential approach goes wrong EMIS does not alert the user to errors made in the process or attempt to steer them in the right direction NHS Surrey feels that the user ex
14. fferent specialties in the same consultation The alternative to test 5 and 6 is for the GP to complete the first consultation end to end and then begin a new consultation for the second referral The request states that at present a user must first file a consultation before beginning an additional Choose and Book referral This means that although the patient only saw the GP once two separate consultations are created This is not a true reflection of the patient care and the consultation figures are then ambiguous Time and reporting would be saved if there was the ability to add two Choose and Book referrals into the same consultation DCR for Test 10 submitted 21 April 2009 The request is for the option for a practice to be able to select documents older than 12 months when attaching to a Choose and Book referral DCR for Section 888 Discussions submitted 21 April 2009 The request is relating to the attachment of a referral letter When accessing the Choose and Book electronic referral letter screen it is possible for the user to click send without selecting any attachments In order to avoid this please insert a message to alert the user For example At least one attachment is required before submitting the referral letter Version 1 4 Page 18 Surrey Part Three EMIS LV Technical Issues Version 1 4 INHS Surrey Technical Issues A number of technical issues are also affecting prescribed work flows
15. ht back to the EMIS consultation screen The patient requires a second referral and so the GP selects N for Next Problem P Template entry ent explanation Summary History pr Otocols Additional Brief summary Examination Follow up Date doctor place Next problem Medication X ray lab requests View sections Mentor Referral Lab results l ndividual Problem Quick keys lt File gt lt Pgup gt lt sF2 Mentor gt The user then completes the remainder of the process and files the consultation The result will be e One UBRN in EMIS Consultation which is the first one that was created e Two UBRNs in the EMIS RF screen e Two UBRNs in Choose and Book Version 1 4 Page 12 INHS Surrey Test 6 Two Referrals in the Same Consultation without using N for Next Problem This test follows the pattern of test 5 but instead of selecting N for Next Problem after completing the first referral the GP simply clicks R for Referral When prompted the user does not cancel the existing entry and then follows the work flow to the end including filing the consultation The result will be e Two UBRNs in EMIS Consultation e Two UBRNs in EMIS RF screen Both UBRNs are linked to the second referral Moving between the two episodes displays the two different specialties e Two UBRNs in Choose and Book e A Referral Letter could only be successfully attached to the second UBRN Test 7 Web Based Choose and Book Launched during the Process and
16. l 8H Read Code A low level chapter eight read code must also be selected in order to determine the exact care path and prepare analysis information on the EMIS system For example Dermatology referral Low Level 8H Read Code Version 1 4 Page 9 Surrey Launch Choose and Book This screen requires a user to click the return key to accept the referring GPs initials New Referral oP teferring Dr Cw This will bring the user back to the consultation screen Clicking return again requests the next sequential UBRN which will appear in the consultation on completion The Choose and Book screen is also launched Referral Dermatological referral Problem title Template entry Comment explanation Summary History pr Otocols Additional Brief summary Examination Follow up Date doctor place Next problem Medication X ray lab requests View sections Mentor Referral Lab results l ndividual Problem Quick keys lt File gt lt Pgup gt lt sF2 Mentor gt Complete Choose and Book Mandatory Sections In the Choose and Book screen the GP will complete the following sections e Search for Services and select Request and Submit e Print the Appointment Request and Password e Log Out File Consultation Having closed Choose and Book the GP is brought back to the EMIS screen and must now select F8 to file the consultation The process is now complete The UBRN can now be viewed in e EMIS Consultation e EMIS RF screen e Cho
17. ollowing ECR numbers ECR 5085645 ECR 5187610 ECR 5212587 ECR 5219973 Users are following the correct process when attaching documents using EMIS integration during which time no warning or alert messages appear The referral status in the Choose and Book activity work list changes from Not Sent to Not Reviewed to indicate that the transmission is successful The practices were only alerted to the problem by the providers who could not open the documents and rejected them on this basis Although EMIS are aware of the issue and have confirmed that there are a number of practices around the country that are affected there are questions that remain unanswered e Are all EMIS sites that could potentially be affected aware of the issue e What check could users make in order to recognise the issue e What is the work around if they do become affected e What is the timescale for a fix EMIS Workaround EMIS have advised the practice of a workaround This is to save the letter again before uploading and manually removing the XX2 extension or to advise the hospital to open the file with an image viewer which will display the document This programme office feel that this workaround is time consuming and unacceptable Version 1 4 Page 21 INHS Surrey Issue 2 Duplication of Investigations All practices in Surrey PCT are encouraged to make full use of the investigations tab within the Electronic Referral Letter screen
18. ose and Book Version 1 4 Page 10 INHS Surrey A UBRN in the locations identified in test one ensures that the remaining part of the process such as uploading the referral letter will be successful Test 2 Chapter 8 Read Codes Omitted In this scenario the GP completes the work flow up to the point of the high level chapter 8 read code screen Instead of selecting a three byte code the GP clicks return This immediately launches Choose and Book without any warning that important steps have been omitted from the process The result will be e No UBRN in EMIS Consultation e No UBRN in EMIS FF screen e UBRN created in Choose and Book Test 3 Option A Referral for Further Care Selected as a Read Code In this scenario the GP completes the work flow up to the point of the high level chapter 8 read code screen Here the GP selects Option A Referral for Further Care This is only a two byte read code and should not be used because it affects the prescribed work flow and will not produce useful analysis information for the practice regarding referral patterns Entry All Enter free text line label or move cursor lt gt to back up Admit to intensive care unit Cs ES B C Emergency hospital admission 8H2 D Non urgent hospital admission 8H3 E Referral to physician 8H4 F Referral to surgeon 8H5 G Referral to other doctor 8H6 H Other referral 8H7 I Follow up arranged 8H8 J Planned telephone cont
19. perience can be significantly improved by the introduction of the changes highlighted in this report This will allow GPs to concentrate on clinical decisions The report is divided into four parts described below Part One EMIS LV Workflow Problems Part Two NHS Surrey response to EMIS LV Problems Part Three EMIS LV Technical Issues Version 1 4 Page 3 Surrey Part One EMIS LV Workflow Problems Version 1 4 Surrey Introduction Choose and Book is a national computer system that supports the secure electronic transfer of referral information from a GP practice to a secondary care provider In order to successfully embed this system into existing operational processes within a GP practice clinical suppliers developed integration software This software links Choose and Book to a GP system such as EMIS LV Combining Choose and Book with EMIS LV necessitates the need for strict prescribed work flows to be adhered to that meet both national and local protocols The current national work flow can be found on the Choose and Book web site This has been agreed between EMIS LV and Choose and Book Two documents are available to view print or save to your desk top for quick reference To access press and hold the control key and left mouse click on the link below When Choose and Book opens select the relevant document described below www chooseandbook nhs uk staff live training index_html endusermanuals e EMIS LV
20. ribed work flow This was then followed by all the possible deviations a user may incur during the referral process Below is a list of all the tests conducted including a basic description e Test 1 EMIS prescribed work flow This must be followed in order to create a successful referral where there will be a Unique Booking Reference Number UBRN in the Consultation Patient Referrals RF screen plus Choose and Book e Test2 No Chapter 8 Read Codes have been selected e Tes3 Option A Referral for Further Care was selected as a Read Code e Test4 No low level Read Code was selected For example the user clicks Referral to Physician but then bypasses the next screen e Test5 Two referrals created in the same consultation using N for next problem This is the prescribed EMIS work flow under these circumstances Version 1 4 Page 6 INHS Surrey e Test6 e Test 7 e Test 8 e Test 9 e Test 10 e Test 11 Two referrals created in the same consultation without using N for next problem EMIS is minimised and Choose and Book launched from the web site Upon return to EMIS Choose and Book is launched again and the web based referral is repeated This is the same as test 7 up to launching web based Choose and Book for the second time In this test however the Choose and Book screen is closed after fully opening and without completing any fields This is the same as test 8 but the second launch of the
21. rienced problems in the past when a scanned document is required to be uploaded that is more than 12 months old After selecting the document and clicking send in the electronic referral letter screen the system would often time out and the user would be presented with an XML Time Out Error message EMIS have researched this problem and discovered that when a document is selected for upload the system searches through the patient s entire medical history This caused the time out issue In order to resolve this EMIS have withdrawn from the electronic referral letter screen all documents that are older than 12 months There are two workarounds First to call the EMIS help line to request all documents to appear in the electronic referral letter screen temporarily Second to scan the document in again This does not appear to be acceptable for the following reasons e Telephone EMIS This is time consuming and if all the documents are made visible to the user this may trigger the time out message which caused the problem in the first place e Re scan the document Again this is time consuming If the document when scanned in for a second time remains in the patient s history it may cause confusion by appearing twice and will certainly add to the problem by increasing the number of documents that already exist Issue 4 Editing an Existing Consultation to refer by Choose and Book Where a standard referral has previously been created E
22. s for the Choose and Book screen to open fully or closes it before it completely populates The result will be e One UBRN in EMIS Consultation which relates to the second launch of Choose and Book e Two UBRNs in EMIS RF screen e One UBRN in Choose and Book which relates to the first referral process Version 1 4 Page 13 INHS Surrey Test 9 Web Based Choose and Book Launched Once and then Closed Immediately upon the Second Launch This is a repeat of test 7 up to the point of clicking any key to continue This begins to launch Choose and Book but in this scenario the user immediately clicks Cancel on the Electronic Referral Letter box in order to prevent Choose and Book from opening a second time CH Launching Electronic Booking Patient E Eoo Booking Health Care Professional SS Request ChS Service EET Referral Dermatological referral Problem title Template entry Comment explanation Summary History pr Otocols Additional Brief summary Examination Follow up Date doctor place Next problem Medication X raylab requests View sections Mentor Referral Lab results ndividual Problem Quick keys lt File gt lt Pgup gt lt sF2 Mentor gt Because the Choose and Book screen has been stopped at such an early stage no UBRN has been requested A message will briefly appear on the screen to say No UBRN created in EMIS The user then files the consultation A further message is then displayed to say
23. the patient and the 18 week target A user may decide to by pass EMIS LV and attach the referral letter direct to Choose and Book using the web based system In this scenario where the same busy conditions apply the user will not be able to complete the process without actually attaching a document They will be presented with a prompt error message to say that at least one document must be attached to this referral Could EMIS LV create a similar message prompt in order to eliminate this risk Version 1 4 Page 16 Surrey Version 1 4 Part Two NHS Surrey Response to EMIS LV Problems INHS Surrey Development Change Requests NHS Surrey Choose and Book Programme Office have been in consultation with EMIS in an attempt to improve the problems that can be associated with current work flows The response from EMIS was to take the formal route of submitting Development Change Request DCR forms for each change See below for details DCR for Test 3 submitted 21 April 2009 The request is for an additional screen message which is displayed when a user is attempting to select the 8H Read Code of Referral for Further Care For example If you are adding a Choose and Book referral please select a more specific clinical term The request also includes the alternative to remove the term when adding a referral DCR for Test 5 amp 6 submitted 21 April 2009 This relates to a GP referring a patient to two di
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