Emis Web - Merger Guidance for Practices
Introduction
The IT Training Team's Clinical Applications Specialists possess extensive experience in facilitating practice mergers over the years. Each merger has presented unique learning opportunities, contributing to the team's wealth of knowledge in this area. Leveraging this expertise, the team has developed comprehensive guidelines to aid practices in the preparation and streamlining of system administrative tasks associated with mergers. The following guidance explains the essential preparatory actions to be undertaken within the Source Practice (the practice being taken over) prior to the merger, and then subsequently the actions required following the merger within the Target Practice (the practice taking over). This guidance compliments the merge activities 'Check List' that emis provides upon merger agreement.
Non-Data Transfer
Before the merger date, it is recommended that practices clear all inboxes in Workflow Manager, as this data will not transfer to the target practice's Workflow Manager following the merger:
This includes crucial data such as patients' Lab Reports, Medicines Management and Documents which should be actioned for clinical safety reasons. Practices may choose to print these inbox items prior to the merger. Either way, it is important to acknowledge that any items left in Workflow Manager following the merger will be irretrievable.
Discuss a change to internal processes in the days leading up to the merge e.g. admin staff to send medication requests on paper rather than use Medicines Management.
Data Transfer
The only Workflow Manager exception is the Tasks Inbox. Any outstanding tasks created for registered patients will transfer across to the target practice's Tasks Inbox following the merger:
While patients' tasks are transferred, the task owner (associated user/team) does not move with the task post-merger. Therefore, it is highly recommended to complete tasks prior to the merger, to minimise confusion with unidentified task owners afterward.
DTS (Data Transmission Services)
GP Links (Registration) and Lab Reports Links must be suspended 7 working days prior to the merge go-live. Please contact the relevant trading partners to arrange suspension in sufficient time. Practices may wish to consider an action plan for processing any urgent Test Requests/Results during downtime. A recommendation would be to revert to the manual paper process using the reverse side of the (ICE) paper request labels/form.
Contact details should be recorded within the Trading Partners section of Workflow Manager>Configuration:
Document Management
If the practice receives electronic discharge summaries, out of hours transmissions, hospital letters at the source organisation, suspension of these services must be discussed with the relevant providers.
Deactivate Inactive Users
For the purposes of good housekeeping, ensure any users who no longer work for the organisation are deactivated prior to the merger, preventing any unnecessary data transfer. Within Organisation Configuration, using the Search option on the ribbon, locate the relevant user, and once retrieved, highlight the user and select Deactivate on the ribbon:
If deactivation is prevented by further actions being required, please access the following link: Emis Web - Activate and Deactivate Users in Organisation Configuration for a comprehensive, step-by-step guide on the necessary actions to remove a user.
Active Users
If users have been created and exist within both the source and target practices, these users will become duplicated in the Users section of target practice's Organisation Configuration following the merger. The transferred users from the source practice will not function in the target practice and is therefore essential to clearly identify redundant duplicate users following the merger by uniquely marking users prior.
Within Organisation Configuration, locate the relevant user by selecting the Search option on the ribbon and once located select Edit User on the ribbon. Within the Role section place an asterisk (or any other special character) in the User Mnemonic field: For example, LH becomes LH* (as per screen shot below):
The source user is now uniquely marked and will be clearly identifiable in the target practice following merger. Click OK to save the changes. Please note: this will not prevent or affect any user access. Please repeat the steps to mark all relevant users.
It is recommended to make a list of the teams that currently exist on the source organisation if they are to remain the same following merger.
Searches
As searches are not transferrable, it is recommended to export any required searches to an external location i.e. shared drive, prior to the merger so that the searches can be imported back into the target practice following the merger.
It is recommended to for the practice to run a 'Practice Population' search to identify the latest patient count prior to merger and save this data by either exporting or printing the result. See how to:
Using 'Batch add' to a Practice Population
Practices should consider if the identification of source verses target patients is necessary following the merger. For example, to identify branch patients from the main site (if required). This identification can be achieved by batch adding a unique administrative code to the practice population search just prior to the merger. Previous practice mergers have acted upon the Training Team's advice and have found this guidance beneficial.
One support request that a practice raised with the Training Team, 4 years post merger, was the need to identify how many patients remained from the original source practice and whom had since de-registered. As a unique code had been batch added to the practice population prior to the merger, the information was identifiable.
Practices should consider the use of:
- Batch adding codes
- Batch adding patient warnings
- Protocol triggers (pop-up on alert panel)
If useful, an alert such as a Precis bar 'Patient Warning': Branch patient of xxx location, can be batch added to the practice population. On activating a patient (Find a Patient/F5), this warning will enable quick identification of where the patient is located.
If practices would like the ‘Records At’ field to be populated against source patients, a request should be made prior to the merge taking place by sending a written request to migrationservices@emisgroupplc.com. Please note: The ‘Records At’ field will only be populated where the field is blank. The benefit of uniquely coding a record in addition to populating the 'Records At' field is the safety element. The 'Records At' field is free text, that once added, can be edited or even removed.
Patient Facing Services Account re-registration
It is recommended that a Patient Online Access Search is run to identify patients who have a status of 'active' or 'live'. These patients will need new registration code access (account linkage keys) for the target practice, if the patients want to continue using the original Patient Facing Services Application. Please see the following link: Search to Identify Registered Patients with an Active or Live online service account
Alternatively, Emis Library has a standard search which identifies all account statuses:
- Active
- Live
- Inactive
- Archived
Access the Emis Library, and drill-down through each of the following folders: SNOMED Searches> Workload Analysis> Online Services> Activation Status> Denominators:
Click Run on the ribbon to run the search. Once complete, select Export Results or Print as appropriate.
Quality Outcome Framework (QOF)
In support of data quality and clinical safety, identify and record a variety of patients from the GP Contract QOF registers for comparison purposes following the merger.
Patient Search using Find a Patient
Anticipate missing patients following the merger at the practice being taken over. Carry out random patient searching using Find a Patient/F5 and make note of the details for later comparison following the merger.
Clinical and Document Templates
Clinical and Document templates do not transfer across during the merger. It is recommended that any required templates are exported to an external location i.e. shared drive prior to the merger and then imported into the Target practice following the merger.
Appointments
Patient future appointments and clinic sessions templates will not transfer in the merger, therefore it will be necessary to have a plan in place for inputting appointments and building clinic sessions following the merger. The practice may wish to create a back up of the appointment book prior to merging. This will make it easier to recreate following the merge: https://www.emisnow.com/csm?id=kb_article&sysparm_article=KB0019254&sys_kb_id=2a62bd461b3f73403f9cea0e6e4bcb26
The practice may choose to create screenshots of each of the appointment session templates, including slot types, embargoes etc. plus a screenshot of the appointment configuration for replication in the target practice.
Week Templates
The source practice will still have its existing Session Templates but the Week Templates may have been removed and need to be re-created.
Medication Formulary
If the practice has created any formularies in addition to the Emis Standard Formulary, it will be necessary to export these as they will not transfer across during the merger. From the emis button, select Configuration and then select Formulary Manager. Highlight the required formulary and select Export on the ribbon.
Save all relevant formularies to a suitable destination folder and following the merger import back into the target practice.
Unmatched: Lab Results and Documents for the practice being taken over land into Unmatched Inbox following DTS switch on.
Registration: Duplicate Records
If patients have been registered at some point in both the source and target practices, these patients will be duplicated following the merger, whether Active or Inactive. Any duplicate patients will appear within Registration Workflow: Duplicate Records inbox. Please process the duplicates by merging the two records. Access the following link to view guidance on how to merge duplicates patients within the Registration section of Workflow Manager: Workflow Manager Presentation
Add a Patient Warning for Duplicate Merged Records
For the purpose of clinical safety it is highly recommended to add a patient warning to any merged patient as Problems and Immunisations may be hidden within the attachment and go unnoticed in the future. Patient Warning 'Merged duplicate patient, see ‘Transferred Attachment’ document dated: __/__/__. This warning can also be batch added by printing off the task list of duplicate users, and creating a Patient List search using these patients. Once run 'Batch add a Patient Warning' as per above to the search results.
Workflow Configuration
- Global Viewers: Global Viewers (users) of the practice being taken over will need to be re-added.
- Task Escalation Settings: Administrators of the settings may need re-adding/amending.
- Inbound User Matches: Ensure all GPs are configured correctly.
- Task Default Settings: Amendments may be necessary to these settings.
Registration
The practice may need to look at reconciliation with the Health Authority (PCSE) following a merger if patients are missing. Make contact with PCSE to arrange this.
Test Requests
ICE Test Request logins will need to be re-added against the target practice in Emas Manager. Contact the relevant Pathology Department for this process.
Tasks
Patient Tasks will transfer across to the Target Practice's Workflow Manager Tasks Inbox but with no specified user/team, making the task owners unidentifiable. A recommendation would be to highlight all the associated tasks and change owner to a specified user/team, who would individually go through each task and re-allocate to the most appropriate recipient.
Tip: Patient Tasks also contain RE: in the Subject Heading i.e. ‘RE: Bloggs, Joe (Mr)’ instead of the usual ‘Bloggs, Joe (Mr)’. These differences are clearly visible from the right-hand pane.
Tasks can be linked to users that have been made inactive during the merger. Please access the following link to process inactive users and associated tasks : Emis Web - Activate and Deactivate Users in Organisation Configuration
Users
Following the merger, please note: the users do not transfer across immediately and may take time to appear on the day. Emis advises practices to wait until a notification is received either via telephone or email to confirm merger completion. Only then should the deactivation of duplicate users take place. However, this delay can impact tasks associated with duplicate users if the tasks are not completed within the source practice, as recommended, prior to merger.
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- Teams: Ensure the users are added to the correct Teams for task purposes
- Session Holder Filters: Ensure the users are included in the appropriate session holder filters
- Out of Office Settings: Reconfigure Out-of-Office Deputies as these will have been removed
Teams: Teams/users within team will need to be re-added.
Services: Service Persons will need to be re-added i.e. Referrers.
Locations: From Locations a main site will need to be allocated to the target practice and any branch surgeries added as locations. ‘Branch Surgery’ must be the location type to be selectable from the Branch Surgery drop-down list within the Practice Information section of Registration.
Organisation: Check the practice details: name and address – especially if it’s a merge with a main and branch site/s, as branch scripts may print with the main sites address which is incorrect.
Following the merger both User Mnemonics will both be listed in Users (duplicated), one with an asterisk and one without. This is clearly visible from the Role tab in the lower section of the screen. Deactivate the asterisked user as this is the user no longer in use from the practice being taken over. Highlight the user and select Deactivate on the ribbon. All duplicate users must be deactivated. If deactivation is prevented by further actions, please access the following link: Emis Web - Activate and Deactivate Users in Organisation Configuration for detailed guidance on the necessary steps for user removal.
Deactivate leaving the one remaining, original user:
Medication
- Issues: If users are not able to issue medication and receive a warning messaging advising that the authorising clinician is not able to authorise the medication, this is linked to the issue of duplicate users. If the clinician authorised scripts in both systems prior to the merger and the old system user is then deactivated, the warning message will appear. This requires the user to highlight the medication required, re-authorise it again for the user concerned on the merged system and then select issue.
- End Course: If the above workaround doesn’t work, the user will have to end the course and re-add the medication.
- Mapping: Should the practice experience continuous prompts with mapped drugs (click ok to approve and complete); log a call with Emis Support. This, however, could be an issue with unmapped items in one of the CDB numbers (practices involved) and may need Medicines Management guidance. Emis Support confirmed that if drugs have been mapped in one practice, these shouldn’t need remapping following a merger.
- Last Issue/Number Method: For patients in the practice being taken over, the Last Issue/Number Method in Medication tab reads as ‘Electronic’ with no R2 This issue is rectified once a new approval is made against the items following the merger.
Check that documents are accessible. Be aware that there may be some issues with practices who may use different Document Management Suppliers i.e. Docman. Log a call with Emis Support in this event.
Registration Authority
Smartcard Synchronisation - when users from the source practice login to the target practice for the very first time using their smartcard, the role(s) will need to be synchronised with the new target practice.
Identity agent: select role and organisation - if users still have access to roles for both the source and target practices on their smartcard following merger, log a call with the IT Service Desk to inform the Registration Authority of this removal. Only the target practice should be available on the smartcard. It is a common problem for practice staff to still try and login to the source practice by mistake following the merger and this issue can cause problems with mismatches on roles if not removed.
From the Organisation Options access the following sections to update changes:
- Session Holder Filters: These will need reconfiguring with the clinicians from the Practice being taken over
- Session Locations Filters: Add location filters for each site (if relevant) so that appointments can be filtered to any location
- Session Header Colours: Choose a colour scheme for each location (Branch/Main site), to make identification easier from the Appointment Book:
New Session Templates
In preparation, consider the naming convention of the session templates, to include the site locations (or abbreviation) as these sessions will be visible from Patient Facing Services when booking online appointments.
- Location: When creating sessions it is vitally important to select the correct location for either the main site or any branch surgeries. This session location is linked to the appointment location and therefore when a patient receives an appointment booking confirmation (either via sms or letter) this advises the patient where to attend:
Week Templates
The practice being taken over will still have its existing Session Templates but the Week Templates may have been removed and need to be re-created. The Week Templates will then need to be add to the Planner following merger.
Run a search prior to and following the merger to check the practice has the correct population combined practice population. Export or print this search. Import any saved searches into the appropriate folders within Population Reporting.
Anticipate missing patients following the merger at the practice being taken over. Carry out random patient searching. If any patients are not found log a call with Emis Support for this issue. Emis Support is aware that this is likely during a merger.
Import any saved clinical or document templates into the appropriate folders within Resource Publisher.
If any exported formularies from the source practice need to be imported following the merger, from the emis button, select Configuration and then select Formulary Manager. Select Import on the ribbon and browse for the required formulary and select Open.
Remember to select Activate on the ribbon once the required formulary has been imported.