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Copyright © INPS Ltd 2014
The Bread Factory, 1A Broughton Street, Battersea, London, SW8 3QJ T: +44 (0) 207 501700 F:+44 (0) 207 5017100 W: www.inps.co.uk
Vision 3
Vision+ User Guide
http://www.inps.co.uk/
Copyright Notice
© 2014 INPS
All Rights Reserved.
No part of this document may be photocopied, reproduced, stored in a retrieval system or
transmitted in any form or by any means, whether electronic, mechanical, or otherwise,
without the prior written permission of INPS.
No warranty of accuracy is given concerning the contents of the information contained in
this publication. To the extent permitted by law, no liability (including liability to any person
by reason of negligence) will be accepted by INPS, its subsidiaries or employees for any
direct or indirect loss or damage caused by omissions from or inaccuracies in this
document.
INPS reserves the right to change without notice the contents of this publication and the
software to which it relates.
Product and company names herein may be the trademarks of their respective owners.
INPS Ltd.
The Bread Factory
1a Broughton Street
London
SW8 3QJ
Website: www.inps.co.uk
iii
Contents
What's New 9 DLM 457 (08/04/2014) 9 SIS 10245 (26/03/2014) 10 DLM 451 (15/01/2013) 12
Introduction to Vision+ 13
Overview 14
"Real Time" Alerts 15
Simple Data Entry Tools 16
Templates 17 Additional Templates - Download Web Files 19
Inbuilt Calculators and Questionnaires 21
Vision+ Recall Management 21
Vision+ Reports 22
Getting Started With Vision+ 23
Installation and Vision+ Versioning 23
Accessing Vision+ 25
Initial Set-up 27 Forward Dating Explained 28 Vision User Rights to Vision+ 30
Clinical Audit and Vision+ 30
Mail Gateway and Vision+ 30
Multiple Consultation Managers and Vision+ 30
Vision+ Alert Indicator Screen 31
Viewing the Alert Indicator Screen 31
Navigating the Alert Indicator Screen 32
Colour-Coding of Contract Indicators 33
Toolbar 34
iv
Using the Right Click Menu 35
Hide and Re-Invoke the Alert Indicator Screen 35
Moving the Alert Indicator Window 35
Re-sizing the Alert Indicator Window 36
Vision+ Data Entry 37
Read Code Data Entry in Vision+ 37
Adding Current Exception Read codes 39
Expired Exception Read codes 39
Entering Additional Codes 40
Recording Measurements and Values 40 Recording BMI Values 41 Recording Blood Pressure Values 41 Recording Smoking Status 42
Using the Notes Summary Data Entry Screen 43 Indicators screen 43 Registers screen 44
Assessment Forms & Risk Calculators 45 Questionnaires 46 ASSIGN CVD Risk Calculator 47 CHADS2 - AF Stroke Risk Calculator 50 eGFR Calculator 53 Framingham CHD/CVD Risk Calculator 56 JBS 2 CVD Risk Calculator 58 QRISK2 CVD Risk Calculator 60 Peak Expiratory Flow Rate (PEFR) 62 ABPI Calculator 64
Add to Register 66
Extra Indicators 68
Prevalence Searches 69
Register Checks 69
Vision+ Contract Templates 71 Overview of the Contract Template Screen 72 Summary - Viewing or Adding data to a Template 73 Using Contract Templates 74
Toolbar 76 Default Date 76 History Tab 76 Status Bar 77 Contract Icon 77 Undo Last Entry 77 Undo All Entries 78
v
Tabs 78 Next Tab and Previous Tab Buttons 78 Next and Previous Buttons 79 Viewing Details of Contract Information 80 Listing and Graphing Historical data 81 Viewing All Templates 82
Alternative methods of Opening a Contract Template 82
Practice Reports 83
Overview - Practice Reports 83
Accessing the Practice Reports Tools 83
Using Patient Target Lists 84 Patient Target Lists 85 How Patient List Information is calculated 85
Working with Data within the Patient Target Lists 86 Recording Information Using Patient Lists 86 Printing a List of Patients on a Patient List 86 Looking at Other Indicators for Patients in the Patient Lists 86 Opening a Patients notes from the Patient List 86 Producing Recall Letters Using Mail Merge Tools 86 Designing Patient Recall Letter Templates 87 Create a New Recall Letter Template 88 Edit or Delete Letter Templates 89 Important Information about Letter Templates 89 Running a Mail Merge from Patient Target Lists 89 Multi-Disease Registers 91 Important Information about Influenza Recalls 92 Managing the Recall Status using Letter Levels 96 Targeting High-Value Patients for Recall 97 Recalling Patients by Phone 97 Adding Codes to Multiple Patient Records 98 Read code Data Entry Screen for Non-Contract codes 99
Last Run button 100
High Value Patients 100
Contract Manager 102 The Contract Manager Screen 102 Updating Contract Manager 103 Navigating Through the Different Contract Domains 103 Working with Data on the Contract Manager Screen 104
Viewing Contract Point Statistics 104 Using the Points Screen 105
Entering Manual Point Information 105 Adjusting Point Aspirations 105 Opting out of Clinical Categories 106 Specifying Payment and Prevalence Information 107 Generating a Points Report from Contract Manager 108 Generating a Percentage Report from Contract Manager 109 Updating and Displaying Yearly Results 110 Printing Information on the Contract Manager Screen 110
vi
Exporting Information to a CSV File 110 Shrinking / Enlarging the graphs 111
Data Extract 112
Vision+ Scheduler 113
Configuration and Settings 115
Using the Settings Screen 115 Options Tab 116
Roles 116 Indicators 116
Forward Dating 117 Advanced Tab 118 Scheduler 119 Order Tab 121 Protocols Tab 122 Reset Position Button 122
Security Access to Vision+ 122
Changing the Appearance of Vision+ 122
Creating and Modifying Vision+ Templates 123
Accessing the Vision+ Template Designer 123
Customise an Existing QOF Template 125
Create a New User-Defined Template 125
Replacing an Existing QOF Template 125
Opening Existing User-Defined Templates 126
Working with Indicators in the Template Designer 127 Adding a Header or Footer Image to a Template 127 Creating a Menu Image for the Template 127 Adding Multiple Pages to Your Template 128 Changing the Appearance of Page Markers 128 Adding New Codeset Rows to the Template 128 Adding Existing QOF Indicators to the Template 130 Adding a Read code Row to the Template 131 Adding Blood Pressure Rows to the Template 133 Adding BMI Rows to the Template 133 Adding Smoking Rows to the Template 134 Adding a BNF History Row to the Template 135 Adding an Image Row to the Template 135 Adding a Text Row to the Template 136 Adding a URL Row to the Template 136 Adding Attachment Rows to the Template 137 Adding Read code Group Rows to the Template 137 Adding a Calculator Row to the Template 140 Inserting a Row into the Template 141 Deleting a Row on the Template 141 Changing the Position of Rows on the Template 141
vii
Saving the Changes to Your New Template 141
Changing the Status of Templates 142
Logic Tools 142
Indicator Logic Tool 143
Rule Logic Tool 145
Rule Logic Exception Tool 146
Additional Templates - Download Web Files 147
INDEX 149
9
What's New
DLM 457 (08/04/2014)
England, Wales and Northern Ireland
Vision+ Changes - As per our recent announcement on the INPS
blog, we have made some changes to the way Vision+ is accessed. This
is so that we can continue the rollout of scheduled DLM releases and
properly address the intermittent freezing and crashing in Vision+ that a
minority of practices are experiencing. On receipt of DLM 457, you will
notice that the Vision+ menus have been removed from the Vision front
screen and there is a new Vision+ floating toolbar in Consultation
Manager. We are hoping to reinstate the Vision+ menus in the near
future. All Vision+ functionality remains unchanged but please read the following topics to familiarise yourself with this and other minor changes:
- Vision+ In Consultation Manager - Vision+ icon and menu in
Consultation Manager is now replaced with a Vision+ floating toolbar
where you can access all your Vision+ patient
functionality. See Accessing Vision+ (page 25).
- Vision+ Module Access - The Vision+ menus have been removed
from the Vision front screen ribbons. Vision+ modules are now
accessed by right clicking on the Vision+ button in the Windows
Notification Area. Your individual Vision+ settings are now only
accessible from here. You can also access the Vision+ patient menu
from here if you have a patient selected in Consultation Manager. See
Accessing Vision+ (page 25).
- Vision+ Versioning - Vision+ Versioning details have changed. See
Installation and Vision+ Versioning (page 23).
- Vision+ Security Settings - From DLM 457, access to Vision+ is no
longer determined by Control Panel - Security settings, all Vision users
can access all the Vision+ modules. See Security Access to Vision+.
(page 122)
Scotland
Vision+ Integration - DLM 457 introduces a new free of charge
QOF management and practice protocol tool called Vision+. This exciting
new update to Vision includes real-time alerts for additional QOF points,
practice-based protocols and a simple but powerful recall and reporting facility.
When a patient record is open in Consultation Manager, Vision+ shows
missing or incorrect contract information and provides intelligent
templates for fast data recording. There are also additional reporting
facilities to help with QOF and protocol management.
Note - Unless specifically stated in these release notes, all other
aspects of Vision+ Functionality remain unchanged.
10
Practices can also create their own protocols that alert users to missing
information during consultations alongside the existing QOF related
alerts.
Some practices in Scotland may already be familiar with the functionality
that Vision+ offers, however, please see Getting Started With Vision+
(page 23) to recap or familiarise yourself with how Vision+ works within
Vision.
Clinical Audit QOF Reminders - For practices in Scotland on
receipt of DLM 457, your QOF reminders in Clinical audit will be disabled.
This is because Vision+ will now be the principal tool for QOF alerts and
data entry.
SIS 10245 (26/03/2014)
Version 27 QOF Business Rules - SIS 10245 brings a new
version of the Business Rules v27 for Vision+. This supersedes the
previous version 26.0. To check the changes in the Business rules refer to the Clinical Audit on-screen help.
Undo All Entries - There is a new Undo All option available when
adding data to Templates. This allows you to remove all Read code
entries that have been added since accessing the template. See Undo All Entries (page 78).
Scheduler - Vision+ now includes an option to schedule the
generation of QOF lists, Contract Manager and Data Extracts within
Practice Reports. The scheduler is available for practices with their own server (LAN) practices. See Scheduler (page 118).
ABPI Calculator - Vision+ now includes an Ankle Brachial Pressure
Index (ABPI) calculator. See ABPI Calculator (page 64).
Warfarin Dosage System - The Warfarin reports have been
updated for practices using the existing Vision+ Warfarin Pathway and Anticoagulation Reports.
Records with End Dates - Patients with an End Date recorded on
the History or Problem Structured Data Areas (SDA) are no longer
counted by Vision+ as being on a Register. See Add to Register (page 66).
Latest, First and New - Vision+ has been updated so that it now
applies the appropriate business rules and takes into account the patient's latest or earliest record.
Skins - The 'Skins' option within the Vision+ Settings has been
removed so that it is no longer possible to change the appearance of
Vision+. The default setting is ‘Office2010Silver’. If you have changed
the 'Skins' setting you will automatically revert back to the default setting.
11
Scot-PASQ Calculator - The Scot-PASQ calculator can now be
selected from the Alert Popup window or from the Calculator section of
Vision+.
Patient Synchronisation - When Vision+ was installed a full
synchronisation was performed which synchronised all the patients on
Vision, including those patients who are Transferred Out. If a
synchronisation is required again (as advised by the Helpdesk), it will
only include patients who have Transferred Out within the past 2 years. On installation, SIS10245 will perform a resynchronisation.
CVD Primary Prevention (CVD PP001) - Vision+ now only looks
at the latest entry when looking for patients with a new diagnosis of Hypertension.
Alert Popup Display problems - Some users with admin rights
have experienced intermittent problems with the Vision+ alert popup displaying then instantly disappearing. This is now resolved.
Contract Manager - Some larger practices had an error message
when running Update Results in Contract Manager. This has been resolved in SIS 10245.
Temporary Patients - Temporary patients who are registered and
removed (eg Transferred Out) on the same day, are no longer included in the Vision+ Recalls.
Discontinued Read codes - Discontinued Read codes are no longer included in Contract Manager, Alerts and Practice Reports.
Vision + Scotland Only
The following changes are implemented for practices in Scotland:
CVD Primary Prevention (CVD PP003) - The Contract Manager
report now includes patients with a new diagnosis of Hypertension after
the 1st April 2009 given advice on increasing activity using the Scot-PASQ (68L, 38Q5) after 1st April 2013.
Target Threshold change for CVD Primary Prevention (CVD
PP003) - The higher target threshold has been updated to the correct value of 90%.
Medicine Management (MED003) - Medicine Management is
now looking back 12 months instead of 15 months.
Note - Temporary patients registered and deducted on the same date are usually test patients who are used for training purposes
12
DLM 451 (15/01/2013)
Oxford Calculator - The Oxford Hip and Knee calculators now only calculate the score once all questions have been selected. See .
ASSIGN CVD Score - The Vision+ ASSIGN calculator score has
been updated so that it now matches the latest algorithm from the ASSIGN Score website (version 1.5, October 2013).
Read Dictionary Quarter 3 - Vision+ has been updated to
incorporate the Quarter 3 2013 Medical Read Codes Release of the Read dictionary.
Pinning Vision+ Alerts - The Vision+ alert screen can no longer
be pinned to task bar on Windows 2008/7 clients. Note this will not remove existing pins, they must be manually unpinned.
Vision+ Error Reporting - The contents of Vision+ error dialog
box has been updated so that it no longer contains patient demographic information.
Vision + Letter Template Folder - For hosted practices, Vision+
mail merge now points to the correct letter template folder (p:\visionplus).
Various behind the scenes fixes are also included in this release.
13
Introduction to Vision+ Vision+ is an integrated QOF Management Tool which is free of charge to all Vision
users. Vision+ functionality includes real-time alerts for additional QOF points,
practice-based protocols and a simple but powerful reporting and recall facility.
When a patient record is open in Consultation Manager, Vision+ shows missing or
incorrect contract information and provides intelligent templates for fast data
recording. There are also additional reporting facilities to help with QOF management.
Practices can also create their own protocols that alert users to missing information
during consultations alongside the existing QOF related alerts.
Vision+ comprises the following changes and additions to Vision modules:
Consultation Manager Menu and Toolbars - The Vision+ toolbar and
menu option takes you directly to the Vision+ functions. The Vision+
options consist of a Contract Indicator Alert screen which provides colour
coded timely alerts that capture the patient's QOF requirements at a
glance. There are also some easy to use data entry tools that allow you to
record key terms quickly and efficiently. QOF Templates can be used to
help record information in a structured format. Calculators and Questionnaires are available to help manage patient care.
See Vision+ Alert Indicator Screen (page 37) and Vision+ Data Entry
(page 37).
Practice Reports - The Vision+ Practice Reports module consists of
numerous reporting tools that enable you to run patient target lists and
setup a recall programme. There is also a contract management option that enables you to monitor your points and targets.
See Practice Reports (page 83).
Configurations and Settings - The Vision+ Settings module allows you to customise Vision+ to suit your individual needs.
See Configuration and Settings (page 115)
Editing and Creating Vision+ Templates - You can edit existing
QOF templates or create your own data entry templates using the Vision+ Template Designer module.
See Overview - Creating and Modifying Vision+ Templates (page 123)
Download Web Files - The Download Web Files module allows you to
download other practice and local health board protocol templates. Available templates may vary.
See Download Web Files (page 19)
Mail Gateway - Mail Gateway includes Vision+ synchronisation. This
keeps the Vision+ database up to date with the patient data changes.
You will not see any visible change in Mail Gateway but for Vision+ to work properly, Mail Gateway should be open at all times.
14
Overview Vision+ is a free of charge QOF management and practice protocol tool which is part
of your core Vision modules. Vision+ provides an immediate way of capturing
essential QOF data using real time alerts and templates. Vision+ also brings a
comprehensive reporting site which includes a recall management programme and
QOF Reporting Tools.
The following topics outline the changes and provide an overview of the new
functionality. Once the Vision+ installation has completed, you will see the new
modules and icons and can start using Vision+ straight away.
New icons in Consultation Manager
New Vision+ menu option in Consultation Manager
New Vision+ Module Access in Windows Notification Area
15
"Real Time" Alerts When a patient record is opened, Vision+ provides colour coded timely alerts that
capture the patient's QOF or other practice protocol requirements at a glance.
Alert Screen
Individual data items can be entered directly into the patient's journal from the alert
screen. Once recorded, the alert is instantly updated to display the remaining
outstanding alerts. The alerts can also be printed and taken on house calls.
Smoking data entry screen
16
Simple Data Entry Tools One of the other major features of Vision+ is the ability to record key items of
information quickly and efficiently using intuitive data entry tools.
For example you can quickly access Contract codes from the Alerts screen in
Consultation Manager:
Choosing a Data Entry Screen
Simply choose the Read term and click OK to enter data.
Data Entry Screens
17
Templates In addition, Contract and Clinical Templates provide step-by-step protocols and links
to other templates and screens.
Contract Templates
By a single click you can view a patient's historical data and graph it.
Templates
You can also edit existing QOF templates or create your own data entry templates
using the Vision+ Template Designer module.
19
Additional Templates - Download Web Files
Vision+ has access to a number of additional templates that can be used to improve
patient care, creating a single template that holds all the relevant information and will
also allow the user to input information from the template. These templates are
similar to the QOF templates, but contain non-QOF information such as NICE
guidelines and Local Enhanced Services. It is up to the practice to download the ones
that they choose to use.
To access downloadable files:
1. Log into Vision, right click on the Vision+ icon in the Windows Notification
area and select Download Web Files from the menu.
Download Web Files
Note - You may not have access to all templates. This depends on
your health board, where you are in the country and if you have purchased additional templates.
Note - To access Download Web Files, you must not have a patient
selected in Consultation Manager else the patient-specific menu displays.
20
2. A list of files available for download and files already downloaded is displayed.
Download Web Files
Group Name - details the name of the download
Web Version - tells you the version of the download available to import
Local Version - tells you the version of the download you currently have
installed on your system
Status - tells you the status of the download
Download - tick the box to select a download to import
Delete - tick the box to select a download to delete
3. Select the file(s) you wish to download by ticking the box in the download
column.
4. Then click Download. You do not need to log out of Vision whilst the files are
downloading.
5. A splash screen will appear showing the progress of the download.
6. The status column quickly shows which templates have already been
downloaded to the system, and which templates have a new version that may
be downloaded. Template Version numbers can be compared between the
Web Version and Local Version to see if a more recent version is available for
download from the web. To remove a template from the system simply click to
place a Tick in the Delete column alongside all the templates you wish to
remove, then select Delete from the Toolbar.
Note - Templates that have been downloaded by the practice are
available to all users providing that Disable User Defined Indicators is not checked in Configuration and Settings.
21
Inbuilt Calculators and Questionnaires There are numerous integrated calculators and questionnaires available within
Vision+ to assist with the management of patient care. These are easily accessed
from the Vision+ menu on the floating toolbar in Consultation Manager.
In Built Calculators and Questionnaires
Vision+ Recall Management A simple, comprehensive recall programme is built into the new Reporting module.
The recalls can be per disease area or there is a facility to merge co-morbidity cohorts
in order to facilitate streamlining of letter invites.
Recalls
Vision+ will keep a track of the number of letters sent to the patient and it will
automatically update the invite status and record an entry in the patient's journal.
The Vision+ recall functionality uses history entries rather than Vision recall
entries.
22
Vision+ Reports Contract Manager is also part of the new Reporting Tools. This is an essential tool for
monitoring your practice QOF performance over the year. It can be used to track
aspirations, help plan monthly workloads, compare year on year performance and
show your practice prevalence and provide you with financial information.
Contract Manager
23
Getting Started With Vision+ The following topics give some useful information regarding the installation of Vision+
and using it alongside existing Vision modules:
Installation and Vision+ Versioning Vision+ is automatically enabled for all Vision users. You will know that this has
happened as you will see Vision+ alerts in Consultation Manager and a new floating
toolbar in Consultation Manager and a Vision+ icon in the Windows
Notification Area see Vision+ Modules (page 25). However, you can also check
the Vision+ versioning from the Vision front screen About Vision window:
1. Login to Vision.
2. From the front screen click Help - About Vision....
3. The Vision+ Details section tells you the version of Vision+ you have installed
and the database status.
Version - Details the version number of Vision+ which is installed on your
system.
Database - Standalone
24
You will be informed when new QOF versions are available in Vision+ via the usual
release notifications and web release guides.
Help - About Vision
25
Accessing Vision+ You can access Vision+ functionality in the following Vision areas:
Consultation Manager
1. When you select a Patient in Consultation Manager, the Vision+ floating toolbar
and any relevant alerts for the selected patient are displayed:
Vision+ Floating Toolbar in Consultation Manager
2. Click to access the Vision + patient centric menu. This displays:
Vision+ Menu in Consultation Manager
QOF Templates - are designed to collect QOF information in a
step-by-step protocol based format. They are the same as Contract
Indicator Alerts in that they show "real time" data and use the same colour coding scheme.
Clinical Templates - provide step-by-step protocols for general data
entry and disease management.
26
Add to Register - allows you to quickly add patients to a QOF disease register.
Calculators - there are a variety of calculators and questionnaires to
help manage patient care.
Warfarin Monitor (if enabled at your practice) - is a powerful tool for monitoring INR results and advising on the dosing regime.
3. Click to re-invoke the Vision+ Alerts screen if you have previously closed
it.
Patient Mode - Vision+ Patient-centric Menu
The Vision+ menu for patient specific functionality is also available from the Vision+
icon on the Windows Notification Tray when you have a patient selected in
Consultation Manager.
Patient Mode Vision+ Menu from Window's Notification Tray
Vision+ Modules
1. Whilst logged into Vision, right click on the Vision+ icon in the Windows
Notification Tray.
2. Select the required module from the Practice Mode menu. You can select from:
Vision+ Practice Mode
Practice Reports - for recalls, patient correspondence and
QOF/non-QOF reporting.
Note - You can reposition the floating toolbar anywhere you want
within the Consultation Manager window. Vision remembers where you
last positioned the floating toolbar for when you next login.
Note - If you want to access the Vision+ modular menu options
whilst in Consultation Manager, make sure you don't have a patient
selected, otherwise patient-centric menu displays. See Vision+
Changes in Consultation Manager.
27
Template Designer - for creating or editing existing templates.
Download Web Files - for downloading other Vision templates.
Settings - for configuring individual user settings (there is no global
configuration). This is no longer accessible from within Consultation Manager.
3. The required Vision+ module opens for you to use.
Initial Set-up Once you have Vision+ installed on your system, you can start using all the modules
straightaway. However, there are some configuration options for Vision + which we
advise you to to review beforehand:
Within the Settings screen, there are configuration options which allow
each user to customise how Vision+ works for their individual Vision
account. Initially all users are set-up with a GP role profile which sets
predefined options for that role but you may want to change this to
Nurse, Admin or create custom Vision+ settings. See Configurations and
Settings in the Vision+ Quick Reference Guides (page 30) for further details.
Also within the Settings screen there is a forward dating option which
determines the baseline date for the alerts and reports within your
individual Vision account. The default is set to today which means in QOF
terms that alerts and reports reflect today's data rather than projecting
back from the end of the QOF year, so you may wish to change this. See Forward Dating (page 28).
Note - For the above two points, there are currently no global
settings to configure individual Vision+ preferences. You must login as each user to do this.
28
Forward Dating Explained
The Forward Dating Tab within the Settings screen provides three different options for
forward dating of indicators. These options will change the information that you see
displayed in the Contract Indicators, Contract Templates and Patient Target Lists (the
reference date is clearly shown on these screens). By default the Alert Indicator
screen defaults to None (today’s date) every QOF start date. The diagram below
attempts to explain the timeframes you may initially require for forward dating.
1. To access the Vision+ Settings screen, right click on the Vision+ Icon in
the Windows Notification Area and select Settings.
Access to Vision+Settings
Note - To access the Settings module, you must not have a patient
open in Consultation Manager.
29
2. The Settings Configuration screen is displayed.
Forward Dating Tab
3. To change the forward dating, select from the following options:
None – Only those indicators requiring completion as of today's date will
be shown. This is the default setting when Vision+ is installed on your system.
Forward Date – Will also show those indicators that have already been
completed as of today's date, but will need to be re-recorded before a
specified reference date. You can set this date using the date picker or by typing in a date.
Rolling Days – Will also show those indicators that have already been
completed as of today's date, but will need to be re-recorded within a
specific number of days ahead. You can set the number of days using the Days field.
If you choose the Forward Date or Rolling Days option, you also are able
to select the Show Inactive Triggers checkbox to display those items
that will need recording in the future, but cannot be recorded within the
specified time period. Depending on which option you have selected, the
indicators will appear in different colours in the other screens. For more
information on the colour-coding of indicators, see Colour Coding for
Contract Indicators.
4. Click OK to save.
30
Vision User Rights to Vision+
All Vision users have full access rights to all Vision+ functionality.
For practices in England, additional RBAC roles are not required to use Vision+.
You may also notice that you have an inactive user in the security module called
VPLUS. This is used for maintenance purposes and should not be amended or deleted.
It will not appear on any practice reports or lists.
Clinical Audit and Vision+ All functionality within Clinical Audit and QOF Guidelines remains unchanged with the
introduction of Vision+, apart from QOF reminders which are automatically disabled
once Vision+ is installed.
As Vision+ offers dynamic, up to the minute alerts on patient data, direct access to
intuitive templates, real time reporting and simple yet effective recall management, it
is intended to be the principal tool for QOF and practice protocols in Vision. We
encourage you to take advantage of this new functionality. However, you can
reactivate Clinical Audit reminders and use them alongside Vision+ alerts until you get
used to the different screens. QOF Clinical Audits and guidelines will continued to be
maintained until further notice.
As Clinical Audit will still manage and transmit your end or year QOF reports, it is
important that you keep check on how it is running and maintain your regular system
management for this.
Mail Gateway and Vision+
Important - Please note that the Mail Gateway must be running for Vision+
services to run correctly. Whilst you are not able to close the Mail Gateway per se, the
Mail Gateway program will close if the machine it is running on is turned off.
Task exclusion times should only be set for times when your backup is running
overnight, not during the day. If these services are not running during the day,
Vision+ functionality will not work as expected and other messages will be delayed.
Multiple Consultation Managers and Vision+ Please be aware that when opening multiple Consultation Managers, Vision+
functionality is only available in the most recently opened instance of Consultation
Manager. As you close extra instances of Consultation Manager, Vision+ functionality
becomes active in the most recent remaining Consultation Manager screens and alerts
display for the relevant patient if they are selected.
Note - To disable the Vision+ alerts in Consultation Manager for a
particular user, go to the users Vision+ settings in their Consultation
Manager screen (this can also be accessed from the Management Tools
menu on the Vision front screen) and tick Disable Auto Popup. See
Configuration and Settings in Vision+ Quick Reference Guides (page
30).
31
Vision+ Alert Indicator Screen The Alert Indicator screen is displayed when you select a patient in Consultation
Manager. The screen shows a list of items that need to be recorded for the patient.
Each set of indicators is grouped into QOF, Enhanced Services and Extra Indicators
(eg annual reviews).
Viewing the Alert Indicator Screen 1. In Consultation Manager, select the patient and open a consultation.
2. After analysing the patient's data the Alert Indicator screen appears.
Alert Indicator Screen
3. The screen shows a list of criteria relevant to the patient, and displays:
Category Headings - QOF Categories eg Cardiovascular disease primary prevention
Contract Indicators - QOF Indicators eg Lifestyle advice required
Any other alerts for Vision+ protocols that your practice is using.
4. To collapse the heading click the collapse icon and to expand the heading
click the expand icon.
5. You can double click on any indicator line to enter data. See Data Entry (page
37).
Note - The Alert Indicator window does not display in Consultation
Manager if you are working in the new Practice Reports module in
Reporting as some parts of Vision+ require exclusive access to the
database. In order to see the Alert screen you need to exit Practice
Reports. As this is a user specific setting it does not affect anyone else in the practice.
Note - All categories are expanded by default to show the indicators
within them.
32
Navigating the Alert Indicator Screen At the top of the Alert Indicator window is the patient's name and QOF date. The date
can be set as the Reference date eg QOF year end, today's date or a future date. For
more information on how to change the date, refer to Configuration and Settings
On-screen help (page 115).
Alert Indicator Screen - Patient Name and QOF Date
33
Colour-Coding of Contract Indicators The lines on the alert screen often display different colours. If you have changed any
settings on the Forward Dating tab in the Settings screen, future information is
displayed in addition to the indicators that you can currently record. For more
information on changing the settings, refer to the Configuration and Settings
on-screen help.
The following colour-coding conventions are used to show contract information:
Colour Type of Indicator
Bold green text represents a Category where there are no
current outstanding indicators or within a template where an
indicator has been completed.
Black text represents information that requires completion
now. Following the QOF business rule set, these are either
outside the time constraints, or have never been recorded.
Indicators in bold blue text mean that you have recorded the
information but you need to do it again as it falls outside the
time frame.
Light blue text is information that cannot be recorded until
specific criteria is met, eg within a set period for the year, or a
specific age is reached within the year. These indicators are for
information purposes and are not removed if data is recorded
when outside the criteria.
A red flag indicates a category has been exception coded in the
current QOF year.
An orange flag category or indicator signifies that a previous
exception code has expired.
Information in bold grey text means that the category does not
currently apply to the patient, eg where a patient is not part of
a register.
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Toolbar The Toolbar is located along the top of the Alert Indicator screen and is used to access
the various functions eg contract codes, exception codes, depression questionnaire,
BP measurements, etc. If you highlight an Indicator the relevant icons on the toolbar
become enabled or disabled depending on whether they are available for use.
The table below describes the function for each icon on the Alert Indicator screen:
Icon Function
Displays the Contract Read Code Data Entry screen to enter Read codes
Displays the Contract template of the currently highlighted category
Displays the Indicator logic screen of the highlighted indicator
Displays the Smoking data entry screen
Displays the Rule logic screen for the highlighted indicator
Displays the BMI data entry screen
Displays the Read code data entry screen to enter Exception Read codes
Displays the Read code data entry screen to enter Expiring Exception
Read codes
Displays the Read code data entry screen to enter additional Read codes
Displays the Blood pressure data entry screen
Displays the Rule logic exception screen for the highlighted indicator
Displays the Depression questionnaire
Displays the GPPAQ questionnaire
Print preview the contract indicators displayed
Print the contract indicators displayed
Training Tip - Hover the cursor over the Toolbar for a description
of their function.
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Using the Right Click Menu If you right click on an Indicator line a menu appears showing the options available for
that particular Indicator. The menu is essentially the same as that shown on the
toolbar (page 34).
Right click menu
Hide and Re-Invoke the Alert Indicator Screen The Alert Indicator screen always stays on top of the consultation screen.
1. To close the window click the close icon.
Closing the Alert Indicator Screen
2. To re-invoke the screen choose the Show QOF Indicators icon on the
Vision+ floating toolbar.
Moving the Alert Indicator Window By default, Alert Indicators appear in the bottom right hand corner of your screen. To
move the alert window to another part of the screen, simply drag and drop it to the
preferred position. Vision+ remembers your preferences so that you don't have to
keep changing the position each time you use it.
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Re-sizing the Alert Indicator Window To re-size the Alert Indicator window, move your mouse pointer over the border of the
box. The mouse pointer will change to a Resize cursor.
Resize cursors
Click and hold with the left mouse button and drag the border until you are happy with
the preferred size. Release the mouse button to keep the new size.
Note - The size of the window is saved as your personal preference
and only changes if you resize the window again.
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Vision+ Data Entry One of the main features of Vision+ is the ability to record key items of information
quickly and efficiently using intuitive data entry screens. These same data entry
screens are frequently used throughout Vision+. This section explains the most
commonly used screens and how to add data.
Read Code Data Entry in Vision+ The Read Code Data Entry screen is the most used tool in Vision+. From this screen
you can list and select individual or multiple Read codes. To access the Read code
Data Entry screen:
1. From Consultation Manager, select a patient and open a Consultation.
2. If your practice uses problems, open or create the relevant problem.
3. The alerts screen is displayed showing data that is missing from the patient
record (see Alert Indicators (page 31)).
Alert Indicator Screen
4. From the alerts screen either:
Double click on the indicator line
Highlight the Indicator line and choose the Contract icon on the
toolbar
Right click and choose Contract
Note - In order to add data you must have a patient open and a
consultation started.
Note - Do not use the Read Code Data Entry Screen to record
measurements such as BP, weight and height and smoking as they have their own data entry screens with specific boxes to enter values.
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5. The Read Codeset screen is displayed.
Read Code Data Entry screen
6. In the Apply column, select the Read code you wish to use. You can also make
selections from the other columns:
Priority - Select from the
drop down list. If left blank
the Priority will be the same
as your default setting.
Where the entry does not
require a Priority eg tests,
this box is ignored and not
written back to the patient's journal.
Episode - Select the Episode
type from the drop down list.
If not selected the Episode
defaults to the same as that
in your setup. Where the
entry does not require an
Episode type eg tests, this
box is ignored and not
written back to the journal.
The default Episode type is blank.
Date Recorded - A date can
be entered or a calendar
appears if you choose from the drop down list.
Read Code - This is QOF
compliant and shows the
commonly used contract
codes. It is for information
only and cannot be changed.
Description - This is for
information only and cannot be changed.
Value - This box is for data
requiring numeric values. If
not required e.g. for history
entries this box should be ignored.
Comments - Optional freetext
comments can be accessed
from a pre-defined list.
Alternatively, you can start
typing freetext comments.
Comments
Button - Click on the
Comments button to setup a
pre-defined list. To enter a new
comment start typing. If you
press return you move to a
new line as if you are creating a
new comment. Click OK to save the changes.
Show More
Button - The QOF Read code
list is quite exhaustive which is
why the Read code list displays
the most commonly used
codes. Clicking Show More
allows you to expand the Read
selection.
7. Click OK to enter the data on the patient record. The alert for the missing data
is now removed from the alert screen.
Note - The Apply column is automatically ticked if you change any
of the other columns.
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Adding Current Exception Read codes Exception codes are used when you want to exclude a patient from QOF. To enter an
Exception code:
1. From the Vision+ Alerts screen in Consultation Manager, highlight the
indicator line or the category heading you wish to exclude the patient from and
either:
Click the Exception code icon
Right click on the relevant line and select the Exception option
2. The Exception code screen is displayed.
Exception Code screen
3. Tick the box in the apply column for the required exception and click OK to
save the changes.
4. Where a patient is exempt from a full clinical domain, the whole category title
appears in red eg .
Expired Exception Read codes Previously used Exception codes for the selected patient are represented with an
Orange flag icon. If you hover the mouse over the exception icon it displays the
Exception Read code along with the date of the previous exception entry.
1. To add another exception code select the icon or right click and choose either:
Orange flag icon - Previously selected Exception code
Red flag icon - Choose a new Exception code
Exception Code icons
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2. The Exception code screen is displayed.
Exception Code Screen
3. The previous Exception code is already selected, either click OK to save the
changes or choose another code.
4. Where a patient is exempt from a full clinical domain, the whole category title
appears in Orange.
Entering Additional Codes Additional Read codes are used to help monitor patient annual reviews.
They are displayed on the Alert Indicator screen under the heading Extra Indicators
and can be accessed by:
Double clicking on the line(s) below Extra Indicators
Highlight the indicator line and choose the Additional icon.
Right click and choose Additional from the menu.
The Read Code Data Entry screen is displayed, choose the Read code and click OK.
Note - Additional codes are used internally by the practice to
improve patient care and do not count towards QOF. Extra Indicators is
a user specific setting.
Recording Measurements and Values To help with recording of data, Vision+ has some additional screens that make it easy
to record everyday information such as Blood Pressure and BMI as well as various
calculators. These user friendly screens simply require the values to be entered and
the Vision+ will automatically add the appropriate Read codes for you.
Note about thyroid entering results - at the moment Vision+
allows you to enter alphabetical characters in the thyroid value box.
This will not save on the patient record. Please be sure to enter numerical values only.
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Recording BMI Values
The BMI Data Entry screen is used to quickly input the height and weight values.
Vision+ will then calculate the BMI for you and record the appropriate Read code into
the patient's journal.
1. In Consultation Manager, from the Vision+ alert screen, highlight the indicator
and choose the BMI icon or right click and choose BMI.
2. The BMI form displays, select either Metric or Imperial.
3. Type the Height and Weight values or select by using the drop down list.
4. The BMI is calculated automatically and is stored in the weight SDA in Vision as
usual.
5. Enter the date or choose from the calendar.
6. The default Read code is 22K, but can be changed by using the drop down list.
7. Click OK to save the changes on the patient record.
BMI
Recording Blood Pressure Values
The Blood Pressure data entry screen can be used to quickly record the blood pressure
values.
1. Highlight the indicator line and either double click or choose the Blood Pressure
icon.
2. Enter the Systolic and Diastolic readings.
3. Record the date of the blood pressure or use the drop down list to choose from
the calendar.
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4. Click OK to save the changes on the patient record.
BP
Recording Smoking Status
1. To record a smoking status, highlight the indicator and either double click, right
click or choose the smoking icon on the toolbar.
2. Select a smoking Read code and optionally enter a quantity.
3. Record the smoking date or choose from a calendar.
4. If the patient is a smoker or ex-smoker record the smoking cessation advice
and optionally enter a second cessation code.
5. Enter the date of cessation date or choose from a calendar.
6. Click OK to save the changes on the patient record.
Smoking
Note - When the smoking entry is added to the patient record, the
date started and date stopped boxes are not currently populated.
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Using the Notes Summary Data Entry Screen The Notes Summary screen is an unique template that helps you summarise patient
records. It can be used to quickly input significant medical conditions and add new
patients to registers. The screen is split into two sections:
Indicators - Indicators are used to record measurements and QOF
information
Registers - Registers are used to quickly place a patient on a register
1. To access the Notes Summary screen, in the alerts screen, click on the Notes
not summarised indicator line which is listed below the Records and
Information section on the Alerts screen.
2. You can then either:
Double click on the indicator line
Right click and choose Notes Summary
Choose the Notes Summary icon from the toolbar.
Indicators screen
The Indicator screen enables you to record readings and measurements. You can also
choose which Read code you want to use to indicate that you have summarised the
clinical record.
Indicators Notes Summary Screen
You can use the drop down arrow icon to see a summary of any previous
readings. If you want to enter a new measurement, click one of the icons at the end
of the row to open the relevant Data Entry screen. For more information on the icons,
refer to the On-screen help.
Note - To view Popup Alert Indicators for the Notes Summary, the
Notes Summary setting must be enabled in the Settings screen. See Using the Settings Screen (page 115).
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Registers screen
The Registers screen is used to quickly place a patient on your QOF register with the
appropriate Read code.
To view and record information use the toolbar to the right hand side of each line.
Register screen
When you have finished summarising the patient clinical record, click OK and the
entries are written back to the patient's journal.
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Assessment Forms & Risk Calculators Vision+ has additional tools and utilities which make it even more useful when
capturing data for the contract as well as forms and calculators that help your practice
improve patient care. These forms and calculators are extremely intuitive and reduce
the clinicians workload by simplifying the process. They can be accessed by clicking on
Calculators from the Vision+ menu on the floating toolbar menu, and selecting from
the relevant group.
Calculator from Vision+ Floating Toolbar Menu
Alternatively, you can choose it from the Vision+ icon in the Windows Notification
Area (you must have a patient selected).
Calculator from Vision+ Icon in Windows Notification Area
The calculators are divided into five categories so that the correct calculator can be
quickly located.
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Questionnaires
Many questionnaires are available to help the clinician assess the patient. The
answers provided by the patient allow the clinician to quantify and scale severity, and
then add the result along with the relevant Read code onto the patients record. The
questionnaires all work in the same way, following a published algorithm to convert
the answers given into a score. The Clinician can either turn the computer monitor to
face the patient and allow them to make their own selections, or the clinician can ask
the patient and record the answers given.
Questionnaires currently available are:
Asthma Control Test (ACT)
Alcohol Use Disorders
Identification Test
(AUDIT)
Depression
Fast Alcohol Screening Tool (FAST)
General Health
Questionnaire (GHQ12)
Mini Mental Health State
RCP3 Asthma Assessment
COPD Assessment Test (CAT)
CHADS2 score
for Atrial
Fibrillation
Stroke Risk
and Smoking Pack Years
General Practice Physical
Activity Questionnaire
(GPPAQ)
The following explains how to complete a questionnaire. The Audit questionnaire has
been used in the example below:
1. Select a patient in Consultation Manager.
2. From the Vision+ menu on the floating toolbar, select Calculators and choose
the required questionnaire:
Questionnaires
47
3. Once you have selected the required questionnaire, work through the
questions with the patient by clicking on the relevant answers.
4. When each page has been completed click then next page.
5. When all the questions have been answered the calculated score is supplied in
the bottom right-hand corner of the screen.
6. Select the Read code to be entered into the patients record from the Read
code drop down menu (the calculated score is added onto the Read code
selected).
7. Enter the Date or choose from a calendar.
8. If you want to add a priority, select it from the Priority drop down box.
9. Click on OK to save the Read code and Risk percentage.
Audit Questionnaire
ASSIGN CVD Risk Calculator
The ASSIGN CVD Risk Calculator can identify people free of cardiovascular disease
most likely to develop it over ten years. 'High risk' (score 20 or more) implies it
necessary for risk-lowering medication and/or other medical help. ASSIGN is the
cardiovascular risk score chosen for use by SIGN (Scottish Intercollegiate Guidelines
Network) and Scottish Government Health Directorates.
In order for the risk to be assessed, the calculator needs information on blood
pressure, cholesterol, and the number of cigarettes smoked per day. Without this
information the calculator cannot work out the risk. If one or more of these pieces of
data are not available then clicking on the relevant Mean button will use the Average
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results for the patient’s age and sex as defined by ASSIGN (these values are NOT
recorded within the patient record).
Accessing the ASSIGN Calculator
1. From Consultation Manager, click on the Vision+ icon on the floating toolbar
and select Calculators - Cardiovascular - ASSIGN.
Accessing the Assign Calculator
49
2. The ASSIGN calculator is displayed:
Assign Risk Score
3. Missing patient data can be entered or updated by clicking on the relevant Add
Data icon at the base of the screen. If the data is not available then the
relevant Mean button can be used instead. The most recent data entry is
shown in the History column. Historical data other than the most recent can be
viewed by clicking on the history drop down icon.
4. If relevant, tick the Family History of Stroke/CHD and the risk score will be
amended as per the ASSIGN algorithm. Note that Diabetes diagnosis is not
taken into consideration.
5. When all the data is entered the risk in 10 years is displayed along with the
relevant Read code.
6. Click on OK to save the Read code and Risk percentage.
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CHADS2 - AF Stroke Risk Calculator
CHADS2 is a method of calculating stroke risk in patients with atrial fibrillation. The
patient is allocated points based on their previous medical history in the following
areas:
Congestive Heart Failure
Hypertension
Age
Diabetes Mellitus
Strokes or TIA
The CHADS2 risk score is calculated using the following data:
Condition Criteria Points
C Congestive Heart Failure Any Read code starting G580% 1
H Hypertension Any Read code of G2% 1
A Age Over 75 years old 1
D Diabetes Mellitus Any Read code of C10% 1
S2 Prior stroke or TIA Any Read code of G6% 2
This results in a CHADS2 score of between 0 and 6 which translates to the annual risk
of stroke shown in the table below:
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CHADS2 Score Stroke Risk %
0 1.9
1 2.8
2 4.0
3 5.9
4 8.5
5 12.5
6 18.2
Accessing the CHADS2 Calculator
1. From Consultation Manager, click on the Vision+ icon on the floating toolbar
and select Calculators - Cardiovascular - CHADS2:
Accessing CHADS2
52
2. The CHADS2 Calculator is displayed for you to use:
CHADS2 Calculator
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eGFR Calculator
The eGFR Calculator is a tool used to measure kidney function, and is part of the
Chronic Kidney Disease requirements. The calculator incorporates two different
protocols and you can use either method.
The Sex, Age and any previously recorded Creatinine levels for the patient are
displayed (you can also type in the Creatinine result, but this is NOT recorded within
the patient record). You can then choose the Equation type – either Abbreviated
MDRD or Cockcroft and Gault. If you choose the former type, you will need to specify
the Race of the patient.
Accessing the eGFR Calculator
1. From Consultation Manager, click on the Vision+ icon on the floating toolbar
and select Calculators - Others - eGFR:
Accessing th eGRF Calculator
2. The eGFR Calculator is displayed for you to use:
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eGFR calculator
55
If you choose the latter Equation type, the eGFR Calculator screen will change to the
one below.
eGFR Calculator - Equation
The Cockcroft and Gault Equation uses the patient's weight as part of the calculation
and this is picked up from previously entered data (you can also type in the weight
measurement, but this is not recorded within the patient record).
The eGFR value and recommended CKD Stage is displayed in the Result box.
1. Do one of the following:
Click the more icoon to choose an appropriate Read code for the CKD register if the result is Stage 3, 4 or 5.
Click the Exceptions button if the result is Stage 1, or 2, or if you
want to exception code this patient for any other reason.
2. Click OK.
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Framingham CHD/CVD Risk Calculator
The Framingham CHD/CVD Risk Calculator is based on the Framingham index and
uses existing data such as Age/Sex, Blood Pressure, Cholesterol, Smoking Status,
Diabetes, and ECG readings to calculate a predicted risk.
The screen is split into 2 sections:
The upper section of the screen is used to display the data that has already
been collected by the calculator from the patients records. There are also some options that you can use to modify the calculation.
The lower part of the screen can be used to view historical information, or can
be used to input the relevant data. Use the drop down icon to see historical
data, or use the more icon to enter a Read code.
To access the screen and record information:
1. From Consultation Manager, click on the Vision+ icon on the floating toolbar
and select Calculators - Cardiovascular - Framingham CHD or CVD.
Accessing the Frammingham Calculator
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2. The Framingham screen is displayed:
Framingham CHD
3. In the Blood pressure box, choose either the Systolic or Diastolic option to base
the calculation on that value.
4. In the period box, choose either the 10 years or 5 years option to base the
calculation on that time period.
5. Select the Read code to be entered into the patients record from the Read code
drop down menu (The calculated risk is added onto the Read code selected).
6. Enter the Date or choose from a calendar.
7. If you want to add a priority, select it from the Priority drop down box.
8. Click OK.
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JBS 2 CVD Risk Calculator
The JBS 2 CVD Risk Calculator is based on the Joint British Soieties guidelines for the
prevention of CVD. It uses existing data such as Age/Sex, Blood Pressure, Cholesterol
and Smoking Status to calculate a predicted risk.
The lower part of the screen displays historical information, or can be used to capture
relevant data. Any data that has already been collected by the calculator will be
automatically pre-populated. If there is any data missing then it will be displayed in
Green and 'No Data Recorded' will be in the history column.
The data is recorded as below:
1. From Consultation Manager, click on the Vision+ icon on the floating toolbar
and select Calculators - Cardiovascular - JBS 2 CVD.
Accessing the JBS2 Calculator
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2. The JBS 2 CVD screen is displayed:
JBS 2 CVD Risk Calculator
3. Use the drop down icon to see historical data.
4. You can Use the Contract icon to enter a Read code, or the BP icon in
the case of a blood pressure.
5. The information that is relevant is shown in the Patient Values area of the
screen. This can be altered to give a 'What If" scenario.
Note - Any 'What If' changes to values are not recorded within the
patient record.
6. The CVD Risk prediction is then plotted on the graph and using the legend you
can see the CVD Risk over the next ten years.
7. In the Read code box, select the Read code to be added from the drop down list
.
8. Enter a Date or choose from the calendar.
9. Click OK.
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QRISK2 CVD Risk Calculator
QRISK2 is a cardiovascular risk score developed by Julia Hippisley-Cox at the
University of Nottingham.
QRISK2 (the most recent version of QRISK) is a prediction algorithm for
cardiovascular disease (CVD) that uses traditional risk factors (age, systolic blood
pressure, smoking status and ratio of total serum cholesterol to high-density
lipoprotein cholesterol) together with body mass index, ethnicity, measures of
deprivation, family history, chronic kidney disease, rheumatoid arthritis, atrial
fibrillation, diabetes and antihypertensive treatment. A QRISK over 20 (20% risk of
CVD event over the next ten years) indicates that primary prevention with lipid
lowering therapy (such as statins) should be initiated.
To access and complete the QRISK2 screen:
1. From Consultation Manager, click on the Vision+ icon on the floating toolbar
and select Calculators - Cardiovascular - QRISK2.
Accessing the QRISK2 Calculator
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2. The QRISK2 calculator is displayed. Any relevant data from the patient record
is populated.
QRisk2 Score
3. Missing patient data can be entered or updated by clicking on the relevant tick
box, Add Data icon or list selection. Older data can be viewed from the
history drop down list.
4. To record the score, please make sure you have selected Read code -
38DP.QRISK2 CVD 10 year risk score.
5. When all the data is entered, select calculate.
6. Click on OK to save the Read code and Risk percentage.
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Peak Expiratory Flow Rate (PEFR)
The PEFR Calculator can be used from the QOF tools. The PEFR calculates the patients
Peak Expiratory Flow Rate as a percentage of the target flow rate based on standard
data for that age and height.
To use the PEFR Calculator, do the following:
1. From Consultation Manager, click on the Vision+ icon on the floating toolbar
and select Calculators - Respiratory - PEFR.
Accessing the PEFR Form
63
2. The PEFR screen is displayed:
Peak Flow Rate
3. Enter the patients PEFR by typing it into the box or using the up and down
arrows.
4. The Height and Age should be displayed but can be altered/added as necessary
(please note that this change is NOT recorded within the patient record).
5. The Percentage predicted is then displayed.
6. Read codes can be selected from the drop down boxes and the Event Date can
be altered if necessary by clicking on the down arrow and selecting a date on
the calendar, or by typing the date directly into the box.
7. Click on OK to save the data.
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ABPI Calculator
The Ankle Brachial Index (ABI) is the systolic pressure at the ankle, divided by the
systolic pressure at the arm. It has been shown to be a specific and sensitive metric
for the diagnosis of Peripheral Arterial Disease (PAD). Additionally, the ABI has been
shown to predict mortality and adverse cardiovascular events independent of
traditional CV risk factors.
To access the calculator:
1. From Consultation Manager, click on the Vision+ icon on the floating toolbar
and select Calculators - Other - ABPI.
Accessing the ABPI Calculator
ABPI Calculator
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2. The ABPI calculator is displayed.
ABPI Calculator
3. Select either Dorsalis pedis or Posterior tibial.
4. Record the relevant blood pressures.
5. The Read codes and score are displayed at the base of the screen. Click OK to
record the data.
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Add to Register You can quickly add patients to a QOF register using the Vision+ Add to Register
option.
1. From Consultation Manager, select Add To Register from the Vision+ menu
on the floating toolbar or right click on the Vision+ Icon in the Windows
Notification Area:.
Vision+ Menu on the Floating Toolbar
Add to Register from Vision+ Icon in the Notification Area
2. Choose the required register from the menu.
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3. The Read Code Data Entry screen is displayed with QOF compliant Read codes.
Add to Register - Data Entry Screen
4. Choose the Read code by selecting Apply. You can also enter a priority and
notes.
5. When adding a patient to a register that also requires therapy recording to
count for QOF, a list of applicable therapy items is displayed below the Read
code list. You have the following choices:
If you want to add therapy – Tick the Apply box. If the drug is to be
prescribed as an acute prescription select Acute, if this box is not selected the drug is recorded as a Repeat.
If you have already recorded relevant therapy in Consultation
Manager – You can ignore this list.
Add to Register - Drugs
6. Relevant Vision prescribing support is displayed; click OK to save the data.
Note - Some QOF Categories require a drug to be present in
addition to the Diagnostic Read codes in order for the patient to appear on the register.
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Patients who have an end date entered in history or problems in Consultation Manager
are automatically removed from the Vision+ register.
Extra Indicators Vision+ provides Extra Indicators which are used by the practice for recall purposes.
Extra Indicators help the practice monitor the QOF disease category recalls. These
Extra Indicators allow call/recall for the purposes of monitoring, assessments, annual
reviews etc. If the category already has a review as part of the QOF then that one
should be used. As with other templates, Popup Alert Indicators are available, and
patients can be sent letters from the Practice Reports screen.
Extra Indicators
In addition the template can be accessed just like any other QOF template. This is
done from the QOF templates list on the main Vision+ menu on the floating toolbar
or via the Vision+ icon in the Windows Notification Area . The data
can be input through the standard Read code data entry screen.
Note - To view popup alert indicators for the extra indicators, the
Extra Indicators setting must be enabled in the Settings screen.
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Prevalence Searches Vision+ provides a number of data tidy searches which allow the practice to maintain
accurate disease registers. Prevalence Searches look for patients who have been
potentially overlooked and should be on a QOF disease register. If the patient should
be on a QOF disease register then the clinician can add the relevant Read code by
clicking on the Contract icon in the usual way from from the Read code data entry
screen. If the patient should not be on the QOF disease register then they remain on
the Prevalence Searches list. All the usual functionality associated with patient lists
are available. As with all other templates, the popup alert indicator will appear
advising the clinician of the Prevalence Search.
An example of a Prevalence Search are patients with Asthma related Read codes who
do not have an Asthma diagnosis. It may be that the patient has a History of Asthma
Read code but no Diagnosis Read code, and they may need one adding on to their
record. This can then easily be done through Vision+.
Register Checks Another data tidy search that Vision+ provides is the Register Checks. Register
Checks display a list of patients who may have fallen off a Register due to some
reason.
An example of a Register Check is a patient who has an Epilepsy diagnosis Read code
but has not been prescribed Epilepsy drugs in the last year. For a patient to be on the
Epilepsy disease register they are required to have an Epilepsy diagnosis Read code
and to have been prescribed Epilepsy drugs within the previous year. The patient
therefore may have been overlooked, or may not be taking their Epilepsy drug.
As with other templates, popup alert indicators are available, and patients can be sent
letters from the Practice Reports module.
Note - To view Popup Alert Indicators for the Prevalence Searches,
the Prevalence Searches setting must be enabled in the Settings
screen.
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Vision+ Contract Templates Contract Templates are designed to collect QOF information in a step-by-step protocol
based format. They are the same as Contract Indicator Alerts in that they show "real
time" data and use the same colour coding scheme.
Contract Templates
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Overview of the Contract Template Screen
Below is an example of a Contract Template Screen.
Note - The Template screens vary depending on the disease area
highlighted eg some Templates have questionnaires on the toolbar.
Contract Template screen
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Summary - Viewing or Adding data to a Template
To add data to a Template, highlight the line and choose one of the following Data
Entry icons at the end of the line:
Icon Function Icon Function
Previous Entry - This
blue icon indicates that
the patient does not have any previous records.
Smoking - Selecting this icon
launches the smoking data
entry screen and allows you to
record the patient's smoking status.
Previous Entries - When
the row contains more
than one relevant Read
code, a drop down arrow
appears in red to alert you
that more Read codes are
available than the one
currently being displayed.
Where numeric data is
recorded a graph is also visible.
Blood Pressure - Selecting this
icon displays the blood pressure
data entry screen and allows you
to record a patient's blood
pressure details.
Contract Read Code -
The Contract icon takes
you to the Read code Data
Entry Screen where Read
codes can be chosen from
a predefined list of
relevant contract Read
codes.
BMI - Choosing this icon
displays the BMI data entry
screen and allows you to record
a patient's BMI status.
Exception - Choosing
this icon allows you to
enter an exception code from Read code list.
CHADS - This icon provides
quick access to the CHADS
calculator screen.
Rule Logic Exception -
Choosing this icon displays
the rule logic exception
screen for the highlighted
indicator
Depression Questionnaire -
This icon provides quick access
to the Depression Questionnaire.
Rule Logic - This displays
the logic screen for that
highlighted indicator.
Undo - The Undo Last Entry icon
deletes the Read code previously
entered on that line during the
current session. If multiple Read
codes are added then the most
recently added one is deleted
first. If no Read codes are
available to be deleted this icon
is greyed out.
GPPAQ - This icon provides
access to the Physical
Activity Questionnaire.
Undo All Entries - The Undo All
option allows you to remove all
entries added to a Template.
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Using Contract Templates
The QOF Templates can either be selected by:
Highlighting any line on the alert indicator screen and choosing the Show
Template icon or right clicking and choosing Show Template. This option takes you directly to the clinical or public health domains.
Alert Indicator - Contract Template
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Alternatively, you can choose QOF Templates from the Vision+ menu on the
floating toolbar or from the Vision+ icon in the Windows
Notification area. This gives you the option to view all Templates or select a specific one.
Vision+ Menu on the Floating Toolbar
Vision+ Menu from the Windows Notification Area
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Toolbar
The Toolbar is used to access the various functions e.g. contract codes, depression
questionnaire, BP measurements, etc. By highlighting a line the relevant icons on the
toolbar become enabled or disabled depending on whether they are available for use.
Most of the icons on the toolbar are duplicates of those that appear alongside each
category. This means that you can also access them by clicking on the icon alongside
the relevant line. The exception to this is the Indicator logic icon which always displays
on the toolbar but not against the line.
Contract Template Toolbar
Default Date
The default date can be altered by either typing the date into the box or selecting a
date from the drop down calendar . Any Read codes entered
within Vision+ will then assume the default date. Consultation Dates within
Consultation Manager are not applied to Vision+ data entry and vice versa. Any Read
codes added before changing the default date will be unaffected. The default date is
set to the current date by default.
History Tab
The History icon is located at the end of the line and is used to display historical
data for the particular indicator or category selected.
History
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Only the most recent Read code is displayed in the history column. If the row contains
none or one relevant Read code, a blue arrow key icon is displayed. If the row
contains more than one relevant Read code, the drop down arrow appears in red
to alert you to the fact that more Read codes can be viewed.
Historical Data
To close the history screen click the icon. The window can also be resized by
clicking and dragging the resize icon .
The following options are also available when viewing a patient's history:
To the left of the history icon is the history column which shows the most
recently dated relevant Read code. When the cursor rests over the
history column a popup window displays the entire history line, which is useful if it exceeds the width of the history column.
To the left of the history column is the indicator name column which
shows the names of the indicators.
Status Bar
The status bar located at the bottom of the screen displays the history of the currently
highlighted line along with the date and any relevant values.
Contract Icon
The Contract
icon takes you to the Read code data entry screen where Read codes can be chosen
from a predefined list of relevant contract Read codes.
Undo Last Entry
The undo last entry icon deletes the Read code previously entered on that line
during the current session within the current template. If multiple Read codes are
added then the most recently added one is deleted first. If the undo last entry button
is used again it proceeds to remove the Read codes in the reverse order to which they
were added. If no Read codes are available to be deleted then the icon will be greyed
out .
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Undo All Entries
Some Vision+ templates have data entry screens that only show the Read codes
selected once the data is saved in the patient's record. Other data entry screens show
the data in the template as soon as it is selected. This has caused confusion when
using the "undo last entry" option because you have to click through multiple
entries (some of which are not visible), before the data is removed. The Undo All
option removes all entries, regardless of whether they are visible or not.
Vision+ Templates - Undo All Entries
Tabs
Tabs are used to break down templates into smaller and easily manageable portions
(If necessary). Select the tab you wish to view by clicking on it, or alternatively use
the previous and next buttons to move systematically through them. The history tab
is always present and is used to quickly view the history of all GMS contract relevant
data present in the patient’s notes.
Next Tab and Previous Tab Buttons
The next tab button moves forward to the next tab in the series. The previous tab
button moves back to the previous tab in the series.
Previous and Next Tab
Note - Undo last entry can still be used to remove individual
entries.
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Next and Previous Buttons
You can use the next and previous buttons to move to the next or
previous linked template. This is particularly helpful when a patient is on multiple
registers and you need to move from one template to another.
Next and Previous options
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Viewing Details of Contract Information
At times, you may find it useful to be able to see what clinical information is recorded
for a patient. From the contract templates, you can click the history tab along the top
and see a categorised view of different types of information. Displayed within the
history tab are Read codes, Active Repeats, Acutes, Inactive Acute/Repeats, and
Additional Information.
Viewing Details of Contract Information
For example, if you are unsure of when the blood pressure readings have been
recorded for a patient, you can use the Expand and Collapse icons to view this
information. You can also quickly see from this screen, which staff member has
recorded the data.
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Listing and Graphing Historical data
The latest record is always displayed on the Template screen but you can look at
historical data and where appropriate graph the information. The red icon at the
end of the row indicates you can view more entries. A blue arrow icon signifies
that there is only one record.
Graph
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Viewing All Templates
Using the All Template option you can view all QOF Categories.
To access all templates in Consultation Manager, click on the Vision+ menu in the
floating toolbar or right click on the Vision+ icon in the Windows
notification area, select QOF Templates and select All Templates. You can now
view the QOF categories.
All Templates
Alternative methods of Opening a Contract Template You can also open up a contract template screen from the Patient List screen. Right
click on a patient's name and choose Show Template.
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Practice Reports
Overview - Practice Reports An essential element of the GMS Contract lies within the management of patient
recalls, monitoring of point targets, and the ability to produce statistical, up-to-date
reports.
Contract Administration tools have been designed to help facilitate the management
aspect of the GMS Contract and assist practices with achieving the required targets.
You can be sure that the information you see in target lists, recall management, point
totals, and payment details is a true reflection of the status of the practice.
Accessing the Practice Reports Tools The Practice Reports module can only be opened if you have Consultation Manager
and other Vision+ modules closed.
To access the Practice Reports module:
1. Login to Vision.
2. From the Windows Notification Area, right click on the Vision+ Icon and
select Practice Reports.
Accessing Vision+ Practice Reports
Note - To access Practice Reports, you must not have a patient
selected in Consultation Manager else the patient-specific menu displays.
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3. The Practice Reports module opens by default on the QOF page.
4. Click on the required report to run it. When the report has run, it appears on
a new tab, enabling you to select the Home tab to run a new patient list or
design Patient Recall Letter Templates (page 87). When a new patient list is
run it replaces any previously run ones.
Using Patient Target Lists One of the most useful features of the Practice Reports tool is the Patient Target Lists.
Based on your 'live' data, these lists can readily provide you with your clinical
registers, 'tidy-up' lists and targets for patients with missing indicators, and can be
run off whenever you need them.
You can use them to update patient information, see which patients have more value
than others, create and manage recall letters, view point totals for the category, and
see which staff members are contributing towards the points.
To view the Patient Target Lists click a Category option for the list that you want to
work with.
Note - You can schedule the All QOF Report to run on a set date
and/or time. See Vision+ Scheduler (page 113).
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Patient Target Lists
When a report is run, the Patient List screen is displayed showing the results. The
example below shows the Cervical Screening report:
How Patient List Information is calculated
For Patient Lists that are run from Practice Reports, information is calculated using the
current date as a reference and should reflect what is shown within the popup alerts
screens (which is different to the default Patient Lists available from within Contract
Manager). The same colour-coding is applied to patients within the list.
If you access the Patient List from within Contract Manager, information is calculated
using 31 March 2014 as the reference date with any exceptions taken into account.
You also have the advantage of being able to see both positive lists (completed
indicators), as well as negative lists (missing indicators).
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Working with Data within the Patient Target Lists
Recording Information Using Patient Lists
Just like the Contract Indicators and Templates, the Patient Lists also allow you to
quickly record information using the data entry tools.
You can use the toolbar buttons at the top of the screen to add Contract codes,
Exception codes, additional information and the relevant Template. And because of
the 'real-time' aspect of the software, any information you record will update the
patient's medical record straight away and disappear from your list.
Printing a List of Patients on a Patient List
You can print the list of patients who appear on a Patient List to obtain a hard copy.
This can be useful for handouts or allocating tasks to other members of staff.
A copy of the current screen view can be printed by clicking on the Print button on the
Toolbar, or to view it first click on Print Preview on the Toolbar ( ). It is
necessary to expand ( ) or collapse ( ) the Category headings and descriptions
before printing as the printed copy is an exact view of how it appears on the screen.
Looking at Other Indicators for Patients in the Patient Lists
For any of the patients who appear within the GMS Contract Patient Lists screen, you
can quickly see any other indicators that need to be completed. Simply right-click on
any patient name and from the popup menu and choose Show Indicators ( ).
See