Degraded codes in EMIS Web

Degraded codes in EMIS Web

When browsing the Care History in EMIS Web, users may occasionally find code terms which have a red [DEGRADE] as a prefix. These can occur when a patient's electronic record is transferred via GP2GP from another system; this could be from another EMIS Web site, or from another clinical system such as SystmOne. The reason for degraded entries can be due to legacy and local codes not recognised by SNOMED, or from another coding system such as SystmOne's Read CTV3.

Degraded entries sit in the patient's record and can be easily interpreted by a human, but not be used by EMIS Web for it's own tools and clinical safety mechanisms, nor by searches or concepts. Depending on the type of code, degraded codes are all assigned a SNOMED CT code, the main ones being:
  1. Transfer-degraded record entry [196411000000103]
  2. Transfer-degraded drug allergy [196461000000101]
  3. Transfer-degraded non-drug allergy [196471000000108]
  4. Transfer-degraded medication entry [196421000000109]

What is so important about degraded entries?

At first glance, summarisers might reel at the number of codes marked with a red degrade, fearing they have to re-code all of them. The reality is more nuanced and can be set at a level the Practice is comfortable with regarding the completeness of the record.
Degraded drug allergies must be dealt with!
Degraded drug allergies need to be fixed as soon as possible after the GP2GP record has been filed. EMIS Web has a built-in safety feature preventing anybody from issuing medication until the degraded allergy is fixed. Fortunately EMIS Web also displays a yellow warning above the blue patient precis bar.


Degraded non-drug allergies and codes (record entries) are not critical to using the patient record, but fixing some entries can be very useful to the ongoing use of the system. We cannot produce a definitive list of what is worthwhile fixing, but some of the most common examples are shown below:
  1. Non-drug allergies - useful to code correctly, and some may have been erroneously coded as non-drug allergies despite the associated text showing a drug
  2. Vaccinations - helpful in children for managing recalls; ensures a patient-requested summary of vaccinations is complete
  3. Major operations and diagnoses - less common these days, but may still come in from other clinical system providers
  4. Recent results - depending on the patient's medical history, fixing degraded result codes and values from the past 12 months can help with QOF. Think about the most recent smear result or other screening programmes.

Where can I find degraded entries?

The EMIS Web Workflow Manager has a section called GP2GP. When an incoming record is filed (with tasks) EMIS checks the record for valid codes and generates tasks for degraded entries.
If nothing is visible, the user would need to be added as a Global Viewer for the GP2GP module via the Workflow Manager Config.

If degrade tasks have been cleared it is not possible to view an archive of closed tasks but Practices can still find degraded codes using Primary Care IT's data quality searches & reports DQ-007 (degraded allergies) and DQ-008 (codes).


Within the Care Record module, users and organisations can configure Filters to narrow down degraded entries. These can be created for most modules, but are probably most useful for Consultations and Care History. Medication degrades are rare and dealt with differently.

If you are following the above example, remember to untick Verified amendment to transfer degraded record [353151000000100]

What is the process for dealing with degraded entries?

Ideally the GP2GP workflow inboxes should be checked on a daily basis to ensure incoming records are filed as soon as possible. New patient records should ideally be filed before any New Patient Appointment as this will also help with authorising the patient's existing medication (as opposed to having to manually add all items). If button is available, File as Record with tasks, otherwise File as Attachment (this is for patients who have been previously registered with the practice to avoid duplication of codes).

In the process of filing, some tasks may be generated which should be addressed in the following order:
  1. Allergy Degrade – failure to recode any degraded allergies will prevent all users from issuing medication.
  2. Medication Authorisation – doctors may wish to save time adding new medications on by re-authorising or ending medications from the previous practice. This can be actioned on the patient’s Medication screen, then an administrator can complete the task.
  3. Event Degrade – when the record is ready for summarising, the summariser should deal with all degraded codes. These are due to legacy codes in EMIS LV as well as custom codes in SystmOne and Synergy.

Summarising of GP2GP records may involve editing consultations to remove codes from other clinical systems where there is no equivalent.







Records Received – this section deals with records for patients who have recently registered

Unfiled – records should move from Outstanding into this section.

·       Medication Authorisation – tasks in this section are for patients whose records have come via GP2GP and who have current or repeat medication.

·       Allergy Degrade – tasks in this section are for patients whose records contain an unrecognised allergy code.

·       Event Degrade – tasks in this section are for patients whose records contain unrecognised codes from other clinical systems.

·       Filed Records – completed tasks from Unfiled will be archived in this box.

Tasks in Medication Authorisation, Allergy Degrade, and Event Degrade will be created at the same time as the patient record goes into Filed Records.

Degraded drug allergies

Degraded drug allergies must be fixed as soon as possible. Until they are fixed it is not possible for anybody in the organisation to issue medication (although medication can be added).

EMIS has a safety feature that prevents the issuing of medication when there is an allergy related code that it cannot link directly to a medication.

As an example, EMIS knows that Adverse reaction to simvastatin means that the patient shouldn’t be issued simvastatin. If a user tries to add simvastatin there will be a red warning box prompting the user to Override or Do Not Use Drug.

If the code is h/o: drug allergy with simvastatin in free text, it makes sense to a human who can interpret it in the intended way, but EMIS cannot pick up the nuance of free text. As a consequence EMIS won’t allow any medication to be issued just in case one of the drugs is related to the allergy.

 

In the majority of cases, a task is generated in the GP2GP workflow to highlight action must be taken.

When in the patient’s record, a yellow bar will display at the top warning of the degraded allergy. Anybody can fix them with a basic understanding of what needs to be done.
  1.  Click on the Degraded Drug Allergy warning
  2. EMIS will jump to the Allergy view on the Care History tab
  3. One or more allergies will be shown with [DEGRADE] in red next to the item
  4. Right click on the allergy entry and press Edit
  5. In the majority of cases an old consultation will open for editing.
  6. Click on the Allergy heading on the left (or left click the end of the existing allergy line and press Enter)
  7. Type the name of the drug (eg: Mirtazapine) so a dropdown list appears with coding options.
  8. Select an appropriately worded code, and then type any useful free text afterwards, such as the medication strength, form, and other useful information.

 



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