GP2GP Overview: How does the GP2GP Record Transfer Process Work?
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So what exactly is GP2GP? In simple terms, it’s a software application which enables the electronic component of a patient’s general practice health record to be transferred from one GP practice to another. Such transfers are: - secure and confidential - direct - and almost immediate, ensuring that GPs can usually have a patient’s medical history available to them for their first consultation This presentation deck covers the following key areas and is further supplemented by speaker notes. - How the system works - The benefits of using GP2GP - GP2GP process overview (with screen shots) - How to deal with incoming records - The stages of business change - Considerations and file sizes - Technical requirements - How you can prepare for GP2GP at your local practice - Implementation guidelines
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GP2GP Overview: How does the GP2GP Record Transfer Process Work?
- 1. GP2GP Electronic Health Record Transfer July 2014
- 2. What is GP2GP? GP2GP is a software application that can be used to transfer a patient’s electronic health record from their previous GP practice to their new one.
- 3. What they say about GP2GP “The main advantage of GP2GP will be improved care for patients as GPs can have full and detailed medical records available to them within 24 hrs of a patient registering. The records are transferred directly between the practices and remain secure and confidential at all times.” Dr John Hampson, Greenmount Practice, Bury “Everything transfers across in one quick step and is automatically filed into the relevant sections of a patient's record. At first I thought "it can't be as simple as that? But it really is. I think it's fantastic!” Hilary Ellis, Practice Manager, St James’ Medical Practice, Croydon "The best innovation for medical records since we started using computers for patient care." Dr Rakesh Chopra, Cowes Medical Centre, Isle of Wight
- 4. How does it work? Old GP Practice 3. Patient electronic health record requested from old practice New GP Practice 2. Patient demographics located on Personal Demographic Service 1. New patient wishes to register 4. Patient electronic health record sent to new practice
- 5. Benefits of using GP2GP • Improved quality and continuity of care – Consulting with immediate access to the electronic health record – Past medical history available and information about medication, allergies, immunisations and vaccinations • Improved safety – Accuracy of new patient EHR – Fewer errors, less scope for litigation • Clinical time savings – EHR available during initial consultations – Less request for duplicate lab tests • Administrative time savings – Summarisation – Less data entry – QOF information readily available
- 6. GP2GP process overview Log on using your NHS Smartcard and register the patient as you would normally. Identify the patient on the Personal Demographic Service using Advanced Trace. Use the Spine to make a request to the patient’s previous practice for their electronic health record. The previous practice’s system will handle the request automatically. The patient’s record is sent and is displayed in the ‘Records Received’ folder in Workflow Manager - if the patient’s record has been received, file the record as appropriate.
- 7. Dealing with incoming records Incoming records must be clinically reviewed. File the patient record. Remember, you can amend the record as much as you like once it is filed. Add a note to the record to remind staff that it is an Electronic Health Record and needs to be summarised. Clinicians need to access the record either prior to, or at, the first consultation, to activate medication and allergies. What is transferred? - All data recorded electronically against the patient - All Read coded data - Free text information - Attachments embedded in the EHR or linked by a compliant 3rd Party system - Allergies - Notepad entries/priorities
- 8. GP2GP Business Change • The GP2GP record transfer process can be considered in a series of stages, each of which needs to be supported organisationally by the GP practice. • Practices should ensure that all of these stages are managed effectively and that cover is in place for leave and/or staff changes.
- 9. Business Change – registering the patient • Reception Desk – Obtaining correct new patient information • Reception/back office – Entering patient details on to the clinical system using NHS Smartcard and where possible ensuring a Personal Demographics Service (PDS) match – Generating and managing GP2GP tasks/ requests
- 10. Business Change – Filing the EHR • Reception/ back office/ summariser: – Check and preview record – File the record into the clinical system – Add summarising note to inform staff this is a GP2GP transfer and needs to be summarised
- 11. Business Change – EHR checks and summarising • Notes summariser: – Checking EHR and managing ‘degraded’ entries – Checking & summarising EHRs against the Lloyd George record when it arrives • Clinician: – Checking allergies/adverse reactions – Dealing with medications
- 12. Considerations Only attachments embedded in a patient’s record or linked by a compliant 3rd party system can currently be transferred. There may be a degradation (to text) of some data related to read code matching etc. This will be clearly highlighted in the received electronic health record and the overall process will still be quicker. Transfer of paper records will continue for the foreseeable future. Temporary registered patients will be dealt with as normal.
- 13. File Size • There is currently a 5mb limit on total message size, and a 99 attachments limit. • A future version of GP2GP will remove the restriction of size and attachments.
- 14. What you need for GP2GP • GP2GP compliant clinical IT systems and software versions need to be in use. Currently: • EMIS LV 5.2 • EMIS Web • INPS Vision 3 • TPP SystmOne • HSCIC infrastructure, including: N3 network connections, NHS Smartcards. • Smartcards must be allocated to all registered GPs and support staff who manage patient records (GPs do not need to use Smartcards to access patient records).
- 15. Local preparations - practices • Read the GP2GP Web site information on the Implementation page • Read and implement ‘Good Practice Guidelines’ - available from www.hscic.gov.uk/gp2gp. • Ensure relevant staff attend the necessary training sessions, including at least one GP. • Identify a practice GP2GP lead and allocate staff responsibilities for the GP2GP process. • Obtain Smartcards for GP2GP users if necessary. • Quality of medical records - work with local GP2GP leads to improve/standardise data recording standards. • Practice staff should access the PRIMIS+ online learning resource which is based on the Good Practice Guidelines produced by the Joint General Practice Information Technology Committee (JGPITC).
- 16. Implementation • CCGs will verify which practices are currently eligible for GP2GP. • CCG leads and practices will have access to implementation guidance on the GP2GP Web pages. • Clinical system suppliers will contact practices to book training. Training will be delivered on-site at practices or on-Line.
- 17. Further information GP2GP web pages at: www.hscic.gov.uk/gp2gp
Editor's Notes
- So what exactly is GP2GP? In simple terms, it’s a software application which enables the electronic component of a patient’s general practice health record to be transferred from one GP practice to another. Such transfers are secure and confidential direct and almost immediate, ensuring that GPs can usually have a patient’s medical history available to them for their first consultation
- GPs, their professional bodies and practice staff have been looking forward to the introduction of GP2GP for many years. And, as you can see, those sites currently using GP2GP have responded very positively to its introduction. It is worth noting that the project has been working closely with both the Royal College of GPs and the General Practitioner Committee of the BMA. In addition, clinicians have been involved in the project at every stage, ensuring that GP2GP is safe and fit-for-purpose.
- Here’s a simple schematic showing how the GP2GP record transfer works. Let’s go through the process step-by-step: A new patient comes into a practice wishing to register. The practice accepts a patient onto its list for primary healthcare and the patient’s identity is matched using the Personal Demographic Service (PDS). A message is then sent to their previous practice requesting a copy of their Electronic Health Record (EHR). If the sending practice is GP2GP enabled an EHR extract will be generated from the patient health record on its clinical system and this will be automatically requested by the new practice. This is an automated process and will require no intervention from the previous practice. (If the previous practice is not GP2GP enabled, the new practice will receive a message indicating that a GP2GP record transfer can not take place). The receiving practice will receive a message informing it that the patient’s EHR is available for filing. The receiving practice has the ability to view the record and decide whether or not to proceed with the transfer. If it is accepted, the patient’s EHR will be imported into the new practice’s clinical system. The practice is then able to review and amend the record as necessary. If a practice does not file the record but adds it as an attachment to the patient record it will not be able to use the information held in the EHR for searches or reporting. It would have to re-key in this data to have it accessible for these purposes. 7. The normal deductions process and the transfer of the paper record will continue.
- GP2GP clearly brings a range of benefits for GPs and other clinicians, support staff and patients. Clinicians will have immediate access to their patients’ Electronic Health Records. They will have their medical histories available, with key information about what medications have been prescribed, what allergies patients suffer from, and details of immunisations and vaccinations. This will ensure genuine continuity of care. It will also mean improved safety. For instance, there will be fewer transcribing errors because the need to key in information from paper records will be massively reduced. There will be clinical time savings, because doctors will need to spend less time quizzing patients about their medical history or chasing the previous practice for information. Support staff benefit hugely from GP2GP. Having an electronic record available almost immediately means that less time needs to be spent summarising from paper records. Less printing is required and QOF information is readily available.
- Let’s look at the record transfer process in more detail: Log on using your NHS Smartcard and register the patient as you would normally. Identify the patient on the Personal Demographic Service using Advanced Trace. Demographic details such as surname, date of birth, postcode and sex should be used to enable the patient to be traced. If in any doubt, check! Use the Spine to make a request to the patient’s previous practice for their Electronic Health Record (EHR). The previous practice’s system will handle the request. If it is GP2GP enabled, the patient’s record will be sent automatically. The received EHR will be displayed in the ‘Records Received’ folder in Workflow Manager. It can then be filed as appropriate. Please note that no clinical data in a GP2GP message is copied to or retained on the Spine or elsewhere.
- Practice staff need to take a number of actions once a patient electronic health record (EHR) has been received. The record must be filed onto a practice’s clinical system. Once the record has been filed it can be amended. A note should be added to the record reminding staff that it is an EHR which needs to be summarised. Some summarisation will still be needed once the paper record has arrived, although the time needed for this will be much reduced. An authorised clinician needs to access the record prior to, or at, the patient’s first consultation in order to activate repeat medications and allergies. These are actions that involve the exercise of clinical judgement and it is important they are undertaken by appropriately qualified staff. So what is transferred as part of the EHR? The EHR will include: all data recorded electronically against the patient all Read coded data free text information attachments embedded in the EHR allergies Notepad entries / priorities Having the EHR available will be a massive improvement, ensuring GPs have information for the vast majority of first consultations, and reducing considerably the time needed for summarisation by support staff.
- It is not always possible to transfer attached documents; only those directly linked to patients’ records can currently be transferred. Some practices use third party document systems to handle attachments and not all of these applications make it possible to transfer documents together with the record that they are attached to. For further information about specific document management systems it is recommended that practices contact their clinical system supplier. It is possible that some text will be ‘degraded’ during the transfer. This occurs where the receiving practice’s clinical system does not ‘understand’ a coded record. It might be that: a Read code drawn from the latest version of the Read code directory arrives at a practice using the previous version of the dictionary a local coding scheme or local practice code has been used at the previous practice the EHR contains medication records which carry drug codes not recognised by the receiving system Whatever the reason, any degradation will be clearly highlighted in the received EHR, enabling the receiving practice to amend the record as required. The overall process is still far quicker than the paper-based one. It is important to highlight that, for the foreseeable future at least, GP2GP will run alongside the existing paper-based process rather than replacing it. This is because: EHRs are not used across all patients a full paper record is needed in case a patient subsequently transfers to a practice that is not GP2GP enabled there is a need to validate EHRs against paper records the NHAIAS deduction process will still run separately from GP2GP transfers Lastly, please note that Temporary Registered patients will be dealt with as they are now. Their records will not be electronic transferred using the current version of GP2GP.
- Technical limitations mean that it is not possible to transfer records that: exceed 5mb in volume have in excess of 100 attachments (e.g. scanned letters) These limitations will be fully resolved with a future Spine release. Permitted formats for attachments which will transfer are as follows: rtf, giff, MS Word document, tiff, jpeg, txt, pdf, xml, html, mpeg video, mpeg audio layer 3 and png. If you are sending attachments in a GP2GP transfer, you need to ensure that any attachment documents are as compact as possible. Word processing documents have the potential to be very large, especially if they incorporate images or pictures in the header or background. For instance, a letter headed image may be 100 times greater than the same letter without an image. As a general rule, you are strongly advised to consider removing any embedded images in word processor-generated letters that are attached to the core clinical records. If at all possible, such attached documents should be text-only. This will also free up space on your server.
- We have already said that GP2GP is only available to ‘eligible’ practices. So what eligibility criteria need to be met? Compliant GP2GP primary care systems and software versions need to be in use. Currently, EMIS LV 5.2, EMIS Web, INPS Vision 3 and TPP SystmOne are accredited to GP2GP. As already mentioned, other systems and versions will gain accreditation and join the roll-out at a later stage. Practices need to have N3 network connections and NHS Smartcards. Supplier hardware specifications for servers and desktops need to be met. NHS Smartcards need to have been issued to all GPs and practice staff who will be managing patient Electronic Health Records, though it is important to clarify that GPs do not need to use Smartcards to access such records.
- There are a number of things that practices need to do before GP2GP is implemented: Practice staff should familiarise themselves with the ‘Good Practice Guidelines’. These guidelines were prepared by the Joint GP IT Committee of the General Practitioners Committee and the Royal College of GPs. Written by national experts who are also users of clinical systems in their own right, the guidelines cover the procedures and management arrangements that should be in place with regards to patient Electronic Health Records (EHRs). A supplement was produced in response to the introduction of GP2GP. Both the guidelines and the GP2GP supplement are available from the GP2GP web pages at www.connectingforhealth.nhs.uk/gp2gp All staff involved in managing EHRs should attend the GP2GP training, which will be delivered at practices by staff from the relevant clinical system suppliers. These include summarisers, practice managers and those responsible for processing pathology results. At least one GP should attend the training too, particularly those elements related to the handling of drug allergies, re-authorising of repeat medications and local processes for GP2GP transfers. The PRIMIS+ face-to-face training package "Managing the Electronic Health Record" is available now Practices should ensure that a member of the practice is given the role of GP2GP lead. This should be a member of staff who is able to liaise with both the CCG and clinical system suppliers and who will ensure that all of the relevant staff understand their responsibilities with regards to the record transfer process. For instance, who will deal with incoming EHRs? Remember: make sure that all staff involved in GP2GP and the wider management of EHRs have got Smartcards. Order these if necessary.
- The GP2GP project team within HSCIC is now working with CCGs to verify which practices meet the eligibility criteria for GP2GP. It will then be agreed where the practices will be placed into the national deployment schedule. As discussed earlier, both practices and CCG GP2GP leads will receive a Briefing Pack. This will contain further information about the project, including a factsheet, FAQs and a deployment checklist highlighting the activities that need to be completed in advance of implementation. Clinical system suppliers will be contacting practices directly in order to arrange training. The training will be delivered on-site by the supplier, with the costs of this being met centrally rather than by practices or CCGs. The suppliers will install GP2GP remotely on usually on the same day or within one week of the training being delivered. Throughout the local implementation there will be a CCG lead in place – a named contact within the CCG responsible for supporting practices and for liaising with clinical system suppliers and the GP2GP project team at NHS Connecting for Health. If you are involved in implementing GP2GP at CCG or practice level, please do make sure to refer to your briefing pack for further information.
- This presentation has been a high-level introduction to GP2GP. Further information is contained in the GP2GP briefing pack sent to all CCG leads and practices prior to each local implementation. Practice staff should check the GP2GP web pages on a regular basis. These are the definitive source of information on the project, and contain all the latest news on GP2GP plus regularly-updated Frequently Asked Questions.