EMIS Web facilitates secure and controlled sharing of patient information among organisations and the data sharing features within it not only enhance patient care and service flexibility, but also ensure that organisations retain complete control over their data.  To ensure GP records are current with consultations from other healthcare organisations, EMIS Web supports functionality that works regardless of the clinical IT systems used by the GP practice or the other providers.  The following chart provides a high-level comparison of the three available product features at a glance:

Feature Comparison Chart

Consultation Write Back 

1. The 'Consultation Write Back' functionality is primary for working within Primary Care Networks (PCNs) by allowing connected organisations using EMIS Web to utilise their enterprise agreements to receive a copy of any consultations added to a patient’s record.  This includes when a patient has been referred to another service.  A consultation that takes place at any organisation within the sharing agreement will write back and code into the patient's registered GP practice.  The agreement implications are: 

• Practice-run searches will now include coded activity from those organisations
• Prescribing reports run from the practice will now include coded activity from those organisations
• If a practice were inspected by CQC, the searches CQC run will include activity from patient consultations at other organisations
• ICB level / national extracts from the GP clinical system will now contain activity from other organisations that patient had a consultation at
• Local or National shared care records, including SCR, will now present patient record content resulting from Consultation Write Back as ‘GP Activity’ because the data is coded into the record

Pros and Cons

Sharing Agreement

2. A 'Consultation Write Back' sharing agreement can be activated following the activation of an Enterprise Agreements between two or more organisations.  This agreement will ensure that consultation details are automatically added to a patient’s record when the patient attends an appointment at either organisation.  To locate and activate the agreement select the emis button, then select Configuration from the available options and then from the 'Configuration Modules' select Data Sharing Manager:

2.1. From the Data Sharing Manager screen ensure the correct agreement is activated with a green tick.  Any deactivated agreements will be represented with a red cross.  To activate or deactivate an agreement, select the agreement and click either Activate Agreement or Deactivate Agreement on the Ribbon (as required), as the example image shows below: 

2.2. For guidance on this agreement practices can contact the emis Account Manager to request a data sharing agreement, or alternatively click the following link: EMIS Web - Activating enterprise appointments agreements (emisnow.com)  Once the agreement has been activated all consultations will write back.  Currently, there is no feature available to send consultations selectively.  'Consultation Write Back' will function regardless of whether the appointment was booked internally or externally as a cross-organisation appointment.

Pre-requisite

3. The patient must be fully registered in at least one organisation within the agreement.  A fully registered patient must have one of the following statuses in their Registration Status tab: 

• Notification of registration 
• Medical records sent by FHSA 
• Records received
• Left practice, still registered 

Send a Consultation

4. A consultation is added to a patient's care record in the usual way.  Any Problems, Medications, Test Requests, Documents, Referrals that are added within the consultation will be written back into the applicable modules of the receiving organisation's patient care record.  Upon saving the consultation the delivery status shown to the right of the pane will be recorded as Sent, as the consultation has been sent to the organisations within the agreement:

4.1. A sent (written back) consultation will appear in the patient's registered practice (the receiving practice) as an Enterprise consultation, followed by the source organisation in brackets:

Unsent Status/Errors

5. Any consultations not written back to the GP practice will display an error (No Entry) icon, instead of a Green tick:  

5.1. If an organisation adding consultation data has not activated its sharing agreement, the consultation will only be saved locally and its users will receive the following alert message: 

5.2. If a PCN Hub consultation fails to write back successfully to the patient's registered practice record, the following alert message will appear:

5.3. In this instance users should consider contacting the organisation directly or through a cross organisation task.  See emisnow for further errors.

Confidentiality & Online Visibility

6. Any Confidentiality Policies or Online Visibility settings that have been applied to a consultation can be amended. These entries / icons will be displayed on the right-hand side when the consultation is viewed in either organisation. The Confidentiality Policy icon is indicated by a Yellow Padlock:

6.1. The Online Visibility is restricted icon is indicated by a red cross in front of a computer: 

6.2. Patient record content resulting from Consultation Write Back will be visible in Patient Facing Services as though the consultations were performed by their regular GP (if visibility has not been hidden in the sending organisation).

Audit Trail

7. An audit trail of a written back consultation will be visible in both the sending and receiving organisations.  To view this information, right click on the required consultation and select Audit Trail from the available options:

7.1. Within the Audit Trail Viewer screen details of the consultation include the Date / Time, Location (source), Consulter, Receiving Organisation details and the send Status:   

Error table here.

Remote Consultations

8. A remote consultation allows an unregistered patient to be seen at an organisation, other than the patient's registered GP practice, i.e. Out-of-hours or extended GP services and for that consultation to be created and saved only to the patient's care record at their registered GP practice.  Unlike 'Consultation Write Back, no consultation data is saved within the consulting organisation. 

Pros and Cons

Sharing Agreement

• Enterprise Appointments Agreement

9. An enterprise appointments agreement must be in place and activated by all organisations / GP practices associated with the agreement. Once activated this allows an organisation to find and book appointments for remote consultations in another enterprise organisation's Appointment Book and cancel any appointments for remote consultations.  Each organisation using an enterprise appointments agreement needs to Activate the agreement in Data Sharing Manager, in order to book appointments and view / add data during a remote consultation.

Pre-requisite

10. All clinicians who intend to perform remote consultations must be a session holder with an RBAC Based Profile on one of the following:

• Clinical Practitioner Access Role
• Nurse Access Role
• Healthcare Professional Access Role.

10.1. Emis recommends that all clinicians using Remote Consultations are aware that they need to logon with a password and not their Smart Card, including setting up their security questions.

Send a Consultation

11. From the Appointment Book clinic session, select the required patient appointment slot.  If the patient has already been recorded as arrived, press S on the keyboard to send in the patient.  Please note: only the consulting session holder(s) for this appointment can send in and access the remote consultation.  No administration staff have the permission to send in or view the patient's care record.  The following message is displayed on screen:

11.1. The second instance of EMIS Web automatically opens, showing the Consultations screen of the patient's care record within their registered organisation.  At the bottom of the screen, a notification appears, indicating that the remote consultation is currently in progress:

11.2. On the Consultation Properties screen, click OK. The Consultation Type automatically defaults to 'Enterprise consultation':

11.3. The consulter can view the patient's full care record at their registered GP practice in a second virtual instance of EMIS Web.  If an active Care Record sharing agreement is in place between the patient's registered organisation and another EMIS organisation, any shared data is also visible in the View -> My Record sharing pane:

11.4. Record and complete the remote consultation details within the second instance as required. The consulting session holder(s), will have full access to view and add information to this patient's care record.  Any Confidentiality Policies on this patient's care record will apply.  For example, if a specific consultation has a 'GP Only' confidentiality policy applied, a nurse performing this consultation would not be able to view the confidential data. 

11.5. Local standard operating procedures and workflows around how to manage processes that involve third party products and Spine services i.e. eRS and EPS, which are not available within a Remote Consultation, should be sought. 

e-RS Workaround

11.6. While integrated e-RS is not enabled with this product, practices can revert to using the Web based portal of e-RS to upload referrals that have been exported from EMIS.  However, this does result in any corresponding information from e-RS having to be imported back into EMIS Web.  The practice would also need to regularly monitor e-RS Worklists via the Web based portal.  Web based e-RS is commonly used for Disaster Recovery purposes.  

EPS Prescriptions Workaround

11.7. EMIS has provided the following workaround for the EPS issue: The prescribing clinician should add the medication during the consultation but choose Issue later instead of Issue

11.8. The next step is to access the patient's Medication Module, select (highlight) the recently added medication and select Request Issue to send through to the registered organisation's Medicines Management Inbox in Workflow Manager: 

11.9. The prescription can now be processed using EPS within the registered practice.  Alternatively a non-EPS prescription can be produced.  The printed prescription displays the patient's registered organisation details.

11.10. If a patient comes from a dispensing organisation and attends a remote consultation at an organisation that is a non-dispensing organisation, by default, the prescription will go to the dispensing queue at the patient’s registered organisation (where the patient is a dispensing patient).  To change to a printed prescription, on the Drug Issue screen, select Change all.

11.11 Once the consultation is complete, click Save on the Ribbon.  Close this second instance of EMIS Web by clicking on emis button, then select Session, and then select Log Off.  A confirmation message is displayed, click Yes. The screen is returned to the organisation's Appointment Book.  Mark the patient as left by clicking L on the keyboard.  Please note: the next patient cannot be sent in until the remote consultation patient is marked are being Left.

Confidentiality & Online Visibility

12. Adding new confidentiality polices will not stop the data from being visible online. The Online Visibility option will need to be applied to hide the data online.  All existing confidentiality polices, added before version 9.18.8, will remain hidden from online view, even if they are edited.  When adding a new Confidentiality Policy, a message will appear at the top of the ‘Change/Apply Policy’ screen:

Amend a Remote Consultation

13. Clinician session holders have the ability to revisit a previous remote consultation to modify any information during that particular consultation, until the end of the legitimate relationship period (within 28 days).  Hover over the appointment slot for the 'tooltip' to reveal the legitimate relationship expiry date:

13.1. Right-click the slot and select View Medical Record or click M on the keyboard.  Please note: only the original consulting session holder is permitted to re-access a patient's care record within the legitimate relationship timeframe. The following message is displayed on your screen:

13.2. The second instance of EMIS Web is now automatically opened displaying the Summary screen of the patient's care record in their registered organisation. At the bottom of the screen the following is displayed indicating the remote consultation is in progress.  Amend the consultation as required and click Save on the Ribbon.  To close this second instance of EMIS Web, click the emis button, point to Session, and then select Log Off.  Click Yes to the confirmation message to return to the Appointment Book.

Audit Trail

14. Remote consultation audit trails are visible within the patient's registered organisation only.  To view an audit trail highlight the required consultation:

14.1. Right-click and select Audit Trail from the available options:

14.2. From the Audit Trail Viewer screen a full audit trail of the consultation is displayed including any amendments made against date/time/user: 

GP Connect - Send Document 

15. The messaging feature 'GP Connect Send Document' is primarily designed for exchanging information between different interoperable clinical systems and not just 'EMIS to EMIS'.  NHS England employs a national standard known as Fast Healthcare Interoperability Resources (FHIR) to facilitate the sharing of healthcare data.  Emis Web uses this standard when sending and receiving messages, to ensure patient data can be easily shared between different organisations.  Message senders are NHS organisations and message receivers are GP organisations.

15.1. All GP organisations in England are enabled to receive messages through their MESH mailboxes, so when a patient has a consultation at a clinic other than their registered practice, accredited senders can send a summary of the encounter through GP Connect.  This model is designed to support cases where a patient receives care from out of the area, or even nationally. The summary is sent to the registered practice as a PDF file using an unstructured format, which in turn creates a Document Management task within Workflow Manager that requires review before filing. 

Pros and Cons

Configuration

16. A GP practice can configure the system for each patient type (excluding Regular and Dummy) to automatically send a summary of consultations conducted at their practice back to the patient's registered GP record.  If no configuration is set for a particular patient type, the clinician will be prompted to send the consultation summary manually.  To configure click the emis button, select Configuration, and then select Organisation Configuration:

16.1. The Organisation Configuration screen is displayed.  In the navigation pane, select Organisation, on the ribbon, select Edit: 

16.2. The Edit Organisation screen is displayed.  In the left-hand pane, click GP Connect Configuration. The GP Connect API Configuration screen is displayed:

16.3. Click GP Connect Messaging - Send Consultation (Encounter) Summary.  In the left-hand pane, click GP Connect Messaging Configuration. The GP Connect Messaging Configuration screen is in view, listing all available patient types:

16.4. For each external Patient type used, set the default setting for sending consultations to automatically Send or Don't send back to the patient's registered practice. 

Send a Consultation

17. With a new consultation open, for patient types with a Send preference configured, the default messaging option displayed on the Consultation is Send:

17.1 The clinician can change the setting as required for each consultation. On saving the consultation (click Save on the Ribbon), the GP Connect Message is sent automatically without prompts. The message will be queued for 3 hours before being sent, allowing time for any amendments to be made to the consultation.

Not registered at a GP Practice

17.2. If the patient is not registered with a GP practice, the consultation cannot be sent, as there is no organisation set on the Spine to receive it. The clinician may decide to provide a copy of the consultation directly to the patient instead.  The following warning message will be displayed on the Consultation Module:  

In this instance select Don't Send.

PDS differences

17.3. If the patient has PDS differences, (the minimum PDS check is NHS number, surname and D.O.B), in the Consultation the following message is displayed:

17.4. Please review and attempt to resolve the differences in the PDS.  If PDS issues cannot be resolved, and the consultation is saved with the PDS mismatch, The No Entry Error icon is displayed in the Status column and the consultation will not be sent to the patient’s registered GP practice:

Consultation letter

17.5. Below is a sample of the consultation letter that is returned to the patient's registered practice:

17.6. The sequence of the consultation details in the message is set by the clinician's consultation settings in Consultation Module>CR Config. 

Message Status Column

18. A new Status column has been added to the Consultations and Documents Module, with icons to indicate the sending status of the messages being sent back to the patient’s registered practice.  A message can be viewed after being sent from both locations in the Care Record. To view further details on an individual status, click the required Status: 

18.1. The following image shows the message has been received by the patient’s registered practice:

Status Meaning

18.2. The following statuses are used to indicate the stage the sent message is at:

Errors

18.3. Any errors in the message transmission are indicated by the 'No Entry' icon:

18.4. To view further example transmission messages, click the following link: emisnow GP Connect Document Send

Error Codes

18.5. Error response codes serve to clarify why a message has not been successfully received by the intended organisation.  Should a message fail to be processed by EMIS Web, one of several codes will appear in the message's header to indicate the specific issue:

18.6. If the practice receives one of the above error codes from a message, please contact the sender of the message with the relevant information.

Edit and amend a sent Consultation 

19. When editing and saving a consultation after the initial send, EMIS Web will send a replacement document message with the updated information as version 2 of the consultation letter.  This process occurs each time the consultation is edited and saved again.  The consultation letter captures only the content visible in the Consultation screen.  If alterations are made to problem properties, such as status, significance, or duration, and subsequently saved, this action will also trigger a replacement consultation letter.  However, given that this specific information is not displayed on the Consultation screen, it will not be reflected in the new version of the consultation letter.

Confidentiality

20. If any part of the consultation has been marked confidential, this information will be appropriately redacted in the message before being sent.

Workflow Manager Tasks

Sending Practice

21. At the sending practice, once the message has been sent, a task will be created in Workflow Manager.  To access Document Management from the home page click , point to Workflow and then select Workflow Manager. In the left-hand pane, click Document Management:

21.1. If the message was unsuccessful (it attempts to send 3 times), then a task is created in Workflow Manager:

Receiving Practice

21.2. When a GP Connect message has been sent, the receiving practice will receive it as a document task, within Workflow Manager (Document Management) -  Awaiting Coding and / or Awaiting Filing Inbox (depending on local configuration): See Workflow Config>Inbound Document Tasks for settings:

21.3. The sender will always be 'EXTERNAL, USER' and the message will automatically be assigned the following Document Type:

21.4. Messages must be reviewed and processed by the practice in the usual way:  

21.5. In the patient's Care History module, entries will appear as [Provisional] until the coding task is completed in Workflow Manager.  The Document Type can be edited (if necessary) from the Documents Module within the patient's Care Record.

Replacement and duplicate messages

22. If a user edits a consultation that has already been sent (e.g. after the 3-hour queue), a second message is sent and flagged as a Replacement.  A task is generated in Workflow Manager for the user to review and remove any duplicate data if necessary.  If emis Web receives the same message twice, the second message is flagged as a Potential Duplicate. A task is then created in Workflow Manager for the practice to investigate and eliminate any duplicate data if needed.  Both flags can be applied to the same message, as EMIS Web could receive the same replacement twice.  If a message is a replacement or a potential duplicate of a message already sent, the following will be displayed in the Document Type column:

• **Replacement**
• **Duplicate**
• **Potential Duplicate**

22.1. Practices using a third-party product for patient document management, such as Docman, rather than the EMIS Web Workflow Manager, will need to set up the Document Management task settings within Workflow Manager. This includes specifying a default task recipient, typically a team, and establishing task escalation procedures.  Such configuration is crucial to ensure that messages received are processed alongside other standard Workflow Manager tasks.

Delete a Consultation not sent

23.1 If attempting to delete a consultation for an external patient that has not been sent, the following message will appear:

23.1. Enter an appropriate Reason for deletion and select Delete or alternatively click Cancel.

Audit Trails

24. A full audit trail of GP Connect messaging can be viewed as follows.  From the emis button, select System Tools from the available list of options, then select Audit Trails: 

24.1. Select MHS Logs options on the Ribbon:

24.2. Right-click on a selected line to drill-down for further information.  Please note: error codes can also be viewed within these logs.

Consultation Write Back verses GP Connect Send Document

25. The GP Connect Send Document feature complements EMIS Web's Consultation Write Back feature.  If both Consultation Write Back and GP Connect Send Document are both enabled within a practice, Consultation Write Back will take priority for patients registered at an EMIS Web organisation.  The following chart provides a high level comparison of both features, at a glance:

Contact Us

For all IT Training related issues, please contact your practice's designated trainer.  If you do not have a designated trainer, or are unsure, you can email mlcsu.academy@nhs.net

For further information access the MLCSU IT Customer Portal

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