Using Templates & Protocols

The term Templates in the Vamp Vision system refers to predefined searches for data extraction. By templates this document refers to an electronic form for data input, as per the EMIS system

The templates and protocols do not cover all the possible areas that a practice might require for managing CHD. There is no reason why practices should not add new fields to these templates. However, care should be taken not to remove or modify the existing fields as this might interfere with the accuracy of computerised data collection. (see customising templates)

Templates

Use
Templates function as a two-way filter on the read coded data held in the clinical system. They do not store the data and so changing / deleting a template or using a different template does NOT affect the data held by the system. Templates can be exited at any point using F8. There is no need to go to the end of a template if you have entered all the data you want. You can use arrow and PageDown keys to bypass lines of the template you don't wish to enter data into. The PageUp key allows you to see entries prior to the last one. Templates can be user defined. The template defines which codes stored on the system are displayed and which codes are added to the system through use of the template. The template Ischaemic Heart Disease contains all the relevant fields for CHD secondary prevention.

Location
Templates are identified in the EMIS system by a read code and are accessed through the EMIS system hierarchy. Therefore in order to use a template that has been imported, the read code that the system uses to identify that template must be entered into the hierarchy. The system automatically recognizes that a template is associated with that code. When multiple templates are being imported it is important to structure the hierarchy so that the most frequently used templates are higher up and therefore more accessible.

Design
Templates can be built up from smaller templates. It is useful to define templates for discrete items of clinical care. eg smoking template to include smoking habit, smoking advice and referral for smoking cessation support. This has several advantages. Firstly, because these discrete items are common to different clinical situations eg smoking would be relevant to contraception, health promotion and CHD templates it ensures consistent coding across disease entities. Secondly, it makes the construction of these templates much simpler by mixing and matching these smaller templates, rather than re-keying them each time. Thirdly, these smaller templates can be called by protocols, allowing the user to go directly to the relevant template rather than scrolling through many pages of a template to locate the relevant area for data entry.
This is the reason why multiple templates need to be installed. The IHD template is built up from these smaller ones. Practices can then use these smaller templates to construct others unrelated to CHD should they need to.

Protocols

Described
Protocols in EMIS provide a new level of functionality. They provide a way of programming the EMIS system, opening up the possibility of decision support using patient specific data. The biggest problem facing clinicians in the context of highly evidence-based situation with multiple criteria for good care is assimilating the data on the individual patient in a way that reflects the clinical guidelines in the time available. Protocols are rapidly able to analyse the data on a particular patient in accordance with the guidelines, display the relevant data and make suggestions. They can then be used to facilitate data input by calling the required templates. They thus add value to templates.
Selecting it from the hierarchy activates the mini computer program that is a protocol. Protocols are identified on the system by a code generated by the system in which the protocol was authored. This code needs to be added to the hierarchy once the protocol has been imported so that it can be accessed.

Use
There are two protocols for CHD with a number of associated templates.
The IHD Protocol is intended for use in consultation. Ideally it should be called using a macro in CM so that it is immediately accessible in a consultation. When run it performs a number of checks on data held by your system about the active patient's CHD. Firstly, it checks that the patient has been registered as having CHD correctly ie that the IHD Read code is in the record AND that either a code for MI or angina has been entered. As the presence of these codes is fundamental to the accurate audit the protocol will not proceed until these conditions are met. If met they are passed over automatically and the protocol then checks on the data required for the audit. It then displays a screen showing the results of these checks with suggestions for areas to cover during the consultation based on the findings. On pressing Enter the user is presented with various choices which take the user to the appropriate template for data entry. This is in recognition of the fact that often there isn't time to deal with all possible aspects of care at one consultation. This approach allows the user to quickly enter data in the areas the user is able to tackle then. It also avoids having to skim through several pages of template to find the correct data entry field. On leaving the template (using F8, not F1!) the original screen is displayed to remind the user of other areas they might like to tackle. The protocol can be exited through the multi-choice option display. At the message 'Protocol complete: any key' avoid F1 & ESC or you'll lose data! Don't forget to press F8 on leaving the consultation subsequently or you're data will not be saved.

The IHD Data Input Protocol is designed for initial data input, for new or incoming CHD patients and for capturing incoming data from clinic and discharge letters. The protocol is accessed in Medical Record by (A)dd any data, (Q)Protocols and selecting it. A macro can be used for this. It is important that ansystem is set up so that clerical staff see incoming letters and use the protocol to enter relevant data. The protocol also checks that the patient is correctly registered for CHD, but offers the option of MI or Angina entry anyway to deal with patients having new episodes of MI for example. It then displays a template to work through and then asks a number of further relevant questions depending on the prescribing record for that patient.
Should I Use A Template Or Protocol?
This is really a matter of personal preference. The codes used by both are the same, so it makes no difference from the point of view of data collection. Protocols give the advantage of more detailed analysis of the data, with suggestions for care but is less stable in the EMIS system than templates. There is less scrolling down to find the correct lines for data entry. Templates are more familiar to people. Try both. If a protocol crashes in a consultation you can still resort to the template.

The heart failure & diabetes protocols use a multiple-choice design to provide easy access to templates. This avoids scrolling through a long template.