Beta testing the new EMIS Access module

Originally published in GP magazine .

Written for GP magazine around 2003. This is the version I submitted - the published article may have been edited.

For the past few months my practice has been one of the sites beta testing the new EMIS Access module. As part of a medicines management collaborative we hoped to set up an online repeat prescribing system, so I was excited to find that EMIS were about to beta test software that gave patients access to a range of functions including online prescriptions and appointments.

Unfortunately their first release only featured the online appointments, but the second release, which has fixed most of the bugs in the first, now features a two-way messaging facility.

Beta testing software can make you feel on the cutting edge of new technology, but things can go wrong and you can end up spending a lot of time trying to help the programmers fix problems. Luckily the Access module has been remarkably trouble free, with only a few bugs, the main problem being our BT connection.

The Access website is run and hosted by EMIS in Leeds. You can link to it from your own website or give your patients the address so they can access it directly. The website allows first-time users to register and already registered users to access their profile.

EMIS are very security conscious and there are multiple layers of security. Once an individual has expressed an interest they must come in person with proof of ID and sign a consent form. Once they have signed, they receive a printout that contains a series of unique codes that they use to register. During registration they have to select a password and other security questions. Once registered, it is just a case of entering our practice code, their personal code and password to access the site.

To protect confidentiality, and to bypass some of the more thorny scenarios that arise, e.g. teenage contraception, marital infidelity, secret terminations etc., only adults can register and they must register individually. We have had some people complain that it is a pain if they want to book an appointment for a spouse or child, but it is difficult to see a way around this.

Once into the site a patient sees a range of options that are available. You can choose to enable or disable what is available. The messaging system allows a patient to send a message into the practice and receive a reply; this is similar to email, but as the person has to log on it is more secure and confidential. We have disabled this option as we aren’t ready for it; we currently only use the online appointments.

After security, if they have any existing appointments these are shown with the option to cancel them. A maximum of two appointments are allowed at any one time to prevent people overbooking. Fears about people DNAing appointments made this way have been unfounded and we haven’t had any DNAs so far.

There is an option to book an appointment, and the system then brings up a selection of the next available appointments in the surgery. The practice side of the system allows you to select which consulters’ appointments are available online. Any free routine appointment is available. There is possibly some more work needed on this system, as if you have a complicated regime you may not want all free appointments to be shown, especially if you reserve them for special purposes. We get around this by blocking out appointments that are reserved for special purposes, e.g. child health surveillance.

After confirming booking there is an option to print out a confirmation slip, and within seconds the slot is filled in the practice system and isn’t available for anyone else. Similarly, if a slot has been taken in the time someone has typed in their details, the system won’t allow double booking. Cancelling also works instantaneously.

The only real problem we have had is that, to keep the system secure and centralised, the patients see the webserver in Leeds. The webserver then talks to each individual practice to check on data like appointments etc. The patient is never accessing the surgery computer system. Our old ISDN caused problems if it responded slowly, and it appeared to the user that they couldn’t log on. Our new 256K always-on link is better, but even that has been known to crash.

Feedback from patients is excellent. We have had about 60 sign up in a month with little advertising other than a poster in reception and a leaflet. Of those 60, only a few have actually booked an appointment using the system - we try to encourage people to use us less, not more - but other than the link problem everyone is happy with the system.

We can’t wait to try the online prescriptions, which are promised for later in the year. Hopefully the software will be on more wide release in the near future.