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Provider variance

Known provider variance to the Access Record capability

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Purpose

The purpose of this page is to aid consumers by identifying the variances between provider response banner messages, and detail any business rules applied, where known. The messages provided are NOT requirements; they are for the information of consumers. Providers may change these messages over time.

Cross section/subsection banner variances

GP transfer banner message

The following messages are returned by the provider systems when a GP to GP transfer is in progress:

Supplier Message
TPP Record is in transit and may be incomplete.
EMIS Data may be incomplete due to a pending GP transfer.
Vision This patient has been registered since dd/mm/yyyy but there is no record of successful completion of the GP2GP process. Some information may not yet be incorporated into the local patient record.
Microtest GP transfer underway - record may be incomplete due to the transfer.

Date banner message

The following messages are returned by the provider systems when a date filter is applied, please see each HTML view page for details on where date filters are applicable:

Supplier Message
TPP For the period 'dd-Mmm-yyyy' to 'dd-Mmm-yyyy'.
EMIS For the period 'dd-Mmm-yyyy' to 'dd-Mmm-yyyy' subject to patient preferences and/or RCGP exclusions.
Vision For the period 'dd-Mmm-yyyy' to 'dd-Mmm-yyyy'.
Microtest For the period 'dd-Mmm-yyyy' to 'dd-Mmm-yyyy'.

Exclusion banner message

The following messages are returned by the provider systems when data has been excluded from the dataset returned. Additional information has been provided to describe the message displayed at line item, where applicable.

Supplier Message Line item message
TPP Some patient data is hidden by sharing rules. The data in this section may be incomplete. Event has been made private by another organisation
EMIS Data items removed due to patient preference, confidentiality and / or RCGP exclusions. EMIS return either 'Confidential Item' or 'Sensitive Item' according to the reason for the exclusion
Vision One or more items have been suppressed due to privacy exclusion rules ***********
Microtest Items excluded due to confidentiality, patient preferences and/or RCGP sensitive dataset exclusions. Excluded items
Information: TPP display the section message for all sections regardless of whether there is an exclusion applicable to that section.
Information: TPP only include a table line item message in the Encounters section (or Last 3 Encounters table in the Summary section) and only for items marked private (as opposed to those relating to the exclusion data set). All other sections will not identify if an entry is absent or not.

Incomplete dates

The following explains how the provider systems deal with incomplete dates, where applicable:

Supplier Message
TPP Incomplete dates will be returned with the incomplete element missing, for example, dates may be returned as 2008 or Apr 2009. For the chronology, incomplete elements are treated as the first day of the month and first month of the year respectively.
EMIS Incomplete dates will be returned with the incomplete element missing - for example, dates may be returned as 2008 or Apr 2009.
Vision Not known
Microtest Incomplete elements of a date will be returned as the first day of the month or the first month of the year as applicable e.g. a date entered as ??/??/2011 will be returned as 01 Jan 2011.

Business rules and content banner variances

The following sections give details of variances in how providers populate the HTML view sections and their subsections and the banner messages they provide to inform users. As the Summary view contains subsections of the listed views it has not been listed to avoid duplication.

Encounters

The following business rules apply for encounters:

Supplier Rule
TPP Encounters is a representation of the SystmOne journal which is a full chronology. It therefore covers more than the clinical narrative definition.
EMIS N/A
Vision N/A
Microtest N/A

The following content section messages are returned by the provider systems for encounters:

Supplier Message
TPP N/A
EMIS N/A
Vision N/A
Microtest Contains Appointment information and any related information recorded during the consultation; related items may also occur in other sections.

Clinical items

The following business rules apply for clinical items:

Supplier Rule
TPP Returns practice-specific codes categorised as clinical. Codes are categorised as either clinical or administrative by default according to practice specific configuration. The default can be overridden by users.
EMIS Includes all coded items (clinical and administrative) except those which will be returned as observations (have numeric or associated values).
Vision Contains clinical items including, but not limited to, Procedures, Diagnoses, Symptoms, Conditions; may include items included in other sections such as Linked Problems.
Microtest Coded items excluding Read Code Chapter 2 & codes starting ‘9’ & ‘0’, not filtering out Observations.

The following content section messages are returned by the provider systems for clinical items:

Supplier Message
TPP N/A
EMIS N/A
Vision Read Chapter 1, Read Chapters A-Z.
Microtest Contains clinical items including, but not limited to, Procedures, Diagnoses, Symptoms, Conditions; may include items included in other sections such as Linked Problems.

Problems and issues

The following business rules apply for problems and issues:

Supplier Rule
TPP N/A
EMIS N/A
Vision All problems included in Active Section. Problem related details are included in other sections.
Microtest Low priority mapped to ‘Minor’; Medium mapped to ‘Routine’; High mapped to ‘Major’.

The following content section messages are returned by the provider systems for problems and issues:

Supplier Message
TPP Section includes problem and summary items.
EMIS Past medications may include prescriptions which have been cancelled or discontinued before the original prescribed end date.
Vision N/A
Microtest N/A

Active problems and issues subsection

The following content subsection messages are returned by the provider systems for active problems and issues:

Supplier Message
TPP N/A
EMIS N/A
Vision All problems included in Active Section.
Microtest Contains clinical items including, but not limited to, Procedures, Diagnoses, Symptoms & Conditions that have been designated as Problems used to link together related information.

Inactive problems and issues subsection

There are no content subsection messages returned by the provider systems for inactive problems and issues.

Allergies and adverse reactions

The following business rules apply for allergies and adverse reactions:

Supplier Rule
TPP N/A
EMIS All allergies and adverse reactions will be recorded in the Current Allergies and Adverse Reactions subsection. Historical allergies and adverse reactions data is not supported by EMIS.
Vision All allergy and adverse reactions data will be recorded in the Current Allergies and Adverse Reactions subsection. Vision do not record end dates for allergies & adverse reactions, therefore a history view is not possible.
Microtest N/A

There are no content section messages returned by the provider systems for allergies and adverse reactions:

Current allergies and adverse reactions subsection

The following content subsection messages are returned by the provider systems for current allergies and adverse reactions:

Supplier Message
TPP N/A
EMIS N/A
Vision All Allergies Listed in Current Section.
Microtest N/A

Historical allergies and adverse reactions subsection

The following content subsection messages are returned by the provider systems for historical allergies and adverse reactions:

Supplier Message
TPP N/A
EMIS Historical Allergies and Adverse Reactions data is not supported by this system.
Vision N/A
Microtest N/A

Medications

The following business rules apply for medications:

Supplier Rule
TPP
  • Acute/repeat issues are current until the scheduled end date (issue date plus days duration)
  • Repeat templates are current until actively ended by a system user action
EMIS
  • An acute medication is current for 28 days from issue or the issue date plus the days duration plus 14 days, whichever is the greater
  • Repeat medication courses are subject to a local configuration setting. When enabled, repeat courses will automatically expire after a configurable period from the last issue date plus the course duration. The period can be set from days to years.
Vision
  • All acute medications stay in the current medication issues (acute) section for 1 year (from prescription date) before being moved to Past Medication
Microtest
  • ‘Current Medication Issues’ are repeat and acute medications in the patient’s ‘current’ list, the ‘Current Repeat Medications’ are repeat medications in the patient’s ‘current’ list and the ‘Past Medication’ are repeat and acute medications in the patient’s ‘removed’ list
  • A medication can be moved between ‘current’ and ‘removed’ lists
    • automatically if a drug hasn’t been issued for more than a configurable period, typically 6 months, it will be moved from ‘current’ to ‘removed’
    • manually by the doctor in either direction

It is extremely important for the details regarding the ending of a medication to be available to a clinician, as this will highlight any clinical issues (e.g. stopping a medication due to an allergy etc.) and allow the clinician to make an efficient and informed clinical decision.

For the purpose of the specification the different circumstances of ending a medication are classified as:

  • naturally ended: medication naturally came to an end, i.e. no manual intervention via the user (auto system transition)
  • cancelled: actively stopped acute medication by user
  • discontinued: actively stopped repeat medication by user

Available details for Cancelled and Discontinued (ideally including date and reason) MUST be provided in the Details column in the applicable subsections.

It is not currently possible for all GP system suppliers to distinguish between discontinued or cancelled and/or provide full details of the date and reason. Details of provider variance can be found here:

Supplier Information
TPP Acute medications will return an ‘Ended on’ label and the date ended in the Details column, repeat medications will return ‘Stopped:’ and the date stopped. A description from a coded list will be return along with any free text narrative if available.
EMIS Does not distinguish between cancelled, discontinued or ended (always says expired for naturally ended).
Vision Does not have a concept of cancelled. For discontinued medications they hold a date and reason within their system and this should be included in the details column. Note: INPS use the term de-activated in Vision as opposed to discontinued.
Microtest Can only show that the medication has been actively stopped by a user. They do not hold the date or reason for the ending of a medication (these are not viewable in their GP system).

The following content section messages are returned by the provider systems for medications:

Supplier Message
TPP N/A
EMIS Non - BNF designated items e.g. local mixtures, have been excluded.
Past Medications may include prescriptions which have been cancelled or discontinued before the original prescribed end date
Vision N/A
Microtest N/A

Current medication issues subsection

There are no content subsection messages returned by the provider systems for current medication issues.

Current repeat medications subsection

The following content subsection messages are returned by the provider systems for current repeat medications:

Supplier Message
TPP The medication above is taken from a list of Repeat Medication Templates in the patient record which may have been amended since they were last issued. You should look at the Current Medication Issues section to see what the patient has been given.
EMIS N/A
Vision N/A
Microtest N/A

Past medications subsection

There are no content subsection messages returned by the provider systems for past medications.

Referrals

There are no business rules associated with referrals.

The following content section messages are returned by the provider systems for referrals:

Supplier Message
TPP N/A
EMIS N/A
Vision N/A
Microtest Contains items relating to 'Referral for Further Care'; may include repeated entries due to duplicated data in the source system.

Observations

There are no business rules associated with observations.

The following content section messages are returned by the provider systems for observations:

Supplier Message
TPP N/A
EMIS N/A
Vision N/A
Microtest Contains Observations with numeric and other measurement ranges.

Immunisations

The following business rules apply for immunisations:

Supplier Rule
TPP All immunisations recorded as Vaccinations are included. Immunisations recorded on SystmOne as Read codes (not using SystmOne's Vaccinations functionality) are not included in the Immunisations view. All Read coded immunisations will be included in the Encounters view.
EMIS Includes a record of an invitation for a vaccination and consent / refusal for vaccinations in addition to immunisations administered.
Vision N/A
Microtest Microtest don't have a recognizable Immunisations 'table'; immunisations are extracted from their Recalls & History repositories based on the following Read Codes;
Read Codes; 7L1gz 14b 65 670 6700 68N 8BMb. 8BQ1. 8I23 8MC 8ME 9DN 9ki 9Oo 9OX ZV03 ZV04
where the code is less than five characters long it will include all codes below it in the Read2 hierarchy.

The following content section messages are returned by the provider systems for immunisations:

Supplier Message
TPP N/A
EMIS Content and Part not supported.
Vision N/A
Microtest N/A

Administrative items

The following business rules apply for administrative items:

Supplier Rule
TPP Returns practice-specific codes categorised as administrative. Codes are categorised as either clinical or administrative by default according to practice specific configuration. The default can be overridden by users.
EMIS N/A
Vision N/A
Microtest N/A

The following content section messages are returned by the provider systems for administrative items:

Supplier Message
TPP N/A
EMIS This system does not support retrieval of Administrative Items data.
Vision Contains clinical items including, but not limited to, Procedures, Diagnoses, Symptoms, Conditions; may include items included in other sections such as Linked Problems.
Microtest Contains non-clinical items - including, but not limited to, administrative, occupational, social context, carer information, communications preferences, legal information, learning disability, advance decisions etc.

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