the INR Relay Client Program
Shooting Routine Operation
Shots of INR CLIENT Program
following guide is intended for use by anticoagulant
clinics in the UK, who already use a computerised system
for calculating dose and clinic time information for
anticoagulant patients, and who wish in addition to
transmit results by phone using INR RELAY to their
clinics must be able to generate a batch report of INR
results which can be written as a standard text (.txt)
file. This file will then be sent as a file transfer to the INR
RELAY service via your modem.
The INR RELAY service does nearly all the rest:
that is it interfaces your data to INR RELAY format,
creates voicemail files, populates the dialler database,
allowing patients to DIAL IN and enables DIAL OUT; records patient preferences for printed output etc; keeps a
record of hospital and patient activity and transmits
letters, reports and invoices back to hospitals.
As an automated service, INR RELAY is not resourced
to deal with patient enquiries or complaints - which will
be directed back to the appropriate local clinic.
The following is an easy instruction guide on how
to set up your system.
Careful attention to detail at the time of setup
will give you a fuller understanding of the potential of
INR RELAY and could prevent problems at a later time.
RELAY is a unique set of highly integrated programs which
automate your communication requirements. The design is
such that the hospital users maintain complete control
over their own patients and data, and at the same time
benefit from communicating to a robust centralised call
centre. The INR RELAY CLIENT program on your PC is your key to
this program suite and it is recommended that you
familiarise yourself and your staff with its operation.
INR RELAY CLIENT is designed to be very easy to
use, offering users simple menu options, liberally endowed
with help buttons, and empowers the routine operator or
administrator with all the functions needed to operate and
configure the service - exactly as you want them.
main menu of INR RELAY CLIENT offers only 7 buttons to the
routine hospital user (but the administrator has access to
many more). The
first two options allow the routine user to SEND REPORTS
and FETCH LETTERS. The
principle is that these buttons are used to upload to or
download files from the call centre.
All the other buttons are provided so that the user
can quickly print, view patient files, and set preferences
either for individual patients or global preferences for
your hospital. INR
RELAY CLIENT automatically recognises the type of file it
is dealing with and transfers them the appropriate folders
on your PC. It
has many other features, such as allowing local printer
settings, and setting daily tips which allow you to
locally add information tips to your patient request
will be supplied with a PC, which will
contain all the necessary hardware, (modems etc) and
software (INR RELAY CLIENT) needed for you to
communicate with us and to print your fetched reports.
The first thing you need to provide is the input
data in an acceptable format.
The following section describes what you need to
in and sign the Application Form/Service level agreement
for provision of this service.
A copy can be emailed to you.
CREATING BATCHED INR REPORTS
batch reports (in text file .txt format) from your
existing system: It will considerably ease the issue
of interfacing your data to our system and reduce the
likelihood of issues with validation if you can create a
text file report in the preferred format (see Appendix 1
and 2 -click here
to view) or as close to this as possible.
DAWN 4S users should follow the instructions
refer to Appendix 1 for and explanation of the file
description of the file format follows: One batch file
contains one or more records; each record contains the
required information for one patient episode (as a
minimum patient name, address, telephone number, date of
birth, INR result, desired INR range, anticoagulant
name, dose, miss days, and interval to next test). Each
record can hold fifty two lines (many redundant)
separated by a line feed/carriage return, specific lines
containing the required fields of information - see
appendix 1. The
batch file created should be saved in a standard ASCII
.txt format (as in using notepad.exe).
DAWN 4S: It is a relatively simple process to create
text batch reports using DAWN 4S. Use the “USER LETTER” feature to create the batched
report. This the simplest and most reliable way to
achieve the desired result.
We suggest that you copy the contents of the
enclosed “voicemail.txt” file into your text file
which you have created and you should end up with a
virtually ready made file - ready to send using SEND
are several possible ways that your existing software
may express the dose of anticoagulant the patient is
intended to take. INR
RELAY can accommodate three different ways of importing
dose information and you need to select one of the
methods described below.
The output may
may be a code (METHOD A) for instance
will then refer to
a table from which the daily doses are obtained - see
appendix 7 for example - click here
to access appendix 7); or it may output the actual daily doses for each day of
the week (METHOD B) for instance 3½mg on Mondays, 4 mg
on Tuesdays etc; or
it may be in the form of an average daily dose (METHOD C; for
instance 4.28 mg/day).
Selecting the right method for you is important
at the setup stage and is partially dependent on the
system output capabilities of your existing computer.
Some information regarding the selection follows:
a dose code and dose code table (as in Appendix
METHOD A, you have to provide us with a completed local
equivalent to the table in appendix
The code will be transmitted in field 20 of the
patient record and we will use this value to look up the
daily doses from the dose code table for your hospital.
The advantage of this method is that the dose we
advise the patient to take will be exactly what appears in
the table. The
main disadvantage is that you need to complete the table
and update it centrally whenever you add or edit a code in
your local system.
METHOD B, you will be supplying us with the actual daily
dose in milligrams for each day of the week.
This data is transmitted in fields 36 to 42 of the
patient record. This
method also has the advantage that the dose transmitted is
exactly as specified - and has the added advantages that
you do not need to supply a dose code table and do not
need to worry about updating the dose code table.
This is therefore the preferred method - but it
depends on whether or not your existing software can
output the individual daily doses. (Dawn users can use any of these methods but this is the
preferred one for Dawn users).top
METHOD C, you will be supplying us with the average daily
dose for the patient to take.
This data is transmitted in field 19 of the patient
do not need to create or update a dose code table with
this method but you are allowing INR RELAY to recommend to
the patient what practical doses to take on each day of
the week. Whilst
this method is the simplest to set up; there may therefore
be a very slight discrepancy between the dose we recommend
and the dose that you have transmitted as there is always
some degree of compromise.
Examples of how we convert average daily dose (from
2.86 to 4.14) to
a practical dose for the patient to take are in the table
ADVICE OVER THE PHONE
three mg every day
four mg on Tues and Sat and three mg on all the
three and a half mg every day
three mg on Tues and Sat and four mg on all the
four mg every day
Table equivalents above apply to doses 0 mg to 20 mg; 20
mg to 200 mg in one mg increments only; 200 to 250 mg in 5
mg increments only.
you have settled your best fit batched report file and the
dose method you wish to use, you will need to send some
samples (and a copy of your dose code template if you have
chosen Method A above) to INR RELAY where we will create a
conversion tool which will extract the necessary
information and convert it our format so that we can
create the phone messages and letters etc. for fetching.
UP THE PRINT TEMPLATES
step is only necessary if you have opted to allow INR
RELAY to create some or all of your printed letters to
designing your letter format, you can either accept the
default templates as they appear in Appendix 5 (click here
to access appendix 5), or you can
modify them or you can create your own templates, merging
any of the available variables (Appendix
The INR RELAY CLIENT program contains the default
templates, allows you to modify or recreate them and
transmit them to the call centre for testing.
As administrator, press the EDIT TEMPLATES button,
then select the template of interest.
You are free to edit as you wish, for instance you
can place the cursor at a position of interest, then press
the INSERT VARIABLE button, select the variable of
interest from the drop down list, press INSERT and the
variable will in future appear on your template in the
(You will need to run the SEND REPORTS program to
transmit your changes to INR RELAY).
Full validation of the printed output by the local
clinic is mandatory.
The advantages of allowing INR RELAY to create your
letters for you are: you can
inspect the letters before they are sent;
you will be able to take advantage of patient
selections made during their phone calls (eg. if a patient
has requested a batch of request forms, then the request
forms will appear in your c:\inr\intray ready for viewing/printing); INR RELAY can use its own logic to convert your
patients to the phone system, sending them instructions
letters and switching to voicemail at the appropriate
convenient and popular option would be to allow INR RELAY
to print and post your letters from Basildon. They
should arrive at the patient's home att he same time
as if they were posted locally. For you, the local
clinic administrator, this is the most convenient option,
as by making this selection, INR RELAY will handle all
your patient communication (phone, letter, fax and email)
automatically. Obviously we have to charge you extra
for the cost of this service. All you have to do is
send us a batch of reports, (validate correct
importation etc) and we will do all the rest -
automatically - quite convenient on a Friday afternoon
before a bank holiday weekend. In addition, you do
not need to concern yourself with setting up a printer,
loading it with paper, ink, envelopes and worrying about
postal collection times - this is all done for you.
every effort is made to prevent error, as is specified in
the contract of service and contract disclaimer, PACE
Health Systems Ltd., the software suppliers, and
Basildon&Thurrock NHS Trust and any of its employees
or agents do not accept any liability for any
negligent or non-negligent harm which may arise
from the patient use of the INR RELAY service.
It is therefore mandatory for the local
anticoagulant clinics to perform adequate validation of
the accuracy of transmission of results - whether by
phone, post, fax or email.
The following is a recommended approach to the
validation stage, but more exhaustive validation may be
preferred by some clinics.
Please note that local clinic re-validation is
alterations are made to your database structure,
transmission file format, templates or printer settings.
Again, it is ultimately the responsibility of the
local clinic to re-validate the system as required.
Testing the SEND REPORTS and FETCH
transmissions of your batched INR results to INR RELAY:
this stage, you will be able to create your batched
reports in a text file format, and transmit these reports
using your SEND REPORTS
transmitting your routine data sending each batch of
results to INR RELAY.
This should simply involve inserting a floppy disk
containing a file say called A:\anyclini.txt and pressing
the SEND REPORTS button.
GLOBAL DIALOUT should be deselected, so there is no
danger of patients accessing a non-validated service.
An interfacing program will have been created to be
used on auto receipt of any of your batched reports.
After a few minutes, you will receive your AUTOCALL,
then you should run the FETCH LETTERS program and
then run the VIEW LETTERS and
buttons to see that your results are being imported and
processed correctly by INR RELAY.
If you prefer, you could open your letters in WORD,
inspect/edit and print - if you prefer this environment.
You should validate carefully the contents of these
letters, check that special characters (such as “½”)
are being printed; to make sure that they are as you
require them before posting to your patients.
the validity of voicemail messages to patients:
transmissions and once
again do not inform patients of the service, with DIAL OUT
suppressed. You can test phone safely into the system, as
though you were the patient.
This will allow you to test the interface tool and
your configuration settings without actually going live to
patients. You should test the phone system with at least 100 test DIAL
INs over a period of one to two weeks; You should choose
patient telephone numbers for which you know the expected
reply. You should test the system getting results with INR
below, above and within range; early dates of return and
late dates of return; transport required/not required/
home visits; patients within 28 days of end of treatment
termination; patients with very high INR’s; patients who
have not attended on one, two or three or more occasions. You
will receive file transfers of IMPORT REPORTS, 48 HOUR and
96 HOUR reports and you should check that these area as
there is any variation from expected in any of the above,
please inform the Pathology service at Basildon
correction of the interfacing tool.
The closer your text file format is to the model
file in appendix
2 will result in fewer problems at this
your patients of the system (or allow INR RELAY to do this
for you by enabling dialout and patient instruction
to expect that 20% of your patients will not be able to
use a telephone system alone and will continue to expect
to receive letters in the post.
You can alert us to set these patients for
permanent letters - the easiest way is to use the PATIENT
FILE REQUESTS program - or alternatively you can phone
into our system as an administrator, and change the
settings for these selected
patients (see below).
THE INR RELAY CLIENT PROGRAM
the INR RELAY CLIENT program on your PC to perform
automatically all the tasks you need for routine use and
configuration of your service. Once you click on INR
RELAY CLIENT icon, you will see the main menu screen.
The user is presented with a series of dialog
boxes from which options are selected simply by making
mouse clicks or entering values into selection boxes.
If you opt for the -SETUP - ADMINISTRATOR - SETUP
- option, you will be prompted
for a password and your should enter
”11111111111" - this will give you access
to many further options as set out in the table below.
The INR RELAY CLIENT program is liberally
featured with help buttons which you can use to inform
you of the functions available.
The following table give you a features list of
the main functions available:
sends to the call centre any batches of reports,
patient file requests or updated configuration
or template files. Modem link, program exits on
fetches from the call centre any letters ready
for printing, import or patient reports, updated
templates, invoices and automatically transfers
them to the appropriate sub- folders. Modem link
- program exits on completion.
NEWLY FETCHED REPORTS
the current batch of letters
the previous batch of letters
LETTERS AND REPORTS
the current letters; previous batch of letters;
48 hour reports; 96 hour reports; import files;
invoices, fetched patient reports.
on behalf of a patient any of the following:
report letter, request forms, instructions
After completion, you will need to run
SEND REPORTS to transmit your order.
this feature to select contact preferences to
transmit INR result in any combination for any
You can select from dial out, letter,
email or fax.
After completion, you will need to run
SEND REPORTS to transmit your order.
- ADMINISTRATOR - SETUP*
your administrator password
“111111111111" you will have access to
the further options below:
the margins/page orientation suited to your
printer; choose the number of request forms per
batch to be printed etc.
TIPS OF THE DAY*
you to create up to 10 “Tips” which are
locally determined, which will appear on your
local request forms.
you to edit your print templates for:
Report letters, request forms, DNA
letters, termination letters etc. After
completion, you will need to run SEND REPORTS to
transmit your order.
of pages of options which allow the
administrator to update hospital identification
data; telephone and contact numbers, print
import and telephone options.
After completion, you will need to run
SEND REPORTS to transmit your order.
These options are restricted to use by the clinic
REPORTS and FETCHING LETTERS
sure that your transmission file is in the correct
format and located in the correct directory. - for
Click on the “SEND
The PC anywhere connection will do all the rest -
it will dial INR RELAY, and automatically transfer the
A:\anyclini file to INR RELAY and then automatically
close the connection.
A few minutes after activating SEND
INR RELAY will automatically alert you with a phone call
(AUTOCALL) with a message stating that your
import was successful and advising you of any patients
with incomplete data.
If you then run FETCH LETTERS, and then VIEW
LETTERS and VIEW
REPORTS, you will be able to inspect the
letters ready for printing, and view the import reports
to validate the import proceeded properly and view any
non-imported data. For instance, patients will be rejected by INR RELAY if the
patient’s data was transmitted without a valid
telephone number - You can easily identify this type of
problem, make the corrections to your patient database
should use the INR RELAY CLIENT program PRINT menu
options to configure and perform all your printing
you are dedicated to
using WORD, then you can view and print your letters in
this environment with the following guides: Your letters
will appear in the C:\inr\intray\ directory on your PC. They
are in WORD convertible format and you can inspect (and
edit) them as required before printing. You will be able
to recognise the type of letter you are about to open,
as the eighth character in the filename denotes the
letter type as follows (L= INR report Letter; I =
Instructions letter; D=DNA letter; T=Termination
letter; Q=reQuest forms).
YOUR ACTIVITY - LOOKING AT REPORTS
time you run the “FETCH LETTERS” program, not only
are the patients’s letters collected, but also we will
automatically transmit to you copies of your
transmission reports and transfer them to the
appropriate designated folders on your PC.
You should use the VIEW LETTERS AND REPORTS
menu option to view the appropriate report or, using
WORD, check your c:\inr\import
c:\inr\48hour and c:\inr\96hour and c:\inr\invoice
directories on your PC on a regular basis for
transmission reports and 48 hour, 96 hour reports and
copies of invoices.
Patients who have incomplete data (ie non-valid
telephone numbers; absent date of birth etc) on your
database can be identified in this way.
Your staff should then rectify the problem in
your database, and retransmit the patient result.
You will also get summary reports for each active
day on the system - one report “48 hour report” is
sent after two days alerting you of any still
uncontacted patients, and a final “96 hour” report
sent after 4 days.
Billing is calculated on the “96 hour”
table below gives more information:
BATCH OF LETTERS AWAITING PRINTING
CHARACTER OF FILENAME DENOTES TYPE: L=
INR report Letter; I = Instructions
letter; T=Termination letter; Q=reQuest
BATCH OF LETTERS -ALREADY PRINTED. PRINTED (not
automatic for WORD users)
TIME YOU SUBMIT A BATCH OF RESULTS, AN IMPORT
REPORT IS GENERATED.
THIS GIVES DETAILS OF WHICH PATIENTS WERE
IMPORTED, HOW THEY WERE HANDLED, AND OTHER
REPORTS THAT WERE REJECTED - AND WHY.
QUARTER AN ITEMIZED INVOICE WILL BE GENERATED
AND COPIED TO THIS DIRECTORY.
Invoices are generated on the 5th
Day of April, July, October and January.
HOURS AFTER ANY GIVEN CLINIC DAY A 48 HOUR
REPORT IS GENERATED.
This report gives a summary of who has
been contacted so far, and a list of patients
who have not been in contact with the system.
HOURS AFTER ANY GIVEN CLINIC DAY, A 96 HOUR
REPORT IS GENERATED.
This report is the final report for a
given days activity and is the report upon which
the invoices are calculated.
PATIENT REPORT IS GENERATED BY SPECIAL REQUEST
BY YOU AS A CLINIC ADMINISTRATOR - SEE THE
SECTION BELOW. Patient reports contain a full
audit trail of activity for any one of your
patients and can be used to handle patient
TELEPHONE ACCESS TO THE CENTRALISED
order for any of your staff to gain access to the
central server, at any time, and not be confined to
access via your PC, INR RELAY allows you, or anyone
in your department to submit patient file requests to
the centralized service.
From any phone, you can dial into the system,
using the same access telephone number as your patients,
and when asked to enter your 11 digit UK telephone
number, you should enter a special code
"11111111111" which will divert you to an
administrator script. Once there, follow the verbal instructions to identify
your patient of interest (you must know the patient's 11
digit telephone number), and you will be offered the
BATCH OF REQUEST FORMS FOR THIS PATIENT
FOR A RESULTS
LETTER TO BE CREATED FOR THIS PATIENT
FOR AN INSTRUCTIONS
LETTER FOR THIS PATIENT
FOR A COPY OF THIS PATIENT’S RECORD
record will be sent to your PC's c:\inr\patient
THIS PATIENT FOR PERMANENT REPORT LETTERS
TO SUPPRESS LETTERS FOR THIS PATIENT (DEFAULT)
TO FLAG THIS PATIENT TO HAVE DIALOUTS
TO FLAG THIS PATIENT NOT TO HAVE DIAL-OUTS
TO CHANGE TELEPHONE NUMBER FOR PATIENT
above method has the advantage that it gives the local
clinic administrators easy access and control over how
individual patient’s are handled by INR RELAY.
From any phone, you can respond to patient
enquiries such as “I lost my letter;” “I have run
out of request forms;” “I would prefer to dial-in to
the system” directly by dialling into the system as an
administrator and making the appropriate selection.
TROUBLE SHOOTING ROUTINE
may be because your modem may not be switched on or
responding, or because the INR RELAY number is engaged.
You will be provided with a back up INR RELAY
transmission telephone number if your primary number if is
down for any reason.
If you verify your modem is working properly, and
the INR RELAY numbers are continually engaged or there is
no answer, (after more than three attempts), then contact
the Pathology department at Basildon Hospital on the
A LONG TIME
you should receive a transmission report or an autocall
within 30 minutes of export to us.
Autocall is a special dialout automatic phone call
which we will make to your clinic number as soon as the
import has been completed, informing you that we have just
imported a batch of results from you and advise you to
check your c:\inr\import folder for details if there were
any rejected results.
If you fail to get your autocall after thirty
minutes, you should try FETCH LETTERS as your
report may have been imported successfully anyway.
If your report has not been imported, check the
file format of your batched reports, and retransmit using SEND
REPORTS and try again.
If you are still having problems, contact INR
USE THE PHONE
complains that he cannot use the phone for a valid reason,
ie hard of hearing, pulse phone or techno phobic.
He wants to receive permanent letters as before and
does not want to be troubled by automatic telephone calls.
Patient preferences for requiring letters or
suppressing dialout can be transmitted to us by phoning
INR RELAY (using the patient access number) and when asked
to enter your 11 digit telephone number, enter the local
administrator code number “111111111111"
will divert you to a special script, which will allow you
to select the patient of interest by entering the patient
telephone number (INR RELAY uses the patient UK telephone
number as the patient identifier), then
to press 5 if the patient requires permanent
letters, and later to press 8 if you want DIAL OUT to be
suppressed as well. These
settings will be applied to all future INR report imports
for this patient. See
the section on ADMINISTRATOR TELEPHONE ACCESS TO THE
for more information on how to use this method.
2: This is very similar to
solution 1 - You can use the INR RELAY CLIENT
program, select SET PATIENT CONTACT PREFERENCES,
enter the patients telephone number, then press the
SEND LETTERS TO PATIENTS option, then uncheck the
DIAL OUT TO PATIENT option, then exit and as soon as you
connect to the centralised service by using SEND
REPORTS, your request will be actioned.
Even if you suppress dial out for a specific patient, the
patient (or a representative of the patient) will still
be able to DIAL IN for the result if desired.
phones can be used to DIAL IN to obtain results.
However, because of the high cost of dialling
nationally to mobiles, and the fact that they are often
switched off, we automatically suppress DIAL OUT to mobile
phones. You should tell any patient who uses a mobile as
his primary phone number, that he will not be phoned by
us, but can DIAL IN for his result when it is available.
the patient has an answerphone, it will answer the INR
RELAY dialout. However, only if the answerphone emits an appropriate tone
within the correct time frame and allows recording of
messages of >45
seconds will the voice message be recorded.
The patient may be advised to have the answerphone
switched off the evening of his test or alternatively DIAL
OUT can be suppressed for this number (see above). The patient remains free to DIAL IN for his result as soon as
it is available.
RELAY deliberately uses the patient home telephone number
as the patient unique identification number for the
is done for simplicity and for security reasons.
One slight limitation of this approach is that it
is not possible to have more than one patient on a single
situation might arise if for instance two members of one
family were being anticoagualated simultaneously, or two
or more residents in a nursing home (with a single number)
were being anticoagulated.
The solution is either to use different phone lines
if possible for each individual patient, or if this is not
possible, to assign a
unique 11 digit fake telephone number to one or
both patients (this has to recorded in the local clinic
then to suppress DIAL OUT (see above) for the fake
number(s). The patients or nursing home will have to be informed that
they will have to use DIAL IN to get the patient results,
and to use the fake unique telephone number to identify
the patient. The
caller will get the usual verification of date of birth
identifier to confirm the identity of the patient.
phone do not work with INR RELAY as we need to be able to
detect tone signals from the caller.
These patients should either be flagged for
permanent letters (see above) or preferably, they should
consider changing to a more modern tone phone (the
simplest models are quite inexpensive).
In our area, less than 5% of the population are
using pulse phones.
CLAIMS S/HE WAS
is a rare that a patient claims the wrong information was
given out over the phone.
Usually the explanation is that the patient
misheard the message, or did not comply properly with the
advice. Nevertheless, we are keen to investigate all
alleged mistakes - as it is always possible that there may
be an error in the interface tool for your clinic.
INR RELAY keeps a full audit trail of its activity
- meaning that it is possible to review any individual
patient’s master file to see when and what results were
imported into the system, and when and how results were
conveyed to the patient.
Once again you can dial into the service, enter the
administrator code “11111111111" as your UK 11
digit telephone number, then enter the patient’s number,
and then press 4 to request a copy of the patient audit
trail to view the history of the patient on the system.
For further information on administrator access see
the section ADMINISTRATOR TELEPHONE ACCESS TO THE
you can transmit your request using the INR RELAY
CLIENT program (PATIENT FILE REQUEST followed
by SEND REPORTS). The next time you run the “FETCH LETTERS” program,
the patient record file will be copied to your c:\inr\patient
folder on your PC.