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Coronavirus guidance

Supporting patient care during the COVID-19 Coronavirus outbreak.

Introduction

We have several solutions in place to help your GP practice and patients through the COVID-19 Coronavirus outbreak.

We will regularly update this page with the latest information and advice.

COVID-19 Q&A Webinar: We hosted a free Q&A webinar on Thursday 26 March. Click here to read the answers to your questions.  

Working Remotely

To support the management of coronavirus and the possibility of: 

  1. surgeries closing to contain the spread of the virus
  2. surgery staff working from home due to self-isolation 
  3. re-introduction of retired clinicians in various shared and practice settings 

Vision can help GP practice staff maintain a business as usual approach to patient care using Vision 3 Remote Access and Vision Anywhere. We have provided some details on each option below.

Vision is supporting a national response and working with CCGs, Health Boards and national bodies to deliver their preferred method of remote patient record access.

NHS Wales Informatics Service (NWIS) guidance for remote home working  - NWIS have a solution in place that allows Practice staff to gain emergency access to their practice-based computer from a home computer or device.

 

Vision 3 Remote Access

You can access the full functionality of your GP practice Vision 3 account using a remote desktop connection. You will need the following in place to access Vision 3 remotely:

  • a Windows laptop/desktop PC
  • a security token to access your local NHS Network
  • and for customers in England, a Smartcard reader (so you can access national services such as electronic prescribing and eReferrals).
 

Vision Anywhere Mobile

Use Vision Anywhere on Windows, iOS and Android to access your practice appointments lists and patient records. 

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From Vision Anywhere you can easily:

  • conduct telephone consultations directly from your device. See:
  • view a concise and useful summary of the patient record
  • complete a full consultation from one screen, with or without an internet connection
  • dictate notes straight into patient records 
  • record common observations quickly using predictive data entry
  • use data entry templates and alerts in conjunction with Vision+ and Outcomes Manager. 

Click here to download Vision Anywhere Android (Play Store)

Click here to download Vision Anywhere iOS (App Store)

Click here to enquire about the Windows version of Vision Anywhere

Vision Anywhere for Shared Care

Vision Anywhere for shared care allows all the functionality of Vision Anywhere mobile consultations (as detailed above) with the added value of sharing of patient appointments and records between different practices (including EMIS Web patient records).

Only appropriate data is shared, as agreed between health providers and as pre-defined in your data sharing agreements.

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Click here to enquire about the Windows version of Vision Anywhere

Setting Up New and Returning Clinicians

Click here to see detailed instructions on how to set up new users in Vision 3 and Vision Anywhere. If you have clinicians who  are returning to work from retirement, you can easily update their old details and reactivate their account.

Please also see the MIMS Free learning for retired healthcare professionals returning because of coronavirus.

Clinical Pathway

To facilitate face-to-face and online patient consultations, as well as general monitoring of Coronavirus within your practice population, we have created a Coronavirus clinical pathway which includes guidance issued by NHS England. 

The data entry template, real-time patient specific-alerts and up to the minute reporting tool are all available in Vision 3 once SIS 10500 is installed on your Vision 3 system (estimated the end of March 2020).

A version of the data entry template is also available from Vision Anywhere version 3.3 .

A Vision 3 guideline is available now to download into Consultation Manager.

Vision + Coronavirus Patient Alerts and Reports

Coronavirus Patient Alerts will display when a patient is selected who has travelled to high-risk countries and need further assessment/monitoring (patient status can be gathered from patient SMS questionnaires see below). 

clinical-pathway-coronavirus-screen-shot

Use our Vision+ reports to assist with monitoring and recording of travel history in exposed areas.

Remember from the Vision + Coronavirus reports, and you can manage patients for:

Data Entry Templates

Vision + Coronavirus Template
Allows for quick and concise recording of travel history, vulnerability assessments, diagnostics and monitoring. The reports will help identify patients who may be eligible for a vaccine as and when it becomes available.

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Vision Anywhere Coronavirus Template

Whether you are using Vision Anywhere as a means to access patient records whilst on the move, at home, in surgery or working as part of a shared care service, you can access the Coronavirus Template via Vision Anywhere.

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See Vision Anywhere help page.

NB - Templates aren't accessible on Android devices.

Consultation Manager Guideline.

A Coronavirus guideline is available now to download into Consultation Manager.

Click here for instructions on downloading and importing guidelines.

Click here to download the guideline.

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Reporting & Monitoring

In addition to the Clinical Pathway, we have also created a Coronavirus (COVID-19) Clinical Audit to help you report on and monitor Coronavirus patient care. This is generated automatically on a daily basis.

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The audits are updated in line with the national requests that we receive. We will notify you of any changes to the audit via the Vision blog.

Click here to download the current version of the audit and here for instructions on how to download and import.

Remember, from Clinical Audit you can view and access affected patients, analyse prevalence, add patient reminders and use audit groups in ad-hoc search and reports. See the Clinical Audit help centre for further details.

SNOMED & Local Terms

We will be releasing SNOMED CT & local clinical term updates to support the recording of Coronavirus related clinical activity across the Vision solutions on a regular, ongoing basis.

All customers now have access to the Coronavirus clinical terms released in April. Click here for details.

We have started to rollout the 29.1.0 SNOMED CT & local clinical term update. Click here for details.

Processing Electronic Acute Prescriptions Added in Vision Anywhere

Please see the following guidance on how you can process and issue electronic acute prescriptions added in Vision Anywhere from Vision 3:

England - Processing acute EPS items.

Wales - Processing acute 2DRX items.

  

Repeat Dispensing

During this time, implementing repeat dispensing is especially useful as will help reduce patient footfall and practice workload.

England

Please see: Electronic Repeat Dispensing (via EPS) in Vision

The Business Services Authority (BSA) are offering a service where they will provide NHS numbers of patients who may be eligible for repeat dispensing. See the NHSBSA website here.

Wales and Northern Ireland

Please see: Repeat Dispensing in Vision

Scotland

Please see: ePharmacy CMS Prescribing in Vision 

Electronically Signing and Sending an eMED3

During this time, sending eMED3s by email  can help reduce patient footfall.

Please see: Electronic Repeat Dispensing (via EPS) in Vision

Online Patient Services

Changing Bookable Appointment Slots to Telephone/Online Consultations

It has been advised that patient consultations are conducted by telephone or online where possible. You can easily change your online appointment slots to show as telephone consultations on the Patient Services booking screen as follows:

  1. From the front screen of Vision, go to Control Panel - File Maintenance - Online – Appointments.
  2. Select the Slot Types tab.
  3. Select the slot types that you use online and change the wording in the VOS text box to Telephone Consultation.
  4. Click OK to Save.

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Alternatively, you can create completely new appointments books. See Vision 3 Appointments or the new Appointment App for further detail.

Patient Messaging

For practices outside of Wales, you might want to take advantage of our patient messaging tool which allows for online instant messaging with your patients.

  • Help for practices is here.
  • Help for patients is here.

 

Text Messaging (SMS)

SMS

Text Your Patients - Use Our Vision+ SMS functionality to keep patients up to date with the latest surgery, local and national advice regarding Coronavirus. See the SMS help topics and helpful videos.

Send Coronavirus Health Questionnaires – why not create an SMS questionnaire which can be sent to selected patients within the Coronavirus report or any other group of patients. Patient responses are clinically coded back to their patient record. See the SMS Questionnaire help topics and helpful videos

Click here to submit a contact form to find out more about text messaging, and we'll be in touch. 

My Health Text - Welsh Government has agreed to fund additional messages to help practices communicate with patients. 

 

111 Messages (England)

When you receive an NHS 111 message into Mail Manager which contains one of the Covid-19 disposition codes listed below, Vision automatically generates and files a Medical History entry onto the patient record with the following details:

2020-04-28_NHS111

  • Event Date – The date of the contact
  • Read Term for Characteristic – 1JX1.00 Suspected disease caused by 2019-nCoV (novel coronavirus)
  • Comment – 111 Disposition DXnnnn with the Dx code and description from the NHS111 message (see below)
  • Type of Characteristic – Symptom
  • Episode Type – Other
  • Priority - 1
  • Consultation Type – NHS Direct Report

You can monitor these from Clinical Audit, click here to download the current version of the audit and here for instructions on downloading and importing it.

The Disposition Codes which automatically file are:

·         Dx1112

COVID risk Clinical Assessment service 1 hour

·         Dx1113

COVID risk Clinical Assessment service 2 hours

·         Dx1114

COVID risk Clinical Assessment service 4 hours

·         Dx1115

COVID risk Clinical Assessment service 6 hours

·         Dx1116

COVID risk Clinical Assessment service 12 hours

·         Dx451

COVID Coordination Service

·         Dx391

COVID Self Care

·         Dx01125

Emergency Ambulance Response for Potential COVID19

·         Dx339

Speak to a Clinician from our service Immediately – COVID 19 Chest Pain Assessment

·         DX01214

Emergency Ambulance Response for Potential COVID19 (Category 3)

At Risk Patients (England)

 As previously reported, NHS England have written to 900,000 at very high risk patients advising them to stay indoors (shield) for the next 12 weeks.

As directed by NHS Digital, overnight on 23 March, a utility was run on your patient records and any patients falling in the ‘at highest risk’ group as specified by NHS Digital now have the Read code 9d44.00 Risk of exposure to communicable disease (situation) added to their record.

By default the associated History entry for patients identified as at-risk contains the following details:

  • Read Term for Characteristic - 9d44.00 Risk of exposure to communicable disease (situation) - note the SNOMED CT Description is used for the terms automatically added to patient records.
  • Comment - High risk category for developing complications from Covid-19 infection - Added at NHS Digital request.
  • Priority – 3.

IMPORTANT - Previous communications from NHS England advised that practices should await further instruction before contacting affected patients. However, we have now been advised that the original guidance for contacting and reviewing patients is still valid and you should continue to follow NHS England guidance as detailed in their FAQs here. You will see in this guidance that there is also a letter template which we have rendered into a Vision 3 letter template which you can download here.

At-Risk Patients – Phase 2

NHS England have identified additional At-Risk patients as part of phase 2 of this process. This list also includes the reason why the patient has been included in the list.

On 14th April we ran a utility to add the clinical term "9d44.00 Risk of exposure to communicable disease (situation)" to the appropriate patient records. These medical history records are flagged as priority 1 ensuring inclusion in SCR uploads for consenting patients and the reason why the patient has been identified as at highest risk is included in the free text comments where supplied.

You should review the newly added patients via the Clinical Audit, as detailed below, and once you have received the April 2020 SNOMED CT update, due to start release from 15 April 2020, you can use the following clinical terms to classify the patient risk:

  • 14Op.00 Low risk category for developing complication from COVID-19 infection

  • 14Oq.00 Moderate risk category for developing complication from COVID-19 infection

  • 14Or.00 High risk category for developing complication from COVID-19 infection

At-Risk Patients – Phase 1 & 2 Updated

As directed by NHS Digital, for all your active patients with a clinical entry of 9d44.00 recorded since 1st January 2020 without an End Date added, the following clinical record was added on 4th May 2020:

C-19 4-5-2020

By default the History entry has:

    • Read Term for Characteristic - 14Or.00 High risk category for developing complication from COVID-19 infection

    • Comment – Blank

    • Priority – 1

    • End Date - Matches Event Date

They have a Consultation Type of Administration.

Note - This includes those on the original two ‘at risk’ lists, without an End date recorded.

NHS Digital have issued guidance on the processing of these patients for your reference here.

This guidance includes the templates of the two letters they are asking you to send to the two groups of patients:

Updated 17th June 2020

NHS England are now providing weekly updates to the 'At Risk' patient list. On receipt of this list we will add the following Medical History to any patients that newly qualify:

Important – We have been directed by NHS England to include the provided reason in Comments for these entries. This can contain sensitive information. For this reason the new entry is being added as a Priority 3 to give you time to review the entry without it automatically being loaded to the SCR when accessed.

By default the History entry will have:

  • Event Date – Date the patient was added to the Shielded Patient List (SPL) as provided by NHS England

  • Read Term for Characteristic - 14Or.00 High risk category for developing complication from COVID-19 infection

  • Comment – Reason provided by NHS England

  • Priority3

  • End Date – Matches Event Date

They will be added with a Consultation Type of Administration.

These patients have already been added to the national SPL and been contacted by NHS England.

Manually Recording a Patient is At Highest Risk.

If you have any patients in this vulnerable category that have not been identified with the term 9d44.00 for any reason, for example, newly registered patients, patients with new at risk diagnoses or patients prescribed drugs by a hospital, Read term 9d44.00 Potential infectious contact must be manually added to their clinical record with a Priority of 1 and "High risk category for developing complications from Covid-19" entered into free text comments.

Note - When the term 9d44.00 is added automatically to the patient record, the SNOMED description "Risk of exposure to communicable disease (situation) " is used. When the Read term 944d is added manually, the Read description "Potential infectious contact" is recorded. 

Reviewing At Highest Risk Patients

You can view the patients who have had the 9d44.00 clinical term added to their record by downloading and importing the latest Coronavirus Clinical Audit from here and reviewing the Patients flagged by NHS Digital as increased risk for developing complications from Covid-19 infection (9d44) group:

The group has an active Reminder of ‘At significant increased risk from COVID-19’.

Self-Declared Patients

NHS Digital have provided a list of patients who have self-declared as ‘at risk’ on the Public Health England web site.

We have added the following record to these patients and expect to receive further updates on an ongoing basis:

  • In Practice – Tick removed
  • Read Term for Characteristic - 9N38.00 Message from patient
  • Comment – ‘Added by Cegedim Health Systems on behalf of NHS Digital to flag patients self-declaring as in the high risk category for developing complications from Covid-19 infection’
  • Priority – 3
  • Consultation Type - Administration

NHS Digital have issued guidance on the processing of these patients for your reference here.

This guidance includes the templates of the two letters they are asking you to send to the two groups of patients:

Shielded Patient List (SPL) Subtractions - England Only

NHS England have provided a list of Shielded Patient List (SPL) Subtractions. These are patients that for various reasons are no longer considered ‘high risk’ and now need updating to either ‘moderate’ or ‘low’ risk.

Note – This affects any of your patients, on the SPL, who do not have a moderate or low risk record added later than the date of the subtraction entry on the SPL Subtractions list.

This process consists of two aspects:

  1. The following entry will be added to any of your patients included in this list:
  • Event Date – Will be the date the patient was subtracted from the SPL
  • Read Term for Characteristic – Either:
    • 14Oq.00 Moderate risk category for developing complication from COVID-19 infection

    • 14Op.00 Low risk category for developing complication from COVID-19 infection

  • Comment – As per the description provided by NHS England
  • Priority – 3
  • Consultation Type – Administration
  1. The original SPL entry, of 14Or.00 High risk category for developing complication from COVID-19 infection, will be updated with an End Date:

    • End Date – The date the patient was subtracted from the SPL

The existing Clinical Audit continues to count the entry with the latest Event Date only, so if you have reviewed and updated a patient’s record with a ‘high’, ‘moderate’ or ‘low’ risk entry, these are the records picked up providing the Event Date is after the date received from NHS England.

We are in the process of writing an audit that will identify downgraded records for your review.

NHS England have provided a copy of the letter they are sending patients when they are removed from the SPL, click here for a Vision template of this letter for your use if required.

See Downloading and Importing Clinical Audits for details on downloading and importing Clinical Audits.

C-19 4-5-2020

 

At Risk Patients (Wales)

As extensively reported, NHS Wales will be writing to your ‘most vulnerable’ patients advising them to stay indoors for the next 12 weeks.

As directed by NHS Wales, we have run a utility on your patient records and any patients falling in the ‘at risk’ group as specified by NHS Wales now have clinical term 9d44.00 Risk of exposure to communicable disease (situation) added to their record. We expect a series of these updates to be run over the coming weeks and we will notify when the different batches are run via the Vision blog.

By default the associated History entry will have:

  • Read Term for Characteristic - 9d44.00 Risk of exposure to communicable disease (situation) - note the SNOMED CT Description is used for the terms automatically added to patient records.
  • Comment - High risk category for developing complications from Covid-19 infection - Added at NWIS request.
  • Priority – 1, meaning it is included in WCCG data.
  • Consultation Type of Administration.

Updated 17th June 2020

NWIS are now providing a regular list of patients that are newly qualified for the 'At Risk' category. On receipt we have been directed to add the following Medical History entry to the patient's record:

  • Read Term for Characteristic - 9d44.00 Risk of exposure to communicable disease
  • Comment – Central analysis of NHS Data has indicated the patient may be at high risk. Added at NWIS request
  • Priority – 1

These entries will have a Consultation Type of Administration.

Please Note –Vision uses SNOMED CT Term 443999008 Risk of exposure to communicable disease to record this data, this displays as Read term 9d44.00 Risk of exposure to communicable disease in Vision 3. If you add this Read code manually it displays as 9d44.00 Potential infectious contact.


Manually Recording At Risk Patients

If you have any patients in this vulnerable category that have not been identified with the term 9d44.00 for any reason, for example, newly registered patients, patients with new at risk diagnoses or patients prescribed drugs by a hospital, you can add the following Read term  to the medical history SDA 65Z..00 Infect.dis.prevent/control NOS with a Priority of 1 and High risk category for developing complications from Covid-19 entered into Comments.

Note - this code must be added via the medical history button rather than the Read term add box (as this will add the code as an immunisation).

hx-1

Viewing your Coronavirus/Covid-19 ‘Most Vulnerable’ Patients

You can view the patients who have had the 9d44.00 clinical term added to their record by downloading and importing the latest Coronavirus Clinical Audit from here http://help.visionhealth.co.uk/clinical%20audit/Content/Downloads/INPS%20Daily.htm and reviewing the Patients flagged by NHS Scotland as increased risk for developing complications from Covid-19 infection (9d44) group:

The group has an active Reminder of ‘At significant increased risk from COVID-19’.

See Downloading and Importing Clinical Audits for details on downloading and importing Clinical Audits.

Vulnerable Patients (Scotland)

As extensively reported, NHS Scotland will be writing to your ‘most vulnerable’ patients advising them to stay indoors for the next 12 weeks.

As directed by NHS Scotland,we have run a utility on your patient records and any patients falling in the ‘at risk’ group as specified by NHS Scotland now have clinical term 9d44.00 Risk of exposure to communicable disease (situation) added to their record.

By default the associated History entry will have:

  • Read Term for Characteristic - 9d44.00 Potential infectious contact - note the SNOMED CT Description is used for the terms automatically added to patient records.
  • Comment - High risk category for developing complications from Covid-19 - Added at NSS request.
  • Priority – 1, meaning it is included in Emergency Care Summary (ECS) and Key Information Summary uploads.
  • Consultation Type of Administration

If you have any patients in this vulnerable category that have not been identified with the term 9d44.00 for any reason, for example, newly registered patients, patients with new at risk diagnoses or patients prescribed drugs by a hospital, Read term 9d44.00 Potential infectious contact must be manually added to their clinical record with a Priority of 1 and High risk category for developing complications from Covid-19 entered into Comments.

We are currently receiving a weekly updated batch of patients newly identified as 'vulnerable'. NHS Scotland have requested we run this utility on your system with the new batches each week to ensure you have the latest patient information.

Viewing your Coronavirus/Covid-19 ‘Most Vulnerable’ Patients

You can view the patients who have had the 9d44.00 clinical term added to their record by downloading and importing the latest Coronavirus Clinical Audit from here http://help.visionhealth.co.uk/clinical%20audit/Content/Downloads/INPS%20Daily.htm and reviewing the Patients flagged by NHS Scotland as increased risk for developing complications from Covid-19 infection (9d44) group:

The group has an active Reminder of ‘At significant increased risk from COVID-19’.

See Downloading and Importing Clinical Audits for details on downloading and importing Clinical Audits.

Pathology Results

Preparing for Coronavirus Test results - England Only

You will shortly be receiving the Coronavirus test results from the swabs taken at the nationwide Coronavirus test centres.

These results are received in the same way as normal pathology results, however as the tests were not requested by yourselves, they are sent to a generic recipient at your practice:

  • GP Code – G9999981
  • GP name - COVIDpillar2.

To ensure these results automatically file to the patient record on receipt, we strongly recommend you set up a Local ID for G9999981.

Note – The initial download may be a large number of results, depending on how many of your patients have been tested.

To set up a Local ID

  1. From Mail Manager, select Tools - Local IDs.
  2. The Local IDs screen displays:
    Local Ids
  3. Select Add and the Add a new Local Identifier screen displays:image-82
  4. Complete as required:
  • Local Identifier - Enter G9999981
  • Staff Member - Select the appropriate member of staff from the available list
  1. Select OK.

Yellow Card Reporting

There is a dedicated Yellow Card site for the reporting of new and emerging side effects and medical device incidents in COVID-19 treatments, this includes the reporting of side effects for medicines taken by patients to manage long-term or pre-existing conditions. Please report any new and emerging side effects and medical device incidents in COVID-19 treatments here:

It is important you do not use the integrated Yellow Card functionality within Vision 3 for the reporting of the side effects and medical device incidents in COVID-19 treatments.

The following entry could be used to record the Yellow Card report in the patient’s clinical record:

  • Read Term for Characteristic9G4..11 Yellow card drug react notif
  • Comment - Medication/Appliance name – COVID-19

Cegedim's Business Continuity Statement

Cegedim, the business that brings you Vision, has in place a well-established Business Continuity Plan, inclusive of pandemic impacts, which regularly undergoes testing as part of our ISO accreditation.

Cegedim's business continuity plan has been fully reviewed in the last few weeks to ensure that it will enable us to respond if necessary to either reduced staffing numbers and office closures. Including increased use of working from home options and relocating work in the event of an office closure.

As the situation in the UK develops, we will continue to review our operating status and share any actions we are taking to maintain all our contracted services. In the meantime, our business continues, as usual, your day-to-day points of contact remain unchanged.

Contact customer support

Customer Support is open 07:00-19:00 Monday to Friday and 09:00-13:00 on Saturdays for Wales, Scotland and Northern Ireland.

In England the Customer Support has extended opening hours 06:30 - 20:30 every day.