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Article number: 30008Last updated: 20-05-2024

Consultation Product Features Simplified

Functionality Summary 

Table showing enabled/disabled functions of consultation write back, remote consultation, GP connect

Sharing Agreement

Once the enterprise agreements between two organisations have been activated, Consultation Write Back sharing agreement can be activated, ensuring that consultation details are automatically added to the patient’s record when they attend an appointment at either organisation.  Click the following link to access 'emisnow' guidance on Sharing Agreements: EMIS Web - Activating enterprise appointments agreements (emisnow.com) 

Option 1 - Consultation Write Back 

The consultation write back functionality allows connected organisations 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 (copy) to the patient's registered GP practice.  A pre-requisite is 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 details Status tab: 

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

Functionality

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.  Partner products used in the Hub are functionable, unlike Remote Consultations.  

Once the agreement has been activated all consultations will write back.  There is no current option to selectively send consultations.  Consultation Write Back will function regardless of whether the appointment was booked internally or as a cross-organisation appointment. 

Sent Status

1. A consultation is added to a patient's care record in the usual way.  Upon saving the consultation the delivery status shown to the right of the pane will display 'Sent', as the consultation has been sent to the organisations within the agreement:

the status shown to the right of the pane will display whether it has been sent to the organisations within the copy agreement with the words: Sent

2. 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:

Image of how the consultation is recorded at the receiving practice as an Enterprise Agreement

Unsent Status/Errors

Any consultations not written back to the GP practice will display an error icon, instead of a green tick:  

No entry sign

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: 

Error message when writing back due to no agreement in place between current organisation and registered practice

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

An error explaining that the written back consultation wasn't completed at registered practice due to no Usual GP recorded

In this instance users should consider contacting the practice directly or via a cross organisation task.  Save table of errors - canva

Audit Trail

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 consultation and select Audit Trail.  Details of the consultation include the location source, consultation's user, receiving organisation and the send Status:   

An audit trail of the written back consultation

Benefits

EMIS Web facilitates seamless sharing of patient information among organisations in a secure and controlled manner.  The data sharing features within EMIS Web not only enhance patient care and service flexibility but also ensure that organisations retain complete control over their data.  

Additional advantages include:

  • Ability to involve multiple organisations in the sharing agreement
  • Granting clinicians’ full visibility into a patient's care across a Primary Care Network
  • Enabling creation of cross-organisational appointments
  • Allowing collaboration members to access comprehensive consultation details
  • Furthermore, the system minimises delays in care by ensuring immediate processing of test requests and enabling referrals without the need for patients to return to their registered clinician or GP

Limitations

  • Once a consultation has been written back to a GP practice it cannot be edited from a PCN hub 
  • If the consultation is being written back by a third party partner product or a practice outside the sharing agreement, no delivery status icons will be displayed
  • Partner product data entered within a consultation will not write back, i.e. an AccuRx text message sent from the Hub will not write back to the patient’s registered GP record 
  • There can be a lag on new patients before their status is updated on the PDS
  • Amendments to existing consultation will not be transferred between organisations, only newly created consultations

Confidentiality

Confidentiality Policies and Online Visibility settings applied to a consultation can be amended.  Either feature icon will be clearly displayed to the right of the pane when the consultation is viewed in either organisation.

Option 2. Remote Consultations

A remote consultation allows an unregistered patient to be seen at an organisation, other than the patient's registered GP practice, 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. 

Functionality

Following the patient's consent to access their care record at point of booking; the consulter can view the patient's full care record at their registered GP practice in a second virtual instance of emis web. The consulter can do any of the following:

  • Run templates
  • Book appointments
  • Add standard outbound referrals
  • Add fit notes
  • Utilise F12 features
  • Apply confidentiality policies
  • Access QoF alerts 
  • Add a Task 

If an active care record sharing agreement is in place between the patient's registered organisation and another EMIS organisation, any shared data is visible in the sharing pane. 

Limitations

  • Partner products do not work in the hub. No access to the 3rd party products
  • Only the consultation session holder has the permission to view the entire care record held at the registered practice
  • There is no access to any other part of EMIS Web.  You cannot swap patients (F5 is disabled)   
  • Online Test Requests are disabled.  Workaround: Offline Test Request or create task. Registered practice cannot reply to the task 
  • Any annotations made to documents in Docman and not in EMIS Web, are not viewable to the consulting organisation
  • A consultation can be edited/amended as long as within the legitimate relationship period of 28 days
  • Spine functionality is disabled i.e. eRS (electronic NHS referrals) and EPS (Electronic Prescription Service)   

EPS Prescriptions workaround

emis has devised a workaround for the issue of EPS.  The prescribing clinician can add/issue the medication within the consultation but instead of selecting Issue, the prescriber must select Issue later.   The next step is to access the Medication tab, select the relevant recently added medication and select Request Issue to send through to the patient's organisation's Workflow Manager: Medicines Management Inbox: 

System process for requesting a medication using 'request issue' button on ribbon in Medication tab

The alternative is to produce a non-EPS prescription (with the registered practice details). 

Sharing Agreement

Appointments Enterprise Agreement.  Care Record sharing agreement.  Agreements on your local standard operating procedures and workflows around how to handle processes that relate to third party products and Spine services, such as eRS, EPS, which are not available within a Remote Consultation. 

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. Only organisations which are part of the enterprise appointments agreement are able to book appointments for remote consultations.

All organisations would need to add the same stamp doctor if they want all prescriptions for the service to have same stamp

Confidentiality

Audit Trail

Relevant Audit trails are visible in the consulting organisation.

An audit trail can be viewed for an individual remote consultation by right-clicking on the consultation, then select Audit Trail.  

Remote consultations example Enterprise consultation and icon

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

Audit trail of a remote consultation

Any appointments that have been booked for remote consultations are recorded in the system audit trail. Both the patient's registered organisation and the consulting organisation can view the audit trail of any externally booked appointment slots, as well as those booked by their own organisation.  EMIS Web - Appointments for remote consultations introduction (emisnow.com)

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.

emis recommends that all clinicians who will use Remote Consultations are aware that they need to logon with a password and not their smartcard, including setting up their security questions.

Option 3. GP Connect Send Documents 

The messaging feature within GP Connect Send Document supports consultations carried out at another healthcare organisations by sending a summary of the encounter (consultation) to the patient's registered GP practice, i.e. for extended hours support, in the form of a PDF file.  The GP Connect Send Document feature complements EMIS Web Consultation Write Back, but it is more suited for communication between different clinical IT systems. The consultation summary is sent as a PDF file in an unstructured format, creating a Workflow Document Management task that requires review before filing.  If a practice has both functionality enabled then Consultation Write Back will take priority, where the recipient is a patient at an EMIS Web organisation.  

A GP practice can configure each patient type (except Regular and Dummy) to decide if they want to automatically send a summary of a consultation given at their practice back to the patient’s registered GP record.  If no configuration is setup for a patient type, the clinician is prompted to send the consultation on creation.

To configure carry out the following steps:

  1. Access Organisation Configuration. Click, point to Configuration, and then select Organisation Configuration. The Organisation Configuration screen is displayed
  2. In the navigation pane, click Organisation
  3. On the ribbon, click Edit. The Edit Organisation screen is displayed
  4. In the left-hand pane, click GP Connect Configuration. The GP Connect Configuration screen is displayed
  5. Select GP Connect Messaging - Send Consultation (Encounter) Summary
GP Connect Messaging Configuration Settings - enable/disable options

GP Connect Messaging doesn't require GP Connect to be activated.

In the left-hand pane, click GP Connect Messaging Configuration. The GP Connect Messaging Configuration screen is displayed with all available patient types listed.

Default configuration settings for each patient type (send/don't send/In use)

Within this screen for each external patient type you use, set the default setting to automatically send or not send a consultation back to the patient's GP organisation. 

Set to automatically send

For patient types that have a Send preference set, in the Consultation screen the default messaging option is displayed as Send.

Default configuration setting for send within consultation tab

The clinician has the ability to change the setting as required for each consultation.  On saving the consultation, the GP Connect Message is sent without any prompts. The message will be queued for 3 hours prior to sending, during which time amendments can be made to the consultation.

Not registered at a GP Practice

If the patient is not registered at a GP practice, the consultation cannot be sent as there is no organisation set on the Spine for the consultation to be sent to.  Under these circumstances, the clinician can make a clinical decision to provide a copy of the consultation to the patient instead. The following warning message will be displayed in the consultation screen. Click Don't Send:

PDS Warning: Patient doesn't have a registered GP on the Spine.

PDS differences

If the patient has PDS difference, (the minimum PDS check is NHS number, surname and DOB), in the Consultation screen the following message is displayed.

PDS Differences error message - This consultation cannot be sent to a patient's GP org until differences are resolved.

Please review and try to resolve the PDS differences.

If PDS issues cannot be resolved, and the consultation is saved with the PDS mismatch, in the Status column, Error  is displayed & the consultation will not be sent to the patient’s registered GP practice.

PDS Not responding message: Try again later or save the consultation without sending back to the patient's registered GP

Consultation letter

An example of the consultation letter that is sent back to the patient’s registered GP.

The order of the consultation details in the message is set by your consultation settings.

Example of GP Connect Consultation report located within Workflow Manager Document Management

Upon editing and saving a consultation after the initial send transmission, EMIS Web will initiate 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.

GP Connect message status column

A new column has been added to the Consultation screen and the Document screen called Status, with icons to indicate the sending status of the messages going back to the patient’s registered practice.

GP Connect Message Status - Error or Matched in Consultation tab

A message can be viewed after it has been sent from the consultation or from Documents in Care Record. To view more details on an individual status, click the required status. This example screenshot shows the message has been received by the patient’s GP practice:

GP Connect Message Status - Journey

To view further statuses click the following link: ....

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

Workflow Manager tasks

At the sending organisation, once the message has been sent a task will be created in Workflow Manager.

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

Screenshot of GP Connect Workflow Task - Message sent successfully

Right-click on a selected line to drill down for further information.

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

Screenshot of workflow task GP message 'not sent'

At the receiving GP organisation, a task is created in Workflow Manager (Document Management) -  Awaiting Coding and/or Awaiting Filing depending on local settings.

The imported document will have a [Provisional] tag until the task is completed

Screenshot of inbound doc message 'not sent' at receiving end in Workflow Manager

Replacement and duplicate messages

If a user edits a consultation that has already been sent (eg. after the 3 hour wait) then a second message is sent and flagged as a Replacement. A task is created in Workflow Manager for the user to investigate and remove any duplicate data if required.

If EMIS Web receives the same message twice the second message is flagged as a Potential Duplicate. A task is created in Workflow Manager so users can investigate and remove any duplicate data if required.

It’s possible to have both flags on the same message, EMIS Web could receive the same replacement twice.

Audit Trails

A full audit trail of GP Connect messaging can be viewed, using the MHS Logs button on the ribbon:

Screen shot showing how to view an audit trail of the GP Connect Send Document