Dementia Direct Enhanced Service

Vision 3 Dementia Direct Enhanced Service England Outcomes Manager Copyright INPS Ltd 2015 The Bread Factory, 1A Broughton Street, Battersea, London, SW8 3QJ T: +44 (0) 207 501700 F:+44 (0) 207 5017100 W: www.inps.co.uk

Copyright Notice 2015 INPS All Rights Reserved. No part of this document may be photocopied, reproduced, stored in a retrieval system or transmitted in any form or by any means, whether electronic, mechanical, or otherwise, without the prior written permission of INPS. No warranty of accuracy is given concerning the contents of the information contained in this publication. To the extent permitted by law, no liability (including liability to any person by reason of negligence) will be accepted by INPS, its subsidiaries or employees for any direct or indirect loss or damage caused by omissions from or inaccuracies in this document. INPS reserves the right to change without notice the contents of this publication and the software to which it relates. Product and company names herein may be the trademarks of their respective owners. INPS Ltd. The Bread Factory 1a Broughton Street London SW8 3QJ Website: www.inps.co.uk Contents DEMENTIA OUTCOMES MANAGER 5 What this Guide Covers 5 Background 5 Overview 6 Prerequisites 6 Downloading the Dementia Manager Tools 7 Running the Dementia Manager Reports 8 Reviewing the Dementia Manager Reports 9 Dementia Manager Reports 10 Dementia Manager Admin Urgent 11 Dementia Manager Practice Monitoring Reports 12 Using the Last Run Option 13 Interacting with Patient Lists 13 Working with Patient Lists 13

Print, Print Preview or Export Patient Lists 14 Using the Merge Category/Indicator Option 14 Generating Merged Letters 15 Designing a Dementia Invite Letter 15 Generating a Merged Letter for a Group of Patients 17 Inviting Patients by Phone 18 Accessing the Dementia Manager Template 19 Selecting the Dementia Manager Template from Practice Reports 19 Selecting the Dementia Manager Template in Consultation Manager 21 Accessing the Dementia Manager Template from the Alert Popup 22 Managing your Patients using the Dementia Manager Template 23 Dementia Status Tab 24 Carer Status Tab 25 History Tab 25 Summary - Viewing or Adding data to a Template 26 Toolbar 26 Data Entry Tools 27 INDEX 29 iv

Dementia Outcomes Manager What this Guide Covers This user guide explains how to use the Dementia Outcomes Manager Tools. It covers the following: Background to the Dementia DES scheme - Background (page 5). A Summary of the Dementia Manager process - See Overview (page 6). Prerequisites - Before using Dementia Manager you must download the Dementia DES tools which consist of Reports and a Template. See Prerequisites (page 6). How to run the Dementia Reports - See Running the Dementia Manager Reports (page 8). Reviewing the Dementia Reports - See Reviewing the Dementia Manager Reports (page 9). How to access and view the Dementia Template - See Accessing the Dementia Manager Template (page 19). How to view the Dementia Alert Popup window - See Accessing the Dementia Manager Template from the Alert Popup (page 22). Managing your patients using the Dementia Manager Template - See Managing your Patients using the Dementia Manager Template (page 23). Background The aim of the Dementia Enhanced Service in England is to offer advanced care planning by facilitating timely diagnosis and support for patients with dementia. It involves: Identifying patients at clinical risk of dementia Offering an assessment to detect possible signs of dementia in those at risk Arrange a referral for diagnosis where dementia is suspected and in the case of a diagnosis, provide advanced care planning in line with the patient s wishes Increase the health and well-being support offered to carers of patients diagnosed with dementia For patients with dementia and their families, the benefits of timely diagnosis and referral enables them to plan their lives better, provide 5

timely treatment if appropriate, to enable timely access to other forms of support and to enhance the quality of life Through the INPS Dementia Outcomes Manager Tools, you can identify those patients at risk of Dementia as well as those patients screened opportunistically. In addition, it provides a Personalised Care Plan Pathway to assist in the management of patients at risk or with early signs of Dementia. Overview Below is an overview of the Dementia Direct Enhanced Service implementation process: Dementia Manager Process Prerequisites To use the Dementia tools provided by INPS you will need to: Download Dementia Manager - You must download the Dementia Manager Reports and Templates from Vision+. See Downloading the Dementia Manager Tools (page 7). 6

Downloading the Dementia Manager Tools The first stage of working with the Dementia Manager tools is to download Dementia Manager from Download Web Files. To access the file: 1. Log into Vision, right click on the Vision+ icon in the Windows Notification area and select Download Web Files from the menu. Download Web Files Note - To access Download Web Files, you must not have a patient selected in Consultation Manager. 2. A list of files available to download and files already downloaded is displayed. 3. Select Dementia Manager by ticking the Download box, then select the Download button. Dementia Manager 4. A splash screen displays at the bottom of the screen showing the progress of the download. Note - Templates that have been downloaded by your practice are available to all users. 5. The status column quickly shows which templates have already been downloaded to the system, and which templates have a new version that may be downloaded. Template Version numbers can be compared between the Web 7

Version and Local Version to see if a more recent version is available for download from the web. 6. Close the Download Web Files screen to exit. Running the Dementia Manager Reports The Dementia reports are designed to assist in identifying patients at risk of dementia and help monitor your Dementia enhanced service payments. This section explains how to run the collection of reports: 1. Log into Vision, right click on the Vision+ icon in the Windows Notification area and select Practice Reports. Practice Reports 2. From the Practice Reports main screen click the Other icon. 3. Select Dementia Manager. Practice Reports - Other Dementia Manager 8

4. On completion, the Dementia Manager reports are listed on a separate tab and display various cohort lines. Dementia Manager Reports 5. To view patient names double click on the cohort line or choose the expand icon. For more information now to work with the reports - See Interacting with Patient Lists (page 13). Reviewing the Dementia Manager Reports This section explains the different Dementia reports and points out the areas you may want to consider when reviewing the results. The reports are grouped into categories making it easier to quickly identify specific cohorts of patients. Dementia Manager - Reports 9

Dementia Manager - The Dementia Manager category listed at the top contains a suite of reports that identify patients who are at risk of dementia and whether they have a carer recorded or not. See Dementia Manager Reports (page 10). Dementia Manager Admin Urgent - The Dementia Admin Urgent reports can be delegated to non-clinical staff who can recall patients who may need a follow up. See Dementia Manager Admin Urgent (page 11). Dementia Manager Practice Monitoring - Reports listed in this section are to assist in the submission and monitoring of your DES payments. See Dementia Manager Practice Monitoring Reports (page 12). After identifying the patients you can quickly check a patient's record or invite the patient to attend for a review from Practice Reports - See Interacting with Patient Lists (page 13). Dementia Manager Reports The Dementia Manager category listed at the top of the reports is designed to assist in identifying patients at risk of dementia and is the starting point for the Dementia DES. Note - Some report lines only display if you have patients who meet the relevant criteria. Key Points Dementia Manager Reports Dementia Manager Reports - The Dementia Reports look at your practice population for patients with the following risk factors then group those risk factors into low, medium or high risk of dementia. Patients aged over 60 with one of the following conditions CVD, PAD, CVA, Diabetes, COPD or Chronic Neurological conditions. Patients aged over 60 with a QRisk score more than 20% Patients aged over 40 with Trisomy 21 (Down's Syndrome) Patients aged over 50 with Learning Difficulties Lower (1-3) Dementia Risk Factor Count - The lower risk category looks at patients who are classified as low risk with one to three risk factors. 10

Medium (4-6) Dementia Risk Factor Count - The medium risk group looks at patients who have four to six risk factors. High (7-9) Dementia Risk Factor Count - Those patients in the high risk group have seven to nine risk factors. Note - The reports are split into patients with and without a carer to assist in supporting patients at risk of dementia as well as those caring for them. Also, having a carer is a risk factor for having dementia, which may help you target a more specific group from which to identify cases. To open a patient's record or review the patient's risk factors - See Working with Patient Lists (page 13). Dementia Manager Admin Urgent The reports listed under the Admin Urgent category help identify patients who require a follow-up. Dementia Manager - Admin Urgent 11

Dementia Manager Practice Monitoring Reports The Dementia Manager Practice Monitoring reports are designed to assist in managing the DES and provide an overall picture of your DES achievement. The reports are based on the published business rules for the DES. Any of the report lines can be easily exported to a CSV file and patient identifiable data removed for payment purposes, depending on what is asked for by your local HB/CCG. For information on how to export data - See Print, Print Preview or Export Patient Lists (page 14). Key Points Dementia Manager Practice Monitoring Note - For a full list of Read codes and technical requirements refer to GMS Technical Requirements 2014-15 http://www.inps.co.uk/sites/inps4.co.uk/files/gms_technical_require ments_2014_15.pdf. DEMCC001 Report - This is a Dementia payment report line which displays your practice population as per the start of a new DES quarter. DEMCC002 Report - This is a Dementia payment report line detailing the number of patients who are carers of somebody with dementia. DEMC201 Report - This is a Dementia payment report which shows you the number of patients with a record of receiving an assessment for dementia, up to the end of the reporting period. Dementia Management Information Reports - These reports are prefixed with DEMMl and review all aspects of the Enhanced Service. Where report lines are missing it indicates that you do not have any patients who meet those specific criteria. See the attached PDF for the specific DES requirements. Reminder - Remember you can work on the reports using Interacting with Patient Lists (page 13) and Using the Merge Category/Indicator Option (page 14). 12

Using the Last Run Option If you are on the Practice Reports home page and want to quickly look at the last report you ran, select the Last Run option on the Toolbar. Interacting with Patient Lists From Practice Reports you can work on patient lists. From here you can print patient lists, view patient's records or contact the patient. To view patient information double click on the report line or click the expand icon. Report Lists Working with Patient Lists You can work on patent lists by highlighting the patient's details and choosing one of the following options on the Toolbar or right click on the patient details. Any information you record automatically updates the patient's record in Consultation Manager and removes the patient from your list. Working with Patient Lists Open Patient - Selecting open patient takes you directly into the patient's Consultation Manager screen. 13

Codeset - This option allows you to add an appropriate Read code directly into the patient's record. Show Template - The show template option launches the Dementia Manager screen. See Accessing the Dementia Manager Template (page 19). Show Indicators - This option launches the Dementia Manager Alert Popup window without having to open Consultation Manager. Indicator Logic - Indicator Logic allows you to see why the patient is on this cohort line. Print, Print Preview or Export Patient Lists Patient lists can be previewed, printed or exported as a CSV file. Expand the patient list and select Print Preview or Print. Print or Export options Alternatively, the information shown in the report can be saved as an Excel spread sheet. To do this click on CSV File on the Toolbar, then give the file a name and specify the location you want to save it to. Using the Merge Category/Indicator Option The Merge Category/ Indicator option is helpful if you want to send a letter to a group of patients, invite patients by telephone or bulk add a Read code. If you highlight a category you can choose Merge Category or if you highlight a specific report line you can choose Merge Indicator. Merge Category 14

Merge Indicator From this screen you can: Generate Merged Letters -See Generating Merged Letters (page 15). Invite by Phone - See Inviting Patients by Phone (page 18). Generating Merged Letters You may decide to send patients a letter message. To do this in Practice Reports you first need to design the letter then perform the mail merge. Designing a Dementia Invite Letter 1. From Vision+ Reports, select Practice Reports and choose Merge. 2. Select Letter. Practice Reports - Merge New Template Letter 3. Type a template name and tick the merge field boxes you want to merge into your letter. Click OK. 15

4. Word opens and a basic template is created with merge fields that are represented with a <<>>. The merge fields can be moved to where you want the data displayed. As the document is a Word document you can use the normal word processing conventions such as headers, footers, copy and paste etc. Once your template is created close Word. 5. Close the Letter Templates screen. 6. Next, choose Attach. Choosing the Attach option 7. In the User Protocol screen highlight Dementia Manager and select Attach. User Protocols - Attach 8. From the Letter Template screen, click Letter. Select Letter 16

9. Highlight your Dementia letter - select it by double clicking or choosing Open. Choose the Letter 10. The Dementia letter is listed in the Letter Template screen. Click OK to close the screen. Letter Template - Dementia Letter listed Generating a Merged Letter for a Group of Patients 1. From the Merge Category/Indicator list of patients, tick the box against those patients you want to recall or choose Select All. 2. Choose the required template letter from the drop down list. Practice Reports - Mail Merge 3. Click Preview Letter if you want to view the letter before printing a batch. 17

4. Click the Mail icon on the Toolbar. Mail Option 5. The Dementia letter opens in a single Word document, ready to be printed, each letter is held in a single page within one document. 6. After printing the document you are prompted to confirm all the letters have printed successfully. If you are happy with the format of the letter, click Yes. Letter Confirmation 7. If you click Yes, to confirm the letters have printed correctly, the invite status automatically updates and the Read code 9NC3 - Letter sent to patient is entered in the patient's record. Inviting Patients by Phone To record a verbal invite by phone choose the Phone icon from the Toolbar and confirm that you have made a verbal invite to the patient. The Read code 9b0n.00 - Telephone call to a patient is recorded in the patient's journal along with the text Dementia Manager in the comments. Phone Invite - Dementia Manager 18

Note - The Invite status is also updated in Practice Reports to indicate that the patient has been invited. Accessing the Dementia Manager Template The Dementia Manager template is a simple to use pathway that meets the requirements of the Enhanced Service. It enables you to quickly record carer and management information within one screen. There are three ways to access the Dementia Manager Template: Practice Reports Access the Dementia Template from Vision+ Reports. See Selecting the Dementia Manager Template from Practice Reports (page 19). Clinical Templates Access the Dementia Template from Clinical Templates in Consultation Manager. See Selecting the Dementia Manager Template in Consultation Manager (page 21). Alert Popup window Use the Alert Popup window to invoke the Dementia Template. See Accessing the Dementia Manager Template from the Alert Popup (page 22). Selecting the Dementia Manager Template from Practice Reports To access the Dementia Manager Template from Vision+ Reports 1. Log into Vision, right click on the Vision+ icon in the Windows Notification area and select Practice Reports. 2. Select the Other icon and choose Dementia Manager. Practice Reports - Dementia Manager 19

3. A suite of reports are listed. Highlight the line you are interested in and click the expand icon to view patient names or double click on the line to view the patients. 4. Highlight the patient and choose Show Template. Practice Reports - Show Template 5. The CKD Manager screen is displayed. Dementia Manager Screen For information on recording data on the Dementia Manager screen See Managing your Patients using the Dementia Manager Template (page 23). 20

Selecting the Dementia Manager Template in Consultation Manager To select the Dementia Manager Template in Consultation Manager: 1. From the Windows Notification Area, right click on the Vision+ icon. 2. Select Clinical Templates or click the Vision+ icon off the floating toolbar and select Clinical Templates. Floating Toolbar 3. Select Dementia Manager. Clinical Templates Dementia Manager Template For information on recording data to the Dementia Manager Template See Managing your Patients using the Dementia Manager Template (page 23). 21

Accessing the Dementia Manager Template from the Alert Popup 1. Alternatively, to view missing or due data pertaining to Dementia use the Alert Popup window. Click the Show Other Indicators icon on the Vision+ floating toolbar. Floating Toolbar - Other Indicators Note By default QOF alerts appear when you select a patient in Consultation Manager. To combine both QOF and non QOF alerts, refer to the Vision+ Settings Combine Triggers option. 2. The Alert popup window displays the CKD sub category headings and is expanded to show relevant data. Alert Popup - Other Indicators 3. To launch the Dementia Template either: Right click on the Dementia Manager category and select Show Template Highlight the Dementia Manager category and the click the Template icon on the toolbar, or Double click on one of the expanded lines below the Dementia category heading 22

Managing your Patients using the Dementia Manager Template The Dementia Manager template is a simple to use screen that assists in recording Dementia diagnosis and enhanced reviews. Using the data entry tools you can view historical data or add new data. Key Points Dementia Manager Template Adding Data - To add data to the Dementia Manager screen you can either use the Data Entry Tools at the end of each line or the quick Read code add option. For a full explanation of all the options - See Summary - Viewing or Adding data to a Template (page 26). Viewing Data - The latest recorded entry is displayed on the Dementia Manager screen. To view historical data click the red Previous Entries icon. A blue Previous entry icon indicates that the patient does not have any previous records. Save and Close - All entries made to the screen should be saved by choosing the Save and Close data will be lost. icon. If you do not save and close your Dementia Status - The Dementia tab is used to record the patient's assessment and diagnosis. See Dementia Status Tab (page 24). Carer Status - The Carer tab is where you can record carer information required for the enhanced service. See Carer Status Tab (page 25). 23

Dementia Status Tab The Dementia Status tab facilitates the recording of the management information required for the Dementia Enhanced Service. The Template is interactive and only allows you to add information if the patient is in an at risk category eg low, medium or high. See Dementia Manager Reports (page 10). Note - The only three options available when your first access the Dementia Template is 'Risk Factors for Dementia', 'At Risk of Dementia 'and 'Dementia Diagnosis'. By selecting 'At Risk of Dementia 'or 'Dementia Diagnosis' for a patient the relevant choices become accessible on the Template making it easier to complete the DES requirements. Key Points Dementia Status Tab - Dementia Manager Risk Factor for Dementia - The patient's risk factors for Dementia is displayed at the top of the screen. Dementia Risk - You must select 'At Risk of Dementia' in order to complete the Assessment part of the template. Select the Read code and choose the risk category of low, medium or high from the drop down comments box to further categorise the patient. Assessment - Use this section of the template to record the patient s symptoms, rather than an actual memory assessment (the DES business rules state that they should be recorded separately). Alternatively, you 24

can record if the patient has declined the assessment. There is also a link to the NHS England Dementia Toolkit if further reference is required. Initial Memory Assessment - Use this box to Read code the Initial Memory Assessment (eg GPCOG) and document findings from the initial memory assessment in the comments box. Recording this information automatically makes the Referral to Memory Clinic option accessible. GPCOG Assessment - You can access the GPCOG screening tool website by selecting the GPCOG Assessment link in the Template. As it is a link to an external website the information is not written back to the patient record. Diagnosis - Use this section of the screen to record the patient's Dementia Diagnosis either after diagnosing in primary care, or following assessment by the memory clinic. Once this information is recorded the At Risk section of the screen becomes unavailable and the Dementia Advanced Care Plan section under Referrals and Secondary care becomes available. Referral and Secondary care - This area of the template is for recording referral or offer of a referral for a diagnosis of Dementia. The Referral to Memory Clinic is only available after an Initial Memory Assessment has been recorded. The Dementia Advanced Care Plan details can only be recorded once a Diagnosis has been made. Carer Status Tab This tab is specifically designed to record details of patients identified as being a carer of someone diagnosed with dementia. From here you can record their annual health check or record the fact they have declined the health check. Carer Status Tab - Dementia Manager History Tab The history tab shows the patient's history and includes such information as Medication, Read code entries and Recalls/Diary dates. This is particularly helpful if you want to quickly look at a summary of the patient's record without having to leave the template. 25

Summary - Viewing or Adding data to a Template Toolbar The Toolbar at the top of the Dementia Manager template is used to access different functions within the screen, some of which vary depending on the line you have highlighted. Print Preview or Print - To view or print the information on the Pathway. Save & Close - This saves the data to the patient's record. Codeset - The Codeset icon takes you to the Codeset data entry screen where Read codes can be chosen from a pre-defined list. Show Indicators - This activates the Alert Indicator popup window. Indicator Logic - You can use the Indicator Logic tool to view the rule set logic behind the pathway. Default Date - The date defaults to today, but can be changed by entering a new date or by choosing from the calendar. Previous and Next Tab - The previous and next tab toggle you through the tabs eg Anticoagulation, Warfarin. 26

Data Entry Tools From the Dementia Manager Template highlight a line and choose one of the following Data Entry icons at the end of the line. Icon Function Icon Function Previous Entry - This blue icon indicates that the patient does not have any previous records. Previous Entries - When the row contains more than one relevant Read code, a drop down arrow appears in red to alert you that more Read codes are available than the one currently being displayed. Where numeric data is recorded a graph is also visible. Undo - The Undo Last Entry icon deletes the Read code previously entered on that line during the current session. Codeset - The codeset icon takes you to the Read code data entry screen, where Read codes can be chosen from pre-defined list. IMPORTANT - You must select Save and Close if you have entered any information. 27

M Index Managing your Patients using the Dementia Manager Template 5, 21, 22, 24 O Overview 5, 6 A Accessing the Dementia Manager Template 5, 14, 19 Accessing the Dementia Manager Template from the Alert Popup 5, 19, 22 B Background 5 C Carer Status Tab 25, 26 Copyright Notice ii D Data Entry Tools 27 Dementia Manager Admin Urgent 10, 11 Dementia Manager Practice Monitoring Reports 10, 12 Dementia Manager Reports 10, 25 Dementia Outcomes Manager 5 Dementia Status Tab 25 Designing a Dementia Invite Letter 15 Downloading the Dementia Manager Tools 6, 7 G Generating a Merged Letter for a Group of Patients 17 Generating Merged Letters 15 H P Prerequisites 5, 6 Print, Print Preview or Export Patient Lists 12, 14 R Reviewing the Dementia Manager Reports 5, 9 Running the Dementia Manager Reports 5, 8 S Selecting the Dementia Manager Template from Practice Reports 19 Selecting the Dementia Manager Template in Consultation Manager 19, 21 Summary - Viewing or Adding data to a Template 24, 27 T Toolbar 27 U Using the Last Run Option 13 Using the Merge Category/Indicator Option 13, 14 W What this Guide Covers 5 Working with Patient Lists 11, 13 History Tab 26 I Interacting with Patient Lists 9, 10, 13 Inviting Patients by Phone 15, 19 29