Changing Clinical Software SCIMP Director eRecords Dr Colin Brown General Practitioner SCIMP Director eRecords SCIMP Conference Dunblane 2007 17/07/2018 Changing Clinical Software

Changing Clinical Software Why are we doing this? Where are we starting from? Where are we going? How do we get there? WORKshop – for those of you managing your own practices – hands up? Whose idea is all this? If it’s not your own Business Case but the Heath Boards’s – try customising theirs for your practice Listing the problems is depressing - but Identifying the benefits is very motivating Classic issue of Practice Mx This not about specifics…. Tho’ our recent migration is obviously 1st source for info….. 17/07/2018 Changing Clinical Software

Changing Clinical Software Clinical System Changes Versions referenced: Ascribe to Vision 3 EMIS PCS to Vision 3 from GPASS 5x, Vision 3, EMIS LV GPASS 5x to EMIS PCS, GPass Clinical/2007, Vision 3 from Torex HMC iSoft Synergy from Meditel, Premiere SystmOne from EMIS LV, Vision 3 Vision 3 to GPASS 4x from GPASS 4x, 5x, Seetec, Microtest, EMIS LV, VAMP Medical Systems and V nos – not suppliers Re-branding a system doesn’t avoid the need to migrate data and learn new s/w e.g. iSoft just been bought – but the s/w won’t change GPASS has not been bought – but the s/w is changing. 17/07/2018 Changing Clinical Software

Changing Clinical Software WHY? GP systems are specialist engineered products with these unique functions: constructing a life-long record audit trail of all users unconstrained scale and content structured to support computer processing security usable in front of patients in their 10 mins by any users in Primary Care Team NOT – a word processor NOT - a flat-file database 17/07/2018 Changing Clinical Software

Changing Clinical Software Overall Plan Pre-migration practice development status - data quality issues Data migration issues Data freeze period Go Live Day New-system learning and design issues 3rd-party issues General and specific Lessons Learned 17/07/2018 Changing Clinical Software

Changing Clinical Software Practice development status Software Hardware and system - local, or remote Managed Technical Service - use of old system? - continuing use after GoLive? concurrent? Business processes Training - what are the training needs? - IT training - Specific new-system training - Specify all the version nos - not all suppliers follow conventional version control numbering system, nor for the components e.g. QIRS, CALM; and for all 3rd-party add-ons. - detail the server and workstation specs, also printer model nos for Site Survey - are you continuing to use your local server, or moving to Managed Server? - will your old system continue to run concurrently, or separately on all or some workstations? 3rd-party s/w - can you re-install/re-configure? - connectivity - configuration of tools e.g. SMS / PCAnywhere / WinVNC may differ - eLinks, SCI, Partners are these identified and understood ("modelled"): - repeat prescriptions, document workflow, appointment booking, registrations/leavers, lab results, OOH reports, QOF registers, referrals - any custom screens/templates - can their function be replicated? - are all users Windows-competent e.g. to what ECDL level? - Who does what re functionalities of core and 3rd-party software? - Security - are roaming profiles used? username and password issues? - See the online Guide at http://www.inps3.co.uk/anm/anmviewer.asp?a=356&z=79 17/07/2018 Changing Clinical Software

Changing Clinical Software Data quality pre-migration Codes – standard? - Read versions 2 and 3, SNOMed Freetext Drug dictionary data – another migration? Issues - “OP”, ADRs, BAN/RINN, custom drug items, old scripts Metadata: “data about data” e.g. Non-standard system admin data Priorities Recalls Reviews Migrations are asymmetric and Lossy use of Structured Data Areas may require specific codes – can they be re-mapped in bulk? for Adverse Drug Reactions - should one tidy up before - or after on the better software? - support for "OP" / support for extemp dermatology preps / for custom drugs / for formularies Other drug mapping issues that need manual mapping: P42 drugs - residual unmapped drugs from an earlier VADIS version. already replaced in current repeat scripts - but impossible to clear out of historic record other than manually. SF formulations appear difficult for the mapping to recognise old BAN names not in RINN are unmapped. ADR alerts don't work if the drug isn't mapped; if any one repeat script is unmapped they are flagged as switched off to prevent False Negatives. you have some months to study the 1st migration... use it! court your local friendly new-system user e.g. peripatetic staff - use of trained staff as proxy computer operators 17/07/2018 Changing Clinical Software

Changing Clinical Software Pre-migration Planning: phone a friend ask the audience 1 - access the UG 2 - the patients - involve them 3 - check with occasional team users split the options HB support staff? Nurture your local friendly new-system user Could be virtual.. Make a shared collaboration space – e.g. wiki – pbwiki / tikkliwiki / openwiki 17/07/2018 Changing Clinical Software

Changing Clinical Software Data Migration Extraction of data from old database Conversion of the extracted data to new database format, and of old to new data types. Quality Assurance. Conversion accuracy? Coded and Uncoded data InPS - 2 utilities provided EMIS - these functions built in to the main software must find all data linked throughout the multiple tables of the system by reverse-engineering the software links. InPS do this in 2 stages: Extraction of data from source system by GPData, a separate company specialising in this for several suppliers; then Conversions by the Data Services dept. of InPS EMIS and GPASS do the extraction and conversions in-house, as do - 100% of codes imported, initial 88% mapped correctly, unmapped still displayed as text. - less % of uncoded data e.g. system specific such as call/recall details. for user to complete mapping any unmapped data or drugs enabling live clinical use. 17/07/2018 Changing Clinical Software

Changing Clinical Software Examples here of: User marker (not real codes) Orphan dates Test names not preceded by “serum” These mappings are sent to the supplier before final tape backup taken to be included GOOD NEWS - progressive pooling of these code mappings >> most recent migration had only 14 items to be manually mapped 17/07/2018 Changing Clinical Software

Changing Clinical Software These mappings are done after the final migration.. - can be exported back to supplier for accumulation of mappings Specific to versions of drug dictionaries – this was the first ever mapping from eVADIS version 43. Governance issues about liability for automatic drug mappings. HB-supported migrations -aren’t they all by the business case process – supply pharmacy support to do tis. . 17/07/2018 Changing Clinical Software

Changing Clinical Software Data Freeze Datafreeze? = when your old data has gone for conversion, and your new system isn’t working yet to use the converted data BUT - your old system is still working… So….. Computer Downtime - Is there any need for this? NO ………….. (mostly) - you want your old system, and 3rd-party products like Docman, to continue to operate, to record notes, tick QOF boxes, issue scripts etc. We had 5 working days of Data Freeze, and being paperlight users for 2 years kept on using it . You can photocopy repeat scripts, or double-print acute ones. You can open the old and the new together on the one screen can copy’n’paste text between them . 17/07/2018 Changing Clinical Software

Changing Clinical Software Go Live Day Hints and Tips from Supplier Business Continuity Plan – as if paperless No routine surgeries, clinics Print-offs for the datafreeze period Hardware and system configuration on site Ensure practice migration leads book themselves out of routine surgeries etc to support the migration process Ensure necessary information printed off for up to a day without active system. Make or (if paperless)Review Business Continuity plan in case of longer downtime. Ensure practice manager has the time to process urgent information arriving other than by direct consultations. Establish a system to highlight and enter information from hospital letters Practices will need to: Tailor clinics down for the migration week - reduce workload that doesn't have to be done that week, e.g. audits, nurse clinics, payroll etc Think about projects that staff can do if they haven't got access to the system for a while. Provide information for patients, e.g. posters in waiting room - what is going on, order prescriptions in advance if you can, advise that results may take a bit longer; invite their support. Prepare for temporarily not having access to things they are used to having If consultations are computerised, prepare GPs for how they are going to cope without the computer for up to a day, or possibly a few if problems. Organise GO LIVE day and limit appointments or just have emergency appointments Real computer Downtime - was 90mins for Vision install and configuration, and 2hrs for Docman - total! Help available from now? copying in data from datafreeze into your new system You've got to do this? - not necessarily..... It's a copy of what's in your old system, so you may consider that access to the old system suffices for occasional reference e.g. medico-legally Your new system will show imported data and for clinical continuity you wish to copy in the frozen data - but it's not essential as it's a copy. This applies to much of the historic record that is an electronic copy of an original paper record e.g. scripts issued. 17/07/2018 Changing Clinical Software

Changing Clinical Software Data Melt = copying back data from the freeze. You've got to do this? - not necessarily so… Clinical value is max. if sooner not later. A technological fix? Post-GoLive datafreeze update Consider photocopying repeat scripts / double –printing acute ones ……. Printing out encounter data …… Of old and new s/w can run concurrently- -easy copy/n/paste from old to new Delta-dump – a second copy of the original-system data is compared for changes and retro-fitted to new system. This has been available for some time from InPS, now being offered on MTS sites. An extra-cost option? 17/07/2018 Changing Clinical Software

Changing Clinical Software New System Learning 1 Function re-modelling Predict the functions to be changed…. to anticipate how your new system will work differently and re-model your business processes Original s/w method of delivering a function may not be the only way Version-specific not brand-names The bits the designers want you to adopt The most difficult bit - For us, it was repeat prescription handling that is most different in the new system. Discussion demands knowledge of version nos. of both s/w – not the brand name under which it’s supplied 17/07/2018 Changing Clinical Software

Changing Clinical Software New System Learning 2 Design issues e.g. on-the-fly coding Keyboard use Appointments Better Display > Data Quality issues The bits the designers assume you’ll like – you may not Live coding is a culture shift for clinicians - should be carefully considered by the practice as part of the Business Case - but assisted coding by keywords makes it easy after a few hours of learning. Keyboard use - a major presumption for full system use - a universe of keyboard shortcuts, augmented by Keyboard Express macros. Appts – in GPASS support message notes – can drag’n’drop to a historic time, unsupported in Vision… but note-keeping and tracking of messages superior, needs only a scheduling add-on issues may be exposed by the new display modes e.g. Journal view can show multiple entries of similar data from old system. 17/07/2018 Changing Clinical Software

Changing Clinical Software 3rd Party Issues Docman Labeltrace SCI Gateway (2nd Opinion) SCI Store (web access) Managed Server Microtech as PCTI agents in Scotland used the InPS-written migration s/w for importing No re-installation needed - just re-configure Docman to look at new Vision database. But - it was unclear if Docman can share its default P-drive with Vision; also unclear if Vision install can be re-mapped to other drive letters So Docman was moved to another letter i.e. I:, this taking an extra site-visit and some hours of work incl. update log-on script - however, some shortcuts remained un-re-mapped adn needed manual remap by user. In fact Docman Migration was quick and easy - day 1 can only add new docs - after day 1 can increasingly reference older docs 17/07/2018 Changing Clinical Software

Changing Clinical Software General Lessons Learned Clinical - specific benefits Detailed Pros/Cons – per user Practice Management - similar challenges? Summarising for training status Lloyd George to A4 Going paperlight Changing premises Changing partners Changing or new job Combine some of these? Custom benefits for each user? 17/07/2018 Changing Clinical Software

Changing Clinical Software DO - LIST #1 - for Suppliers online connectivity on Go Live Day √ share the Drug Dix / coding migrations √ improve handling of non-coded data implement post-GoLive datafreeze update consider appointments migrations customise migration advice for “donor” system custom-configure the initial setup of new system guarantee access to archive data + audit trails with their attached notes. " " " " " " for the features changing from original system guarantee access to audit trails in archive data from earlier versions and on earlier formats 17/07/2018 Changing Clinical Software

Changing Clinical Software DO - LIST #2 - for NHS Board IT Depts Original s/w + h/w: keep live √ Prescription mapping: pharmacist support √ Share local expertise in new processes √ Test install /configure s/w on hardware platform before Go-Live. Archive data + audit trails: contract with suppliers to retain legibility custom data quality fixes pre-migration: support GMS IT Facilitators keep original s/w at least x 1 for reference and for audit trail - supplier to guarantee e.g. LHCC / CHP; drug-mapping skills of Prescribing Advisers 17/07/2018 Changing Clinical Software

Changing Clinical Software DO - LIST #3 - for Users custom benefit lists for each user prepare engage your local friendly new-system user to check out your test data. engage your patients access all UG support as if going to Night School? allow pre-migrators e.g. webforums 17/07/2018 Changing Clinical Software

Changing Clinical Software DO - LIST #4 - for Scottish NHS Share lessons from GP2GP project on migrating data between systems on a per-patient basis Develop GP2GP v2 A standard intermediate data format for migrations? Connect to….. Connecting for Health Supplier management via GP2GP is only method English suppliers will engage with. 400,000 patients annually move between Scotland and UK so their individual records need to move with them. 17/07/2018 Changing Clinical Software

Changing Clinical Software DON'T (= specific "errors of commission“) Suppliers Change the GoLiveDay Use non-standard pseudo-Read codes Health Boards Strip kit needed for original s/w to run Users Leave it all to the leader Go on Holiday! 17/07/2018 Changing Clinical Software

Changing Clinical Software Balance – Feeling between a rock and a hard place? Shall I stay or Shall I go? But Staying Still is not an option – esp. if you’re the one on the L. 17/07/2018 Changing Clinical Software

Changing Clinical Software THE END …… ………… ……. www.visioneer.pbwiki.com colin.brown99@nhs.net 17/07/2018 Changing Clinical Software