Patient’s Guide to The Waiting Room™ Version 1.0f Date: 25-May-16 NOTICE: The contents of this document, including the application designs depicted in screenshots, presentation structures described and text herein are copyright Microtest Ltd. 2016. They may not be reproduced in whole or in part without written agreement of a director of Microtest Ltd. Any unauthorised reproduction or copying of the stated elements will be prosecuted to the full extent allowed by law.

Table of Contents TABLE OF CONTENTS .................................................................................................................................................................. 2 THE WAITING ROOM™ ............................................................................................................................................................... 3 ABOUT USERNAMES AND PASSWORDS… ................................................................................................................................... 3 REGISTERING FOR THE WAITING ROOM AT YOUR GP PRACTICE................................................................................................. 3 ACCOUNT DETAILS ............................................................................................................................................................................... 4 CREATING AN ACCOUNT AT TWR............................................................................................................................................................ 5 LOST OR FORGOTTEN USERNAME/PASSWORD .......................................................................................................................... 7 THE WAITING ROOM - HOME PAGE............................................................................................................................................ 9 APPOINTMENTS ......................................................................................................................................................................... 9 THE BOOK APPOINTMENT SCREEN ........................................................................................................................................................ 10 SUCCESSFUL BOOKING ........................................................................................................................................................................ 11 APPOINTMENT DIARY ......................................................................................................................................................................... 11 CANCELLATION.................................................................................................................................................................................. 12 CANCEL APPOINTMENT SCREEN............................................................................................................................................................ 12 PRESCRIPTIONS ........................................................................................................................................................................ 12 THE MY PRESCRIPTIONS PAGE ............................................................................................................................................................. 12 MY PRESCRIPTIONS............................................................................................................................................................................ 13 ORDERING A PRESCRIPTION ................................................................................................................................................................. 14 ACKNOWLEDGEMENT - SHOWING THE ORDER.......................................................................................................................................... 15 PRESCRIPTION RAISED ........................................................................................................................................................................ 16 EARLY RE-ORDER WARNING ................................................................................................................................................................. 16 RECORD ACCESS OVERVIEW ..................................................................................................................................................... 17 SCR CONSENT .................................................................................................................................................................................. 17 RECORD ACCESS RECORD SCREEN CONTENTS .......................................................................................................................................... 17 HEADING ......................................................................................................................................................................................... 17 ALLERGIES AND ADVERSE REACTIONS .................................................................................................................................................... 17 RECORD ACCESS RECORD - HEADING, ALLERGIES AND ADVERSE DRUG REACTIONS ......................................................................................... 17 ACUTE MEDICATION .......................................................................................................................................................................... 18 Current Repeat Medication and Discontinued Repeat Medication .......................................................................................... 18 DETAILED CODED RECORD ........................................................................................................................................................ 19 PROXY ACCESS.......................................................................................................................................................................... 20 APPENDIX A - SUMMARY CARE RECORD - CORE DATA ITEMS................................................................................................... 21 ALLERGIES AND ADVERSE REACTIONS .................................................................................................................................................... 21 CURRENT REPEAT MEDICATIONS .......................................................................................................................................................... 21 ACUTE MEDICATION .......................................................................................................................................................................... 21 DISCONTINUED REPEAT MEDICATIONS .................................................................................................................................................. 21

The Waiting Room™ Although Microtest has offered a patient information access product called The Waiting Room1 for some years, the version described in this document offers a significant uplift of functionality. This version has been revised to accord with the NHS’s drive to enable patients to access practice services and information online. Consequently, users of previous versions of The Waiting Room will see significant changes to the functionality offered and the access methods they may have been accustomed to using.

About Usernames and Passwords… Your account in The Waiting Room (TWR) allows you online access to some of your most personal data. In recognition of this, access to the service is controlled at two levels. 1. A set of credentials which is generated when you first register at your practice to become an Online Service User. This information needs entering into the system just once; the first time you use the service. 2. A username and password that YOU choose and which become associated with your Online Service User information. You enter these each time you use the service, so ensure you have a way to remember these! Don’t worry if these distinctions are not immediately clear to you, you don’t need to understand all the details to use the system, as this guide will take you through the process, step by step.

Registering for The Waiting Room at Your GP Practice In order to access the online facilities offered by your practice, you will need to create an account. This happens in two distinct stages. Registering to be an Online Service User and then creating your account. To begin the Online Service User registration, you will need to give your email address to your practice. To ensure maximum personal privacy, joint email accounts e.g. “[email protected]” cannot be used. Next, the practice will send an automated email (example below) to the email address you registered, in order to verify that it exists and is correct2. You need to reply to this confirmatory email within 48 hours of it being sent.

1

As applied to software dedicated to allowing remote patient access to GP practice information, “The Waiting Room” and its abbreviated form “TWR” are both Microtest Ltd. reserved trademarks. 2 Since the email contains a website link, overzealous spam or junk mail filters may intercept it and put it into your junk or “clutter” email folder. So, if the expected email does not come, it may be worth checking those locations.

When you click on the link within the email, it will open the verification page (example below) in your preferred web browser.

Verified √

The verification page will ask you to enter an item of security information, such as your post code or date of birth. This is a cross-check measure, intended to confirm that the email has really reached the intended person.

Account Details Sometime after the verification screen has been completed, you will receive another email. This second email will contain the details that you need to complete your registration as an Online Service User (example below).

Depending upon how your practice operates TWR, these may have been printed at the practice and given to you straight away when you registered.

Creating an account at TWR Now that you have the details you need, you can proceed to the next step – accessing The Waiting Room and setting the username and password that you will use from day to day, plus completing your one-time registration to become an Online Services User. In your web browser, go to www.thewaiting-room.net. This will take you to The Waiting Room welcome screen, as shown below.

On your first visit to The Waiting Room you need to use the “Register Now” button. This takes you to the “Register User” page.

On this page you enter the user name and password you want to use during every access to The Waiting Room. You can use any username or password you want within the security limitations which are described on the screen. These limitations ensure that over-simple passwords (such as a password of “Password”) are not used! To ensure that there is no confusion from typing mistakes or upper and lower case differences you are asked to type the password twice. Next, as with many websites, you need to choose one of the prepared security questions, and provide an answer to it. This is used as additional security for your Waiting Room account. When everything is as you want it, click “Register”. The registration page will check what you have entered and show messages if there is any problem. All being well, you now proceed to the “Link Practice User” screen – shown in the next screen shot. As a one-time activity, you need to link the user account you have just registered with the Online Service User details that you received earlier by email (or as a printout when you visited your practice). Since these details are (deliberately) quite long and not all that memorable, you may find it easier (if you have them in an email) to cut them from the email and paste them into the appropriate fields on the Link Practice User screen. Retyping them is fine too, but errors are more likely to occur. .

As shown in the screenshot, you will need to enter the system generated Account ID, the Linkage Key and the ODS code into this form. Finally, type in your postcode and press the Link button. If all the information is entered correctly, you will be logged in an see the Waiting Room homepage (see next section). For future visits to The Waiting Room you will only require your username and password.

Lost or forgotten Username/Password If you should ever lose or forget your login details, The Waiting Room uses a standard “Lost Username / Password” procedure. This requires you to answer the security question you selected during registration and – if you answer correctly - will re-send login details to your registered email address.

If your account is disabled for any reason, or if you lose your Account Id, Linkage Key or ODS Code before establishing the link you will need to get your practice to re-issue these details.

The Waiting Room - Home page Now that you are registered you will see your personalised Waiting Room Home page which will look something like the screen shot below.

This page displays a summary of your booked appointments and the medication items that have been requested. At the side of each medication item a panel will show the status; this will be one of the following;  Requested - Waiting for the practice to process the request  Confirmed - The prescription has been printed or sent electronically to the pharmacy  Rejected - The GP has decided against writing a prescription for this item

Appointments Within the Waiting Room you can book an appointment at your surgery; on the top menu bar, click on “Appointments”. This takes you to the Booking Screen.

The Book Appointment Screen

The “Book Appointment” screen (above) has a calendar from which you can select a date and drop-down selectors for specific types of appointment (telephone, in-surgery or any) or individual clinicians. As you make your selections, available appointments matching your chosen criteria are shown in the yellow area of the screen. Each available appointment timeslot has a “Book Appt” button. You make your selection by clicking on one of these. The screen now changes to the one shown below, this allows you to enter some brief details of the reason for the appointment. Finally, confirm your booking by clicking on “Book Appointment”. Note that you can also click on “Back” if you want to cancel your selection and choose another appointment slot.

NOTE: If you book a telephone appointment you will be prompted to enter the telephone number you would like the practice to contact you on.

Successful Booking When your appointment booking has been successfully completed, you will see this screen.

However, you should be aware that Waiting Room is a “real time” service, simultaneously accessed by multiple registered users. Therefore, it is possible that two users may try to book the same appointment slot at the same time. In such a case, the user who clicks on “book appointment” first will get the slot and the other user will see a message indicating that the booking was unsuccessful.

Appointment Diary The Waiting Room allows you to see a list of all your booked appointments. You choose the Appointment Diary option from the appointments menu and you should see a screen similar to the one below.

Cancellation For a variety of reasons it is possible that you may at some time want to cancel an appointment. To cancel via The Waiting Room, navigate to the appointment diary and click on the “Cancel” button for the appointment concerned. The Cancel Appointment screen now appears

Cancel Appointment Screen

You may wish to share your reason for cancellation before clicking “Cancel Appointment” – as seen in the screenshot above. The Appointments Diary is now displayed again, with the appointment removed.

Prescriptions Within The Waiting Room you can see details of your prescription drugs and their statuses. From The Waiting Room homepage click on “Prescriptions” – this takes you to the “My Prescriptions” page.

The My Prescriptions Page The My Prescriptions page shows list of all the medication items that have been requested - at the side of each medication item a panel will show the status as:  Requested - Waiting for the practice to process the request

 

Confirmed - The prescription has been printed or sent electronically to the pharmacy Rejected - A GP has decided against writing a prescription for this item.

My Prescriptions This display shows each item with details that include:  The full name of the drug  The prescribed quantity and unit  The dose instructions  The last date the item was prescribed  The interval to the next review  The number of repeats remaining

The review mentioned above will mean the Clinical Team at your practice reviewing the medication. This will happen automatically and in good time – so there is no need for you to contact the practice if the review is imminent or the remaining number of repeats is low. If the review results in a need for you to attend a review appointment, the practice will get in touch with you.

Ordering a prescription The ‘Repeat Drugs’ are shown at the top of the list. These are drugs that are taken regularly. When ordering these items, it is normally an administrative task at the practice to create the prescription. If you scroll down the “My prescriptions” screen you may see a section headed “Acute Drugs”. These are drugs that are normally only issued on a one off basis. If these items are ticked, the Clinical Team at the practice will need to review the items before a prescription is created. For these items, it will help the Clinical Team if a reason for the request is given. On this screen each item has a tick-box, you can tick individual items to include them in a re-order or click the “Select All” box.

When your selection is complete, scroll to the bottom of the screen and press “Next” >> to move on to the “request prescription” page – show below.

The selected items are displayed and there is an opportunity to add a comment about the order if there are unusual circumstances you want the practice to know about. Click “Confirm” to continue or click Cancel.

Acknowledgement - showing the order

Prescription Raised The screen now changes and for each requested drug, the status will show. When the practice has subsequently confirmed your order, the status of the drug (when you view it on the “My Prescriptions” page) will change to “Confirmed”. Since confirmations are done manually at the practice, the workload and routines there will depend on how long this confirmation takes – but you should not expect it to be anything like instantaneous.

Early Re-order warning If two requests for the same item follow too closely - there will be a warning to the Online Service User that the order is too early. The warning does not stop the order but may remind a patient that the item does not yet need re-ordering.

Record Access Overview Within The Waiting Room the “Record Access” option – available on the home page - allows you to view the information stored in what is known as your “Core Summary Care Record” (or Core SCR). For an accident and emergency department (perhaps treating a shocked or unconscious patient in the middle of the night, or on a bank holiday) there is a lot of clinical value to knowing as much as possible about a patient. SCR was devised to allow clinicians working in such settings to be able to get a very limited, but reasonably current, view of a patient’s medications and allergies.

SCR Consent Some patients (via an active opt-out) elected not to share their information via SCR. That opt-out prevents anyone except the patient’s practice and the patient themselves being able to see their core SCR. If you have opted out of SCR, It’s important to understand that because you can see your core SCR in The Waiting Room that does not mean that anyone else except for your practice has access to it; it is not available to the wider group of NHS clinicians.

Record Access Record Screen Contents The following subsections describe the types of information shown under “Access Record”.

Heading The Core SCR screen includes a disclaimer that makes clear that what is being shown is a subset of the patient record, not the whole thing.

Allergies and Adverse Reactions This is a list, held by the practice, of all the drugs to which you have ever had a recorded allergic or adverse reaction. An allergy is technically a specific type of reaction whereas an adverse drug reaction covers more general clinical manifestations. The list may also include allergies to things other than drugs. Common things of this type are bee stings, latex, peanuts, wheat etc.

Record Access Record - Heading, Allergies and Adverse drug reactions

From within The Waiting Room, access to your core SCR is read-only. If you regard any part of it as outdated, if you disagree with an entry, or wish to discuss some aspect, you would need to make an appointment to see your GP to work this out.

Acute Medication Next on the page comes a list of acute medications including dosage instructions and prescription dates. Following that, you will find a list of your repeat prescriptions.

Current Repeat Medication and Discontinued Repeat Medication

A little more detail about the contents of the core SCR can be found in appendix A of this document.

Detailed Coded Record If your practice has given you access to your Detailed Coded Record, you will be able to select it from the “Record Access” menu (see screen shot); Click Detailed Coded Records and click on a section on the left to view your records.

Your Detailed Coded Record (DCR) is the detailed medical information your practice has about you. When you have a consultation with a clinician they may code some of the information they write. The codes use standard medical terminology, so for example, the GP may make a note of a heart attack but the code may read ‘Acute anteroseptal infarction ‘. You see the coded record but not the text that the GP has entered. Not all practices make DCR information to their patients. Some choose to set date limits upon the information which is made accessible, or to redact individual items. This may be for a variety of reasons. Some examples:    

The information is not in electronic form. Some practices computerised later than others and may still have substantial paper record holdings which it is impractical to scan into their IT systems by reason of sheer volume. In some cases (and especially in relation to communicable diseases) patient records may name a 3rd party, raising complex confidentiality issues. In some cases, the practice may have decided that making the full DCR available to the patient would create unnecessary stress or worry to the patient concerned. The technical language used. Doctors use a huge variety of short-forms and coding systems to refer to conditions. This is the reason for the name “Detailed Coded Record”. As with many documents that are mainly created to be read by people with comparable knowledge and training levels, they can often be impenetrable to an outsider who does not have that training. Worse, because the untrained reader may come away from reading such a technical assessment with only a partial understanding, it may increase worry and stress levels unnecessarily.

As the list above illustrates, having access to your DCR may be useful, but it may also be a double edged sword, creating unjustified alarm or confusion when read without the right context, knowledge or training. The hope is that by giving patients access to their DCR, they can better informed, or prepare better questions for GP’s about their condition or medications.

Proxy Access The very strict access controls that have been specified by the NHS do recognise that there are cases where one patient may access the clinical record of another patient. This happens by means of granting you what is known as “Proxy access” to another person’s records. This is used for various situations where one person is responsible (by reason or age, diminished mental ability or disabilities of various kinds) for another and thus needs to access that other person’s records. Where you have been granted proxy access to another patient’s records, you should be able to select them from a list presented when you first log in (see below) or by clicking on the icon (found on the blue bar at the top of each Waiting Room screen) and selecting from the list provided:-

Depending on the practice setting and the level of access granted to you by the patient, you may have all or some of the services available to you for the patient for whom you are acting as a proxy e.g. husband or wife, child, elderly parent etc.

Appendix A - Summary Care Record - Core Data Items The data items included in the initial GP summary are medications, allergies, and adverse reactions.

Allergies and Adverse Reactions These include the complete record of patient allergies and adverse reactions, including allergies to drugs, foods and substances, and drug interactions but excluding contra-indication codes used for administrative purposes.

Current Repeat Medications     

All repeat medications which have not been discontinued Medication authorised but not yet issued Medications prescribed elsewhere (e.g. hospitals or special clinics) OTC (Over The Counter) drugs taken by the patient Repeat dispenses and post-dated prescriptions which have not been discontinued

Acute Medication   

Acute medication prescribed within 12 months Medications prescribed elsewhere e.g. hospitals or special clinics OTC (Over The Counter) drugs taken by the patient

Discontinued Repeat Medications   

All repeat medications and repeat dispenses which have been discontinued within 6 months Medications prescribed elsewhere e.g. hospitals or special clinics OTC (Over The Counter) drugs taken by the patient