Guidance document for EMIS Web EPS Release 2 deployment

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1 Guidance document for EMIS Web EPS Release 2 deployment Crown Copyright 2011

2 Contents Guidance document for EMIS Web EPS Release 2 deployment Introduction Background Purpose Target audience Scope Assumptions EPS Release 2 overview Key business processes EMIS Web and EPS Release EMIS Web EPS Release 2 system assurance How to prepare for EPS Release 2 in EMIS Web Key areas of the deployment process Deployment plan System order process Ordering EPS Release 2 training Purchasing end user training from the supplier Accredited train the trainer approach Training lead times Training activities Additional support Site readiness checklist Smartcards/ RA Deployment of EPS Release Pre deployment activity During deployment Post deployment activity 12 7 Supplier incident management Minimum data required Logging by phone Logging by EMIS customer reference (ECR) tracker Outstanding issues Lessons learnt EPS Release Crown Copyright 2011 Page 2 of 23

3 9.2 Smartcards Training Business process Deployment Nominations Electronic repeat dispensing Electronic cancellation of prescriptions System issues Appendices Appendix A: EPS Release 2 key business processes Nominations Electronic repeat dispensing Advanced Electronic Signatures Prescription tokens Electronic cancellation of prescriptions Appendix B: EMIS Web upgrade information Appendix C: EMIS Web ECR tracker guide Appendix D: Deployment Verification Report (DVR) Appendix E: DevMAC Crown Copyright 2011 Page 3 of 23

4 1 Introduction 1.1 Background Following successful EPS Release 2 first of type (FOT) deployments, EMIS have been granted approval to deploy their clinical system, EMIS Web Config 2 to further GP practices. This document contains a number of tools and guidance materials which have been developed following the first deployments to GP practices. Further information on EMIS Web Config 2 can be found in Section 3 below. 1.2 Purpose This document has been developed to provide the NHS with guidance and tools required to successfully deploy the EPS Release 2 component of EMIS Web to GP practices. The tools provide detail of the minimum activities that enable the deployment of EPS Release 2. Primary Care Trusts (PCTs) may want to add any local activities that they wish to carry out as part of their local process. The complete guidance consists of this document and the following tools: PCT deployment checklist (including GP checklist) additional process and guidance materials (either linked to this document and/ or the checklist). It is important to ensure that this document contains the most up to date guidance available. The latest version of this document is held on the EPS website. Any copies of this document held outside of the website, in any format (e.g. paper, attachment), are considered to have passed out of control and should be checked for validity. It is therefore recommended that the document is taken directly from EPS website for each deployment to ensure that the latest versions of the tools are used: Target audience This document, and the tools contained within it are intended for the use of PCTs to use when supporting GP practices with the implementation of EPS Release 2, and also for GP practices implementing EPS Release Scope The scope of this document addresses the activities PCTs and GP practices are required to undertake in preparation of and during go live with the EPS Release 2 component of the EMIS Web system. 1.5 Assumptions It is assumed that the PCT has completed a number of activities in relation to PCT readiness for EPS Release 2 implementation. Crown Copyright 2011 Page 4 of 23

5 These are: Stage 1: The Foundation Stage has been completed by the PCT and all of the requirements of the Foundation Stage have been approved by the PCT governance structure (project board). Stage 2: Preparing for EPS Enablement (Obtaining Secretary of State Direction) this means that the PCT are able to authorise their primary medical services contractors or any practice established by the PCT to use Release 2 of the Electronic Prescription Service. Crown Copyright 2011 Page 5 of 23

6 2 EPS Release 2 overview The high level EPS Release 2 overview is depicted in Fig 1 below. Fig 1 high level EPS Release 2 overview: 2.1 Key business processes Appendix A highlights the key business processes, benefits and areas of change that EPS Release 2 will bring, including: Nominations Electronic repeat dispensing Advanced electronic signatures Prescription tokens Electronic cancellation of prescriptions Crown Copyright 2011 Page 6 of 23

7 3 EMIS Web and EPS Release 2 EMIS Web is a full clinical system which is available for upgrade at GP practice sites. EPS Release 2 business go live at GP practices refers to when the practice starts to use the EPS Release 2 functionality of EMIS Web. This requires the GP practice system to be upgraded to the EMIS Web clinical system. Sites may choose to have EPS Release 2 deployed at one of the two following instances: 1. At the same time as EMIS Web This option allows the site to start using EPS Release 2 functionality on day 3 after they go live. 2. At a point in time after EMIS Web has been deployed (recommended option) This option allows sites to become familiar with functionality within the EMIS Web system prior to EPS Release 2 being deployed. Depending on whether the site is choosing option 1 or 2 above, this will affect: EMIS Web/ EPS Release 2 order lead times, EMIS Web/ EPS Release 2 training lead times. [Note: this may also be referred to as EMIS Web config.2, the difference between config.1 and config.2 are outlined below. Configuration 1 is a GPSoC Level 2 system that is hosted to NHS CFH Standards and contains Choose and Book v3 Referrer, Information Governance v2, PDS v2, GP Systems v1, Electronic Prescription Service Release 1, QoFv18 and Data Streaming. Configuration 2 includes all of the above plus EPS Release 2. 4 EMIS Web EPS Release 2 system assurance All systems approved by NHS CFH (including EPS Release 2 compliant systems) must go through a full assurance process prior to them being delivered to the NHS, called the common assurance process (CAP). CAP includes a period (known as the deployment verification period or DVP) where the software is used at a small number of GP practices and monitored closely to ensure the software is functioning as intended. Once the software has been approved both technically and clinically, it is granted full rollout approval (FRA) and the supplier can roll the software out to their estate. EMIS were awarded FRA for EMIS Web for EPS Release 2 functionality on 8 March How to prepare for EPS Release 2 in EMIS Web The EPS Release 2 PCT checklist (which also includes a GP go live checklist) should be used by PCTs and GP practices to support deployments. There are two sections to each checklist that include: Crown Copyright 2011 Page 7 of 23

8 1. checklist of activities for completion at PCT/ GP practice level by an EPS Release 2 project manager/ site lead, including owners of the relevant activities. 2. supporting information which contains more detailed descriptions and guidance on the activities within the EPS Release 2 go live preparation checklist, together with links to appropriate websites and resources. The activities, supporting information and timeline contained within the checklist are based on best practice identified from first of type deployments. A PCT may choose to adapt the activities and timeline to meet local requirements however, these are the minimum activities required. The checklist can be accessed below: 6 Key areas of the deployment process 6.1 Deployment plan The decision to enable the GP practice for EPS Release 2 lies not only with the GP practice but also the PCT, and other factors (such as local pharmacy readiness) will be important too. EMIS will implement EPS Release 2 with the PCT in line with the PCT s EPS Release 2 deployment plan. 6.2 System order process The formal process for ordering EMIS Web functionality (including EPS Release 2) is through the GPSoC Schedule A contract. Schedule A, operated through the tracking database, covers the agreement to deploy services and triggers the creation of a workflow package within EMIS to ensure that all appropriate activities are scheduled and carried out. When the practice chooses to upgrade to EMIS Web and the PCT has agreed to fund the associated costs and considered other local options, the PCT will place an order through the GPSoC tracking database. EMIS will then contact the practice and PCT to discuss the upgrade and agree a suitable upgrade date. Further details on completing the Schedule A are available from the GPSoC website. 6.3 Ordering EPS Release 2 training The process for ordering training on EPS Release 2 from EMIS is dependent on whether the PCT is adopting one of the following methods: accredited train the trainer approach purchasing end user training from the supplier. Crown Copyright 2011 Page 8 of 23

9 It is highly recommended that ALL staff are trained on using EPS Release 2 within EMIS Web Purchasing end user training from the supplier If the PCT is purchasing EMIS end user training, the PCT should request a quote from the EMIS central operations department in advance The accepted quote together with a purchase order from the PCT should be returned to EMIS at the same time as submitting their Schedule A form. As stated previously, sites may choose to have EPS Release 2 deployed at one of the two following instances: 1. At the same time as EMIS Web This option allows the site to start using EPS Release 2 functionality on day 3 after go live. The site will require training on the full EMIS Web system including EPS Release 2. The training session for EPS Release 2 is a 3 hour onsite session. The GP practice can choose to take this half day session as part of their standard training allocation. Alternatively the site could choose to purchase additional EPS Release 2 training over and above the standard training on EMIS Web. The amount of training included in the deployment cost is dependent on which upgrade option is selected at the time the order is placed. More information on upgrade options can be found in Appendix B. 2. At a point in time after EMIS Web has been deployed This option allows sites to become familiar with the EMIS Web system prior to EPS Release 2 being deployed. The EPS Release 2 training provided by the supplier will be a 3 hour session. There may be a maximum number of people allowed in any one training session, however EMIS are flexible and will take into account specific needs of the GP practice site and staff. Further information from EMIS regarding upgrade options is provided in Appendix B Accredited train the trainer approach If the PCT wishes to deliver the training themselves they must first undergo train the trainer training. Timescales for this training must be built into any deployment plans the PCT have. The PCT must request a quote from EMIS and inform EMIS of agreed training dates with individual practices, either before or at the same time as submitting their Schedule A form Training lead times The lead time for training on EPS Released 2 is currently 8 weeks and EMIS stipulate that ideally training should occur no sooner than 1 week prior to deployment Crown Copyright 2011 Page 9 of 23

10 of EPS therefore, it is important to bear this in mind while agreeing deployment dates with GP practice sites Training activities All EPS Release 2 training will take place at the GP practice site. Training activities for the half day (3hrs), face to face training session to be delivered on-site (at the GP surgery) include: PowerPoint presentation to discuss high level business process, benefits and impact e-learning module for full software functionality training. This will be split by role type e.g. prescribing and administration and using dummy patients and scenarios. national guidance products created by the EPS programme team referenced during the training session. ance Included in the training pack provided to sites will be information on how to access the EPS business process guidance documents aimed at healthcare professionals. These processes will be covered during the onsite training and reference to the document will be made. EMIS do not intend to create any further documentation to cover high level business processes for the GP practice. It is expected that any communications aimed at the patient will be managed by the PCT and the GP practice Additional support EMIS will also provide on-going support including materials and actions to underpin training received: e-learning module for full software functionality training left with practice for self study and cascade training user guide to include overviews and full software functionality training handouts on pertinent areas quick reference guide follow up communication contact with operations manager, training newsletter, internal updates helpdesk. All relevant training materials are available for the site end users to download from EMIS-online by accessing the following link and adding a username and password: Crown Copyright 2011 Page 10 of 23

11 In addition, the EPS website contains various guidance materials including e- learning. 6.4 Site readiness checklist An EMIS Web deployment site readiness checklist will be sent by EMIS to the PCT s EPS Release 2 project manager once a completed Schedule A has been received by EMIS central operations. This checklist states the practice requirements for EMIS Web as well as specific EPS Release 2 requirements. The deployment site readiness checklist must be signed off and returned to EMIS no later than 1 week prior to the technical go live at the site at: Alternatively, it can be sent to the following address: EMIS Central Operations Fulford Grange Micklefield Lane Rawdon Leeds LS19 Note: The EMIS Web deployment site readiness checklist is provided by the EMIS operations manager and is separate to the EPS Release 2 PCT checklist provided as part of this document. These checklists should be used in conjunction with each other. If the EMIS Web deployment site readiness checklist is not signed off and submitted to EMIS, EMIS will not perform the technical go live at the practice, resulting in delays to the EMIS Web/ EPS Release 2 deployment. 6.5 Smartcards/ RA All users of EMIS Web will need to be provided with their own Smartcard. In addition, all users will need to be assigned an appropriate role and activities, or to an appropriate position according to the roles/ activities that are required by the site. This is a standard process and further supplier RBAC guidance including appropriate roles and activities can be found at EMIS online. 6.6 Deployment of EPS Release Pre deployment activity Prior to deployment, the PCT must complete all steps within the PCT checklist. Key areas include: the GP practice site have complete all steps outlined in the GP checklist which is included as part of the PCT checklist attached to this document (see section 5 above). Crown Copyright 2011 Page 11 of 23

12 ALL staff have been trained to use EPS Release 2 including locums and attached staff ALL staff have Smartcards allocated to them with the appropriate roles added and certificates checked During deployment During deployment the PCT should be available to provide any support e.g. business process and RA support Post deployment activity The PCT should contact the site to ensure the system is working as expected and that no major issues have been identified. Any lessons learnt should be uploaded onto the EPS website. Alternatively they can be sent directly to the following address: Any feedback in relation to this document and associated checklists and information should be ed to: 7 Supplier incident management Any issues relating to EMIS Web/ EPS Release 2 should be raised with the supplier. This can be done in one of two ways: Logging by phone Logging by ECR tracker 7.1 Minimum data required In order to ensure all relevant data regarding an issue is provided when logging a support call with EMIS, the minimum data required is: what task the user was performing at the time the incident occurred patient s EMIS number which user performed the task time the task was performed any error messages. It is important to obtain and note the reference number that is supplied. Crown Copyright 2011 Page 12 of 23

13 7.2 Logging by phone 1. When you call EMIS support , you will hear the following announcement: Welcome to EMIS support s automated system. Press 1 to use the automated system, press 2 to speak to the call centre. Press 3 to listen to details on how to use the automated system. You do not have to wait until the message finishes before making your selection: 2. Select option 1 3. Select option 66 this will connect you to an EPS Release 2 trained member of the helpdesk team. (Please note this option is for calls regarding EPS Release 2 only) 7.3 Logging by EMIS customer reference (ECR) tracker New incidents can also be logged by accessing the EMIS customer reference (ECR) tracker. Details of how to do this are contained within the ECR tracker guide (see Appendix C). 8 Outstanding issues The development milestone achievement certificate (DevMAC) and deployment verification report (DVR) contain the known issues/ defects arising from FOT deployment. These are both detailed in Appendix D and Appendix E and will be updated once the DVR and DevMAC are updated with the latest information on the status of the issues/ defects (which are accurate at the time of authoring this document). 9 Lessons learnt Below are some useful lessons and recommendations identified from EMIS FOT deployment. EPS Release 1 Smartcards Training Business process Deployment Nominations Electronic repeat dispensing Electronic cancellation of prescriptions Crown Copyright 2011 Page 13 of 23

14 System issues 9.1 EPS Release 1 Wherever possible, all staff should issue EPS Release 1 barcoded prescriptions in the run up to EPS Release 2 going live. This will help to ensure that staff are used to using Smartcards as part of their usual daily process. 9.2 Smartcards It is essential that ALL staff including remote staff associated with the practice as well as temporary staff have valid Smartcards with the appropriate roles added to their Smartcard prior to EPS Release 2 deployment. Ensure the Smartcard lead/ sponsor knows how to renew Smartcards and that there is a process in place for renewing Smartcards before they expire. 9.3 Training Training is important and GP practices should ensure all staff devote enough time to being trained on the system and that they are familiar with the new functions and business change that EPS Release 2 brings. All staff should complete the e-learning online prior to using the system. Training and familiarisation of the system should be timely and reinforced regularly. 9.4 Business process It is important that all staff attend EPS Release 2 awareness sessions, where these are provided by the PCT. These sessions are key to understanding the main principles of EPS Release 2 including business change. Ensure all staff, dealing with prescriptions, have experience of the new business process, as soon as possible after deployment in order to reinforce training on the new business processes required in EPS Release 2. Staff should be confident when explaining the benefits of EPS Release 2 to patients in clear and simple terms, whether by telephone or face to face. Experience in first of type has shown that clear communications for example, posters, leaflets or letters improve patient communication. Crown Copyright 2011 Page 14 of 23

15 It has been found that having nominated champions for specific areas of EPS Release 2 can help to ensure that if there is a problem, these champions are able to help further. In addition, details of nominated champions along with the areas they cover should be communicated to all staff so that it is clear who to contact in the event of an issue. Examples of areas that a GP practice could have nominated champions for could include: nomination (setting nominations, changing nominations, deselecting nominations) prescriptions (tracking prescriptions, preparing prescriptions) repeat dispensing. 9.5 Deployment Experience from first of type has shown that it is better for GP practice staff to become familiar with the EMIS Web system prior to training, deploying and starting to use EPS Release 2. It has been found that 4-6 weeks should be enough time to familiarise users with the EMIS Web business process. Specific EPS Release 2 training and deployment should occur after this time rather than at the same time as EMIS Web. Wherever possible try to ensure ALL patients PDS details are synchronised prior to go live. This will help to ensure a smooth transition to EPS Release 2 as GPs cannot set nominations or issue EPS Release 2 prescriptions without this happening. In addition, prescribing staff should synchronise patients medication wherever possible so that a patient s repeat prescriptions are issued on one day, rather than on different days. After deployment, it is advisable to take some time to get used to the system for example, administrative staff should block out 15 minute slots in each prescriber s appointment calendar during the go live week to enable staff to catch up on the system and address any user issues. After deployment, it is essential for prescribers to remember to sign digital prescriptions until this becomes business as usual. For example, administrative staff could prompt GPs to sign their EPS Release 2 prescriptions once or twice per day by adding a reminder on the appointments screen, or a task or by sending an instant message. Consider the best time in the day to do this. 9.6 Nominations It has been found that having a clear process in place for identifying suitable patients for nomination will help with uptake of EPS Release 2. Crown Copyright 2011 Page 15 of 23

16 Having a high volume of nominations set within the first few days of a system being enabled will allow for the business processes to be learnt quickly and reinforced by all staff. Ensuring there is a champion who has detailed knowledge on setting nominations, changing nominations, deselecting nominations and that staff know who to contact helps to resolve issues quickly. When a prescriber wants to produce FP10 prescriptions, they do not have to remove and then re-add nominations. They should just change the prescription type on the system. 9.7 Electronic repeat dispensing When introducing repeat dispensing in the practice, engage nurses that are involved in long term condition clinics to help identify patients that will benefit from repeat dispensing. GPs and GP practice staff should all fully understand the repeat dispensing process and be able to explain its benefits to patients in EPS Release Electronic cancellation of prescriptions Where one item is required to be cancelled on the prescription, the prescriber does not need to cancel the whole prescription as this will mean that the whole prescription needs to be regenerated. During training, prescribers must ensure they understand how to cancel an item and also how to cancel a whole prescription with EPS Release System issues It is advisable to keep the EMIS helpdesk contact details and PCT EPS lead contact details visible and readily to hand in the event of any issues. All system issues should be logged with the EMIS helpdesk as soon as possible, always ensure that an incident number is obtained for reference. It is also advisable to keep an internal log of any issues raised so that staff can keep an audit trail. There are many reasons why a task may be rejected by the system e.g. if the system is used in error. These should be covered by EMIS as part of the training and there should be a clear process on site on how to deal with these when they occur. Crown Copyright 2011 Page 16 of 23

17 10 Appendices 10.1 Appendix A: EPS Release 2 key business processes Nominations Nomination is a new process that gives patients the option to choose, or nominate a dispensing contractor(s) to which their electronic prescription(s) can be sent automatically, using EPS Release 2. Nomination can be likened to existing prescription collection services offered by some community pharmacies (particularly useful for repeat prescriptions), as it removes the need for patients to call at their GP practice to collect a paper prescription form. When a nominated electronic prescription is generated, it is sent to the Electronic Prescription Service. It can then be retrieved by the nominated dispensing contractor s system without the need to scan a barcode. It is likely that the dispensing contractor will retrieve the electronic prescription prior to the patient arriving to collect their prescription items. This will give them the chance to prepare the prescription in anticipation of the patient s arrival. (Source: EPS Release 2 - Business Process Guidance ) The Nomination Policy is a key deliverable for the PCT; the purpose of the Nomination Policy is to provide all stakeholders with information and clear localised protocols on how nomination will be managed and monitored by the PCT. Making sure that patients have given proper informed consent to use EPS Release 2 in nominating a dispensing contractor is essential and should be covered in the Nomination Policy. The policy should include the PCTs approach for prescribers and dispensing contractors with regard to what they are expected to do to collect and set a nomination from a patient. The policy should also consider the impact of nomination on the existing business processes, a complaints procedure, and monitoring process. (Source: Supporting Nomination for EPS Release 2 ) Electronic repeat dispensing EPS Release 2 will support the repeat dispensing process. Whilst it largely mirrors that of the existing paper-based repeat dispensing process, some of the constraints associated with the paper-based process are removed, making it easier to use and manage. Unlike conventional paper-based repeat dispensing, electronic repeat dispensing is possible from a single electronic prescription and does not require paper batch issues to be printed. When issuing an electronic repeatable prescription, the prescriber will authorise a prescription with a specified number of repeats (issues); each repeat contains the same prescribed items. When using EPS Release 2, prescribers are required to Crown Copyright 2011 Page 17 of 23

18 issue a prescription token to the patient, this will have the words repeatable prescription authorising token printed on it. Once a repeat dispensing regime has been authorised, each subsequent repeat will be made available for the nominated pharmacy system to collect seven days in advance. It is possible for a pharmacy to pull down repeats in advance of them being sent automatically from the EPS, for example, where the dispensing interval is flexible and the pharmacist believes that a repeat should be dispensed at an earlier time such as when the patient is going on holiday. Patients should be encouraged to retain their repeat dispensing authorising token for the duration of the prescription term. If the patient needs to sign for their prescription, a dispensing token should be printed for the patient to sign. Once all authorised repeats have been dispensed, or if the prescription has expired, or been completed, the pharmacist should encourage the patient to contact their prescriber to obtain another repeatable prescription (where required). (Source: EPS Release 2 - Business Process Guidance ) Advanced electronic signatures One of the fundamental changes between Release 1 and Release 2 of the EPS is the ability for prescribers to apply advanced electronic signatures to prescription messages. These advanced electronic signatures are unique to individual users and are applied using their Smartcard and passcode. It is the application of the advanced electronic signature to the electronic message that turns it into an electronic prescription. (Source: EPS Release 2 - Business Process Guidance ) Unlike dispensing contractors, prescribers cannot start using EPS Release 2 systems as soon as their system becomes Release 2 accredited. PCTs need to be listed in the Primary Medical Services (Electronic Prescription Service Authorisation) Directions 2008 as amended ( the EPS Authorisation Directions 2008 ) before authorising that their GP practices can use an EPS Release 2 compliant system to generate electronic prescriptions, signed with an advanced electronic signature. (Source: EPS Website Prescription tokens Even when EPS Release 2 is fully introduced, paper copies of electronic prescriptions will need to be made available, by the GP practice or the pharmacy, where necessary. Crown Copyright 2011 Page 18 of 23

19 Paper copies of electronic prescriptions are called tokens. They act as a hard copy of the details contained within the electronic prescription. There are two types of token, known as prescription tokens and dispensing tokens. Prescription tokens are printed at the GP practice on FP10 paper prescription forms and feature a barcode. The main difference between a prescription token and a barcoded FP10 prescription form is that the prescription token is not signed by the prescriber instead, standard text will be printed in the signature box to prevent the prescriber from signing it. (Source: EPS Release 2 - Business Process Guidance ) Electronic cancellation of prescriptions There may be instances where a prescriber decides to cancel an EPS Release 2 prescription before it is dispensed. This is called the electronic cancellation of prescriptions. Prescribers (or other authorised staff working in the GP practice where the prescription was generated) will be able to cancel electronic prescriptions at any point up until they are dispensed. When an electronic prescription is cancelled, a reason for the cancellation must be given. A message is then sent to the Electronic Prescription Service. It is always the responsibility of the person cancelling the prescription to ensure that the patient is informed when their electronic prescription is cancelled. When a dispensing contractor attempts to retrieve the electronic prescription, they will be notified of the cancellation. GP clinical systems will allow the cancellation of the whole prescription or individual items on that prescription. (Source: EPS Release 2 - Business Process Guidance ) Can a dispenser cancel an electronic prescription? No. Only prescribers (or other authorised staff working in the GP practice where the prescription was generated) will be able to cancel the electronic prescription. They can do this at any point up until the prescription is dispensed. However, a dispenser can mark an item not dispensed. (Source: EPS Release 2 - Business Process Guidance ) Crown Copyright 2011 Page 19 of 23

20 10.2 Appendix B: EMIS Web upgrade information PI117 EMIS Web essential upgrade info Crown Copyright 2011 Page 20 of 23

21 10.3 Appendix C: EMIS Web ECR tracker guide UG103 ECR Tracker Guide.pdf Crown Copyright 2011 Page 21 of 23

22 10.4 Appendix D: Deployment Verification Report (DVR) FOT Deployment Verification Report- a Crown Copyright 2011 Page 22 of 23

23 10.5 Appendix E: DevMAC YGJ-EMISWEB R Dev Crown Copyright 2011 Page 23 of 23

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