OneLauncher Prescriber
Introduction
The OneLauncher Prescriber tool brings together all of the tools that are relevant for Prescribers into one easy place so you can easily locate and use the powerful tools that we've created for you. As further tools are developed, these will be added to the Launchers. This guide takes you through the tools in detail.
If you haven't already watched the OneLauncher Prescriber video we would suggest you watch this before going any further:
OneTemplate Prescriber
This is a dynamic template for managing chronic disease - so only things that are relevant to the patient you have in front of you are displayed. For example, if the patient is diabetic the diabetes section will show; if they aren't it won't.
It's so smart - examples (just a few of the many):
- If a diabetic patient is on injectables there is a section to check injection sites, if not there isn't
- Depending on smoking status different length and detail of information is shown (smokers lots, smokers with COPD even more, never smoked very little shown)
- At the top of the COPD page the template automatically tells you what GOLD classification the patient is and what ABCD group they fall into
- If a diabetic patient is on drugs that cause hypos there's a hypos awareness section which shows, if not then it doesn't
- If a patient needs contraceptive advice and is under 16 then competency assessment questions are shown, if they are older then they don't
Introduction Page
The first section of this looks the same for every patient opened and has some information about the colour coding used within the template as well as links to our support site and to add development requests for future versions of the template:
If you have our enhanced package then any locally commissioned services are highlighted in purple within the template
Where there are important safety considerations, these are shown below the template guide, for example where a patient is on medications that mean they need notifying about sick day rules (and this hasn't been done in the last 12 months) the following box shows (if they have been told already it doesn't):
Previous exception reporting is also shown under here so that this can be undertaken at the time of review and not left to year end to complete:
If the patient has codes or drugs that would suggest a diagnosis that has not been appropriately coded, this is also flagged under here
Possible new diagnosis
Where this is the case, further details are shown in the possible new diagnosis page (there are over 30 areas that this covers and if you want to look at this prospectively rather than when seeing patients we provide the searches to be able to do this):
This makes sure that your patients get the care that they need by being enrolled on the appropriate registers. It will also increase your practice income for QOF
QOF
When dealing with QOF there are two pages that show you different information:
Relevant QOF disease areas: This shows you every QOF area that the patient is in and all of the elements of care needed for that QOF area - so that you can see what has been done and re-do everything if you want. If you have patients with singular diseases (e.g. just asthma) this is quite easy to digest and you can immediately see what you need to. If you have patients who have multimorbidity this can get a lot busier and it can be more difficult to separate what's needed from what's not
A simple patient with relevant QOF disease areas:
A more complex patient with Relevant QOF disease areas:
This is why we have the second QOF page: QOF Outstanding. This just shows you what's outstanding for this QOF year. So if we take the same patient as above, you can see that this makes it much easier to hone in on what needs doing:
Earlier in the year the "relevant QOF disease areas" tends to be more useful, because you can go through and tick off the things that need doing. Later in the year when you're just trying to mop up remaining QOF points the "QOF Outstanding" comes into it's own so you can just see what needs doing to finish up for QOF.
Don't forget all of this information is also in an easily digestible form in the OneMonitoring tool
Shared elements
Where a patient has multiple diseases where the same elements of care are needed (e.g. BP needed for both hypertension and CHD) these elements are pulled into the "Shared elements" page of the template:
Notice the level of detail in the information provided about the appropriate blood pressure targets which are patient specific and also highlighting whether or not these have been achieved. This kind of information allows for the devolvement of care to other team members - as everybody is clear what the targets for treatment are.
Where shared elements exist, these elements of care are removed from the disease areas - so in the example above the hypertension and CHD pages would both show but neither would have BP in them - this would be in the "Shared elements" page. There are red alerts to the need to look at the shared elements page where this is relevant for patients in each of the individual disease areas:
Frailty
Where a patient is frail or has suggestions from codes or scores that they may be frail, we have a page that allows you to undertake a frailty assessment, record important information about information sharing and other important information. It also has all of the NICE multimorbidity guidance built into the page - so that if your patient is on any of the drugs that NICE identify as having limited evidence in frail patients then this is highlighted and the evidence for treatment shown to you. This can be really useful to review prior to nursing home rounds, during MDT discussions or at review with your clinical pharmacist.
Anticholinergic Burden calculator
Where patients are elderly or frail and have combinations of drugs that give them an anticholinergic burden score of more than 3, this is highlighted within the template.
- Tick this box and it tells you the score (8 for this patient)
- Drugs shown with a score of one
- Drugs shown with a score of two
- Drugs shown with a score of three
Individual disease area pages
These will show up if appropriate for the patient you are reviewing. As highlighted earlier each of the elements within the pages are also highly dynamic, we try to provide gold standard information which strikes a reasonable balance between giving the user enough relevant information, but also not being overwhelming. As with any change, some local discussion will be needed about how the tools are utilised and what the expectations are about how much information is completed versus the appointment duration given. Where our tools have been shown to have the maximum impact, they have been supported by funded schemes to account for the work required.
Wherever possible we provide information which you can copy and paste to AccuRx to make sure the patient remembers key information
For example:
and:
OneTemplate Acute
This template aids data entry for the commonest consultation types in Primary Care. It can be especially useful for trainees, allied health professionals or even established GPs who just want a structured and evidence based way of recording data. For each of the areas covered we've scoured the available evidence so you can be sure you're entering everything that would be expected for that particular complaint, highlighting red flags (and giving you preformatted text to record their absence) and seeing the latest guidance on how to manage the presenting condition. As the evidence evolves, we add this in to the template so you don't have to. In this way, you can be sure that you and everybody else in the practice is working to a high quality standard when consulting.
As with our other templates this one is highly dynamic - for example:
- If a child is being seen the febrile child template is shown as are details about who is accompanying/caring for the child
- If a smoker has a sore throat the higher risk is highlighted to the user
- For NEWS score things like immunosuppression or COPD are highlighted to the user as key risks
- If diabetic the risk of malignant otitis externa is highlighted in the Earache page
- If the patient is presenting with chest pain and has pre-existing IHD this is flagged
These are just a few examples - there are far too many to list here.
OneRemote
During COVID we have developed a number of resources to help practices. OneRemote is one of the tools we've shared for free to all and is a consultation template both for SystmOne and EMIS – giving not only COVID advice but also guidance on remote consultations with end of life, shielding status and the ethical considerations framework (developed by Sheffield’s Palliative Care Lead, Dr Sarah Mitchell) all built in
The full list of resources available is:
- A COVID19 hub on our website with over 400 resources to help practices/care homes/anybody else manage with COVID – this has been commended by NHSE Medical director and has also featured in the nationwide LMCs communications and has received over 40000 hits in the first month
- A free tool for both SystmOne and EMIS to code and communicate shielding or non-shielding status to patients
- A free Form 4 for cremation for both SystmOne and EMIS which pulls through the information entered into the remote consultation template
- A free protocol for reception staff to help manage risk assessing patients who come into the surgery
- A free notification of diseases form (again for S1 and EMIS) for patients who have suspected COVID.
OneCalculator
This has all the clinical calculators you could need in one place:
- Cockroft Gault
- CHADs2VASC
- HASBLED
- ABCD2
- CRB65
- QRISK2
- Spirometry
- Wells score
- FeverPAIN
- Marburg
- NAFLD
- ACB
Disease review panel
Stroke
This information panel gives you a lot of useful information when reviewing patients who have had a stroke - see below:
Diabetes
This information panel brings together all the information you need to think about when conducting a diabetic review. It can be really helpful to look at before undertaking a review. Where targets are not being hit this is highlighted to the user:
COPD
This protocol gives the user interpretation of the last spirometry and also wider information about COPD; bringing together information that is useful to the clinician in management of COPD:
Spirometry interpretation:
Whilst every effort is made to ensure accuracy, the use of codes varies widely, depending on spirometer, software and convention and as such the clinician is ultimately responsible for interpretation of spirometry and appropriate management of the patient.Respiratory history
This can be massively useful to review before undertaking a COPD review:
Results
QRISK2
This tool is designed to be used when getting a new cholesterol result back. It allows clinicians to assess if QRISK2 is valid to be used in the patient they are assessing. Then to support the clinician in making that assessment and giving them advice in line with NICE guidance. Where our professional package is used, users will also be able to send the patient a letter or text information with a patient decision aid. In this way it should mean that patients are much better informed when subsequently attending to discuss their cholesterol result.
1st step - check that QRISK is valid:
Then after updating data using the template to score the risk information is highlighted:
Then the user asked about what action is needed:
And the appropriate output generated:
HbA1c
Ever worried that you can't possibly keep the long list of exclusions in your head where you shouldn't use HbA1c to screen for diabetes? This tool answers that problem - by checking for and highlighting the appropriate background to the user.
No problems:
Shouldn't be using HbA1c:
And then useful information shown:
TSH
Got a new TSH result for somebody who has thyroid disease? Need to titrate up or down their medication? This protocol will allow you to do this remotely, adding the prescription and communicating the changes to the patient:
Lets say we choose increase:
And send a text:
And then the changes to medications can be selected and prescriptions generated:
Vitamin D
You've got a new vitamin D result that's either deficient or insufficient? Run this protocol to deal with it appropriately and communicate required actions to the patient:
The appropriate prescription can be generated:
and then communicated to the patient:
eGFR
Got an eGFR back and not sure if the patient is appropriately coded, or if they've had an ACR, blood pressure or other relevant information? Use this protocol and get this kind of information without having to dig through the records:
Prescribing
Anticholinergic burden calculator
This is the same information as is in the OneTemplate but as a pop up so users can do this on the hop whilst seeing patients. It gives you information like this:
And then you can look at the detail of the drugs causing the score:
Issue of COPD rescue pack
Speed up the issuing of rescue pack medication for COPD patients. Three clicks and it's done! Working with our handy protocol which ensures coding of exacerbations it also ensures appropriate coding of all exacerbations:
Confirm the information and the scripts are generated:
We're then warned about having not coded an exacerbation (if it was the first issue of a rescue pack this wouldn't flag)
If we select current exacerbation it's autocoded. In this instance we click past exacerbation and are taken to a template to record the accurate date of this.
Issue of end of life drugs
This protocol will guide you through prescribing end of life drugs, taking account of renal function and also alerting you to previous opiate prescriptions via a linked alert in the zap box.
On launching you will see this alert:
At the same time, information about any previous (or none) prescriptions is shown in the alert zap box:
You are then guided through prescribing, first by assessing renal function:
And then working through each of the areas of :
- Pain
- Dyspnoea
- Terminal restlessness
- Nausea and vomiting
- Respiratory tract secretions
It asks you for each area and checks that you're happy with the planned issue:
And at the end allows you to review any of the decisions made:
Care plans
If you're not autolaunching the care plans after using the OneTemplate then you can access them from the OneLauncher manually. Make sure you save a consultation with any new data in it before launching the appropriate care plan. If you have an interest in multimorbidity and want to use our new pilot multimorbidity section in the OneTemplate and associated multimorbidity care plan then speak to your customer relationship manager.
- Asthma (Adult)
- Asthma (Child)
- COPD
- Mental Health
- Dementia
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