Does EMIS Web need new functionality to meet the Working at Scale agenda & to maintain being the system of choice as GPs get bigger and work together​

There are 3 distinct flavours of EMIS. EMIS GP – which each GP surgery has and uses and contains all the pts registered at the practice. There is EMIS Community which community organisations like CCICP of which I’m a director use. These accept referrals from EMIS web and others and allow therapists including DNs and Physios to manage a caseload. With the right data sharing agreements in place, the GPs can see the therapists notes and vice versa. We are currently implementing this for CCICP and it should be a great step forward to have all of our local primary care health economy on effectively the same system sharing data.

It would be nice to get the front door of A&E and GP OOH on board but we do have our GP federation led extended hours hubs using EMIS Clinical Services a halfway in between product. It isn’t as fully featured or as complicated as EMIS community as it doesn’t need to be but it also doesn’t have a registered list. We use it for our weekend and evening hubs. Practices can make an appointment at the hub for a patient wanting to be seen there – either because the practice isn’t open over the weekend or has run out of appointments or out of preference in terms of time/location. Once booked in at the hub the hub doctors can see the patients notes in their own practice and record in the hubs notes – which can then be seen by the patient’s proper practice if they return there. It takes some conceptualisation and a lot of setup with 29 practices and 2 hubs but works well.

Finally there is something I call push consultation – in theory, if I see a patient from another practice perhaps as an emergency or to deliver a service that may be commisioned from me but not their host practice – their “home” notes can be pushed to me and I enter into them as if I was sitting at their home practice. This sounds good but you lose the ability to track activity in the practice you are doing it from as the activity is recorded in the patients practice and there must be a mathematical formula to work out how many data sharing agreements you need for 29 practices patients to be seen in 28 other practice – it might be 29×28 or more and that’s a lot of setup!

However, it seems to be there is a big gap missing. Nationally GPs are being encouraged to work at scale. This means different things to different people and some feel its a drive to amalgamate us all into a salaried service. Some think this is a good idea – some think it will be a disaster. Some are just saying that coping with ,multiple independent providers who all have different views on anything is a nightmare and they would like GP land to come together as one voice – again some say this is the beauty of general practice – that we aren’t all lackeys who say yes to the latest political idea and concentrate on whats best for our patients.

Most feel that to some extent bigger is better or at least there are some opportunities of working at scale and there has been a move towards practices joining or working together – or working in localities. The NAPC primary care home idea of practices working together in groups of 30-50K has kind of caught on and certainly locally in Cheshire it seems to be the policy to make us all work together whether we like each other or it makes sense from a geopolitical point of view. We are being forced into some odd groupings – some of which make sense some don’t.

However, from an IT point of view, there are clearly gaps. We are looking at things like sharing reception, sharing admin, sharing coding, sharing Triagers, sharing typists. In almost all cases we hit problems with EMIS. Other clinical systems may have this sorted in which case I’d like to hear – but I suspect not. Let me give some examples.

In my locality of 6 practices – some large, some small, it might make sense when its quiet for a telephone team based at one surgery to answer all the calls for the group of practices, or the opposite when its really bust for anyone to answer anyone’s calls. So when a patient rings the receptionist looks up their record – books them an appointment or answers their query.

Currently, despite all the systems mentioned above, there is no way of doing this? The receptionist could have 6 versions of Emis open on their desktop – never a good idea – CRASH city… and choose between them but it won’t be elegant and requires receptionists to have multiple logons (also smart cards will only work on 1 system at a time). A centralised super view of all the appointments in an area or group of practices is what is needed.

The ability to pull up a patients record from any of the group of practices would be good. Again imagine a room full of senior ANPs doing telephone triage for 2-29 practices – each patient will be from a different practice – how do they do this? please wait while I shut down the system I’m in and log into another one – isn’t really an option. They need a super practices view of everyone.

We love Lexacom locally – most of the practices have switched to it. You can send your typing to another practice to do – if they have capacity – you can set up a local pool of centrally employed typists or you can send to an outsourcing company like Accuro and they will type the letter but none of them can do the referral – log into your system – create an e-referral – upload the letter add the read code. Its half a job and doesn’t actually take the task away from you just speeds up a bit of it.

We really need a federated working at scale solution. A lot of our plans are inhibited by this.

Even to the point of analysing performance. Locally my group is looking at diabetes care. We each have pop-man which looks at QOF – we have written some searches that we each individually run but there is no easy way of amalgamating them. Yes, we could purchase EMIS enterprise search and reports at £10K but that’s a lot of money and a separate log on and more data sharing agreements just to compare and contrast my blood pressures to the group. (and I don’t think it actually does what I want)

The EMIS search module is amazing in many ways but it doesn’t appear to allow me to search across organisations even if data sharing agreements are in place.

Of course, the federated working facilities need to be flexible. I’m in a research network of 15 practices. They aren’t in one locality but being able to book appointments across that group – or run searches or analyse data would be useful. For some things – we would want to deliver at a locality level – for some at practices that get on level or practices that want to invest in a shared back office level.

I’m not sure the current system despite some of its good bits is letting us develop working at scale as fast as wed like.

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