INR RELAY

AUTOMATIC TELEPHONE REPORTING OF INR RESULTS


                                                            USE THE PHONE


Provide your patients with a better quicker INR results service, make your staff happier, and save yourself some money                - all at the same time !

The Pathology Department in Basildon & Thurrock NHS Trust has developed a new AUTOMATED TELEPHONE SERVICE available to all UK haematology laboratories that run an anticoagulant service.

A unique set of highly integrated and dedicated programs, INR RELAY provides you with access to a system which automates your communication tasks and dramatically improves the quality of service to your service users. The key design features of this new service are high quality, reliability, ease of use, speed, automation, and flexibility to meet your needs - and all this at a lower cost than you are currently incurring in communicating with patients by post. We will provide you with PC with a modem and some basic software installed and configured to your clinic; then you file transfer your batched daily results to us, and we will do nearly all the rest: - virtually "fire and forget." Yes, that's it, you send us your batched patients' INR results, doses, and clinic times and we will relay the information to your patients. We will either phone them, or they can phone us and patients can select for user configured letters according to the preferences allowed by your hospital. When you are ready, you use your modem to fetch from us fully formatted patient letters - selected for those patients who need them - configured to your specification. The best news is that the savings you make in printing and postage costs will pay for the cost of this superior quality service - and you can start straight away. In most cases, modest start up costs, no extra hardware or software, fully auditable, virtually no staff training, itemized billing, user configurable, regular reports to keep you fully informed of what is happening to your patients.

THE BASILDON EXPERIENCE IN UPTAKE AND COSTS

In Basildon, there are 2000 active anticoagulant patients in our clinic and in the past we posted 135 letters each working day (120 patient report letters; and 15 others including "did not attend" (DNA) letters and termination of treatment letters). We calculate that the cost of transmitting one report by mail is 36p (27p for postage; 4p for paper, ink and printer costs; 5p for staff costs). Assuming 255 working days each year, this amounts to an old total £12,393 per annum.

We have had experience of telephoned results reporting since April, 2000, with over 15,000 results correctly relayed to patients by phone. Following establishment of the new system, 80% of our patients are contacted by phone, and allowing for the fact that we now choose to send batches of request forms in the post, our letter numbers have been reduced by 72% to an average of 38 per day - This works out as a saving of 97 letters (£35) per day - and assuming 255 working days each year, this amounts to a real reduction in postal costs of £8905 per year. We plan to charge participating hospitals 23.5p (inc VAT) for each telephone contact we make, so assuming a similar uptake to our patients, where we now make 110 calls on average each day (93 patient reports; and 17 DNA messages) this would result in a bill for £6,590 (inc VAT) annually for the phone service. The cost of contacting the residual 28% (20% reports and 8% request forms) by post remains £3470 giving a new total of £10,060. Compared to the old system, this amounts to an annual saving of £2,333 (19%). These figures are a real estimate of the savings we made in Basildon, but of course, when calculating your savings, you should take into account the size of your clinic, the phone uptake you expect and the print configuration settings you choose. The more your patients use the phone system, the more you save. These savings for your trust are significant, and in addition, you will be providing your patients with a faster, more reliable and higher quality results service. For example, in our service, we have found that 80% of patients who use the phone system, have received their result by 7pm the same day, and in addition, we have an acknowledgement that the message was transmitted to its destination.


HOW DOES IT WORK ?

INR RELAY is a centralised computerised service located in Basildon Hospital. The computers are fully duplicated and backed up, tested and maintained by our trained staff. The computers act as reservoirs for receiving file transfers from client hospitals. Once you have completed set up, the transmission of reports to us is easily achieved by automatic file transfer. We convert these files into voice messages through a customised interface which we will create for each user. The INR reports are phoned the same day/evening (and the next day if no contact was made) - the preferred route is for us to directly DIAL OUT to your patients - anywhere in the UK. You will have the option for us to create customised patient reports (Results letters / DNA letters / Termination letters / request forms) which you then retrieve by automatic file transfer, and print and post locally. We will bill you according to how many and what type of reports we send out and we will notify you by return file transfer and autocall of any patients not imported, and after 48 hours of any patients who were not contacted and after 96 hours you will get a final report for that days work.


IS IT COMPLICATED TO USE ?

We have gone to great lengths to make this system easy to use both for the patient and the client clinics. Our automatic transmissions to patients are so convincing that many patients actually believe that there is a live person making the call. Why not try it out for yourself right now. Simply dial 01268 524016, and when asked to enter your 11 digit telephone number, you should type in 00000000000 which will divert you to a random test result, which we change every day. As for the clinics, once the set up procedure is completed (which should only take a few hours to complete by your clinic administrator), routine transmission and operation by your routine staff is extremely simple - and should involve only the generation of batched reports; then sending us the batched reports (SEND REPORTS icon/program); fetching letters and reports (FETCH LETTERS icon/program); and printing your letters (PRINT LETTERS icon/program).


WHY NOT SUPPLY CLINICS WITH THEIR OWN HARDWARE/SOFTWARE

There are several good reasons to have a single centralised service in preference to multiple local services. A centralised service means:

1) Local hospitals have virtually no costly hardware to buy or maintain - You will be provided with a PC which will be dedicated for use for this system. The PC will be fully loaded with the INR RELAY client program which will allow you complete access to your patients and configured and ready for you to use. As the PC is physically separated from your existing network, there is no possibility of access to your existing computer data - and fewer security issues as a result. Assuming you already have a printer and a phone line, there should be no additional hardware required. This means that we can create centrally robust call centre hardware, fully duplicated and protected against fire or hardware crashes. Centrally we can monitor for system failures and recover data automatically with our experienced staff. It would be prohibitively expensive for each local hospital to set up similarly robust and reliable hardware.

2) Local hospitals purchase no software

You will be provided with a PC which has preinstalled all the software you will need to transmit reports to us, fetch letters from us, print letters and view transmission reports from us. All the transmission software will be tested before you are supplied with the PC - so setting up could not be easier. All you need to provide is your input data in an acceptable format.

3) Your laboratory or clinical staff do not need to spend valuable time training how to use the system. All they need to do is to send us a file (perhaps several) every working day, containing the batched results of your INR results and dosing advice and clinic times -check the fetched reports and print fetched letters as required.


SOME EXAMPLES OF WHAT A PATIENT ACTUALLY HEARS ?

1)"Welcome to the INR RELAY service. Checking your date of birth: Your date of birth is twelfth day of June, day twelve of June, nineteen twenty six. Your INR result from earlier today was as follows: Your INR was four point five repeat four point five - which is a little high for you. You should do the following: Miss two days, take no anticoagulant for two days then take warfarin tablets, two repeat two milligrams on Tuesdays and Saturdays and three repeat three milligrams on all the other days. Your next blood test is due in three repeat three weeks on Tuesday fourteenth day of April, day fourteen of April. A Nurse or phlebotomist will call to take your next blood sample. If you would like to hear a repeat of this message press ONE on your telephone keypad now... If you would like a confirmatory letter sent to you in the post, press ONE on your telephone keypad now -... If you would like a batch of request forms sent to you in the post, press ONE on your telephone keypad now... * Thank you for listening, please hang up now".

* Options in italics are offered only at the discretion of the local hospital/clinic.

2) "Welcome to the INR RELAY service. Only if your date of birth is correct should you accept the following message: Your date of birth is Twelfth day of June, day twelve of June nineteen twenty six.

We note that you did not attend for your INR blood test today as we expected. This automatic telephone call is a polite reminder for you to attend as soon as possible as it is possibly harmful to your health to stay on anticoagulants without blood test monitoring. If you have just attended for your blood test, you can ignore this message. Thank you for listening, please hang up now. "

3) Welcome to the INR RELAY service. Only if your date of birth is correct should you accept the following message: Your date of birth is Twelfth day of June, day twelve of June nineteen twenty six. Your INR blood test result from earlier today is quite high indicating that there is too much anticoagulant in your blood at present. Do not take any further anticoagulant or other medicine which may cause bleeding such as aspirin until further notice. If you are experiencing any unusual bruising or bleeding problems, you should contact your anticoagulant clinic or doctor straight away, - because you may need an antidote or you may even have to go to hospital. We repeat - do not take any further anticoagulant until you have been in contact with your local anticoagulant clinic doctors or nurses. If you have just already spoken to your local anticoagulant clinic staff, you can ignore this message. Thank you for listening, please hang up now. "

HOW DOES IT WORK - CONTD. ?

If you think about it, in order for this system to work, we need to be provided with the following information for each patient included in your file transfers sent to us every day:

Your hospital name - So we can tell who sent the file essential
Patient information details - Patient's name and address - essential
Telephone numbers - essential
Date of birth - essential
NHS or unique clinic number- essential
Patient Episode details - Current INR result - essential
Desired INR range - essential
Name of anticoagulant - essential
Dose advice essential
Date of Next test - essential
Transport arrangements desirable

Most automated systems already have this data or they can be easily added to your database.

WHAT ABOUT THE HARD OF HEARING ?

Clearly there is a subgroup of patients who for various reasons will not be able to use the system. In our clinic, 80% of patients use the INR RELAY system (the majority over 70 years old). The other 20% have refused to use it and therefore continue to receive letters in the post.



Reasons for non-use are as follows:

1) Pulse phones will not work - we require tone phones.

(Nearly all modern phones are tone enabled).

2) Hard of Hearing.

3) Technology rejection/phobia.


We have optimised ease of use for the patients as follows:

a) Latest hardware for superior sound quality

b) System recognises Caller Line Identification (when not suppressed) - In this way, it recognises the home telephone number and therefore the patient. There is therefore usually no need for the patient to enter a PIN to get access to his result. This means that all the patient has to do is to answer the phone at home, press one digit on the keypad, and take down three or four items of information over about 60 seconds.

c) Repeat messages offered during call.

d) We now prefer to DIAL OUT to our patients rather than wait for them to DIAL IN. We DIAL OUT the same evening, and will make three to four attempts before stopping. This has the advantage of increasing the contact rate, reminds patients actively of the test and result; further simplifies ease of use, as the patient does not even have to remember our number (just answer the phone, press any digit, and take down the result - we cannot think of any way to make it simpler), provides a completely free service to the patient; and contacts non-compliant (non-attending) patients cost effectively. With DIAL OUT patients do not get engaged tones, or have to bear the frustration of being told that their result is not yet available. Although there are higher call costs to us in dialling out, we have found the quality improvements which DIAL OUT delivers outweigh the cost disadvantages.

e) If all else fails, specific patients can be flagged for conventional postal reporting - which you or your patient can choose as optional extras. You can either continue to post your reports to these patients yourself or you can have INR RELAY create the reports for you - which you can download for local printing and posting. In addition, you can also arrange for specified patients to have copies of results sent by email and/or fax.


HOW ARE THE BILLS CALCULATED ?

Every time we call a patient, or a patient calls us, or we send the information in the post (or we fax or email a patient), we keep an automatic record, and we will invoice you quarterly. The service will cost you less than you currently pay in postage as long as you allow us to phone your patients in preference to using the post. For instance, most patients will have a single phone call from us, lasting 90 seconds on average, and we will bill you 20p ex VAT (for each telephone contact we make). Compare this with 27p for a first class stamp. Of course, you will make further real savings on clerical staff time, printers, stationary and consumables.

A FEW MORE ADVANTAGES !

1) You don't need to worry about postal strikes or postal delays over weekends or holidays.

2) You get an electronic acknowledgement that the patient actually got the message. With the Royal Mail, there is no way of knowing that the post has actually arrived when you send a letter - even first class.

3) The patient gets the result at least one day sooner than achievable with the post. This is important when dose adjustment is needed.

4) You can now transmit results directly to patients who are visually impaired or who have problems with literacy.

5) You can automatically generate patient specific request forms.

6) You can select special contact procedures for a selected patient ie telephone son if patient not answering, fax or email the pharmacist or GP.

7) Special messages can be sent to non-attenders, patients nearing termination of treatment, or patients with very high INR's.

8) Results are available 24 hours per day, seven days a week.

9) You will be reducing the greenhouse effect by reducing the paper output of your service.

10) You will be supporting the development of pathology modernisation, improving the turnaround time, timeliness and interpretative advice pertaining to the post analytic phase of the laboratory test life cycle.

11) You will be supporting an initiative started in the NHS predominantly for the benefit of the pathology department in Basildon and Thurrock NHS Trust.

12) You will be freeing your staff for more productive or appropriate work.

WHAT ABOUT PATIENT CONFIDENTIALITY ?

In line with the Caldicott recommendations, we only store the minimal data set necessary, for the minimum time necessary for clinical purposes. All our staff are full time NHS employees and bound by NHS confidentiality. Our computers are independent of any other network and by supplying you with a dedicated PC, there is no need to connect to your network. Access to all our files are password protected and all transmissions are encrypted. We warn patients in their introductory letter, that it is theoretically possible for their dates of birth or anticoagulant information to be obtained by other persons using our system, but in our experience, no patient has refused to participate in the service citing confidentiality as a concern. Whilst every effort is made to maintain confidentiality, we have protected the patients from the security features of the service - so ease of use is not compromised.


WHAT TO DO NEXT ?

Have a look at our INR RELAY - GETTING SETUP guide. This will give you details on how easy it is to configure your system, giving ready made setups for commonly used systems such as DAWN 4S and how to transmit your data to us. It also gives information about the service contract we offer, limitations of liability and our price structure.

INR RELAY

AUTOMATIC TELEPHONE REPORTING OF INR RESULTS

USE THE PHONE

EASY FOR YOUR PATIENTS

EASY FOR YOU

HIGH QUALITY SERVICE

RELIABLE

FAST

COST EFFECTIVE

SEND FAXES AUTOMATICALLY

SEND EMAILS AUTOMATICALLY

NHS TO NHS



INR RELAY -

GETTING SETUP

INTRODUCTION:

The 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 patients. Local 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.

INR 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.

The 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 forms.


SETTING UP

You 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 do.

Fill 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

Creating 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 (Appendix 1&2) or as close to this as possible. DAWN 4S users should follow the instructions below. Please refer to Appendix 1 for and explanation of the file format. A 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).

Using 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 REPORTS.

SELECTING THE BEST WAY TO TRANSMIT DOSE INFORMATION:

There 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 "4SW29" (which will then refer to a table from which the daily doses are obtained - see appendix 7 for example); 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:

METHOD A: Using a dose code and dose code table (as in Appendix 7): With METHOD A, you have to provide us with a completed local equivalent to the table in appendix 7. 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: Using 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).

METHOD C: Using 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 record. You 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 below:

Average dose DOSE ADVICE OVER THE PHONE (METHOD C only)
2.86 to 3.14 Take three mg every day
3.15 to 3.39 Take four mg on Tues and Sat and three mg on all the other days
3.40 to 3.60 Take three and a half mg every day
3.61 to 3.85 Take three mg on Tues and Sat and four mg on all the other days
3.86 to 4.14 Take four mg every day

Note: 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.

Once 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.

Setting up the Print Templates

This step is only necessary if you have opted to allow INR RELAY to create some or all of your printed letters to patients. When designing your letter format, you can either accept the default templates as they appear in Appendix 5, or you can modify them or you can create your own templates, merging any of the available variables (Appendix 1). 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 specified place. (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: the post is more likely to reach its destination on time if it is posted locally; 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 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 time.


VALIDATION

While 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 required if 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 LETTERS process:

Test transmissions of your batched INR results to INR RELAY:

At this stage, you will be able to create your batched reports in a text file format, and transmit these reports using your SEND REPORTS program. Start 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 PRINT LETTERS 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.


Testing the validity of voicemail messages to patients:

Continue 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 expected. If there is any variation from expected in any of the above, please inform the Pathology service at Basildon Hospital for correction of the interfacing tool. The closer your text file format is to the model file in appendix A will result in fewer problems at this stage.


Going live:

Inform your patients of the system (or allow INR RELAY to do this for you by enabling dialout and patient instruction letters). Remember 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).

ROUTINE OPERATION

USING THE INR RELAY CLIENT PROGRAM

You should use 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:

FUNCTION COMMENT
SEND REPORTS Automatically sends to the call centre any batches of reports, patient file requests or updated configuration or template files. Modem link, program exits on completion.
FETCH LETTERS Automatically 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.
PRINT NEWLY FETCHED REPORTS Prints the current batch of letters
REPRINT PREVIOUS BATCH Prints the previous batch of letters
VIEW LETTERS AND REPORTS Views the current letters; previous batch of letters; 48 hour reports; 96 hour reports; import files; invoices, fetched patient reports.
PATIENT FILE REQUESTS Order on behalf of a patient any of the following: report letter, request forms, instructions letter, audit report. After completion, you will need to run SEND REPORTS to transmit your order.
SET PATIENT CONTACT PREFERENCES Use this feature to select contact preferences to transmit INR result in any combination for any specified patient. You can select from dial out, letter, email or fax. After completion, you will need to run SEND REPORTS to transmit your order.
SETUP - ADMINISTRATOR - SETUP* Using your administrator password "111111111111" you will have access to the further options below:
LOCAL PRINTER SETUP* Set the margins/page orientation suited to your printer; choose the number of request forms per batch to be printed etc.
SET TIPS OF THE DAY* Allows you to create up to 10 "Tips" which are locally determined, which will appear on your local request forms.
EDIT TEMPLATES* Allows 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.
EDIT CONFIGURATION SETTINGS* Series 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 administrator.

TRANSMITTING REPORTS and FETCHING LETTERS

Make sure that your transmission file is in the correct format and located in the correct directory. - for instance: A:\anyclini. Click on the "SEND RESULTS" icon/program. 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 LETTERS, 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 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 and retransmit.


PRINTING LETTERS

You should use the INR RELAY CLIENT program PRINT menu options to configure and perform all your printing tasks. If 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).

CHECKING YOUR ACTIVITY - LOOKING AT REPORTS

Every 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" report. The table below gives more information:

Folder REPORT TYPE COMMENTS
C:\INR\INTRAY LETTER CURRENT BATCH OF LETTERS AWAITING PRINTING

EIGHTH CHARACTER OF FILENAME DENOTES TYPE:

L= INR report Letter; I = Instructions letter;

D=DNA letter; T=Termination letter; Q=reQuest forms

C:\INR\INTRAYBK LETTER PREVIOUS BATCH OF LETTERS -ALREADY PRINTED. PRINTED (not automatic for WORD users)
C:\INR\IMPORT

IMPORT REPORT EVERY 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.
C:\INR\INVOICE INVOICE REPORT EVERY 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.
C:\INR\48HOUR 48 HOUR REPORT 48 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.
C:\INR\96HOUR

96 HOUR REPORT 96 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.
C:\INR\PATIENT PATIENT REPORT A 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 enquiries etc.


ADMINISTRATOR TELEPHONE ACCESS TO THE CENTRALISED SERVICE

In 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 following options:


PRESS 1 FOR A BATCH OF REQUEST FORMS FOR THIS PATIENT

PRESS 2 FOR A RESULTS LETTER TO BE CREATED FOR THIS PATIENT

PRESS 3 FOR AN INSTRUCTIONS LETTER FOR THIS PATIENT

PRESS 4 FOR A COPY OF THIS PATIENT'S RECORD

(This record will be sent to your PC's c:\inr\patient folder)

PRESS 5 TO FLAG THIS PATIENT FOR PERMANENT REPORT LETTERS

PRESS 6 TO SUPPRESS LETTERS FOR THIS PATIENT (DEFAULT)

PRESS 7 TO FLAG THIS PATIENT TO HAVE DIALOUTS (DEFAULT)

PRESS 8 TO FLAG THIS PATIENT NOT TO HAVE DIAL-OUTS

PRESS 9 TO CHANGE TELEPHONE NUMBER FOR PATIENT

 

The 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 OPERATION

FILE TRANSFER FAILS

This 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 Support number.

TRANSMISSION REPORTS TAKE A LONG TIME TO RETURN

Generally, 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 RELAY.


PATIENT UNABLE TO USE THE PHONE SYSTEM

Patient 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.

Solution 1: 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" instead. This 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 CENTRALISED SERVICE for more information on how to use this method.

Solution 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.

NOTE: 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.

MOBILE PHONES

Mobile 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.

ANSWERPHONES AND ANSWERING SERVICES

If 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.

MORE THAN ONE PATIENT ON A SINGLE TELEPHONE NUMBER

INR RELAY deliberately uses the patient home telephone number as the patient unique identification number for the system. This 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 number. This 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 database) and 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.

PULSE PHONES

Pulse 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.


PATIENT CLAIMS S/HE WAS GIVEN INCORRECT INFORMATION

It 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 CENTRALISED SERVICE above. Alternatively, you can transmit your request using the INR RELAY CLIENT program (PATIENT FILE REQUEST followed by SEND RPORTS). 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.


CONTRACTS / DISCLAIMER

Vendors: Pathology Department, Basildon and Thurrock NHS trust

Purchaser: Local clinic name:

INR RELAY is a system supplied by the vendor which transforms data in electronic format to sound format and then subsequently transmits that data to the purchaser's patients by automatic phone calls. The competitive cost structure that the vendor offers, prevents the vendor from employing staff to deal directly with your patients apart from using the automated systems. The hardware system is designed to be highly fault tolerant with virtually duplicate hardware and software for each participating clinic. Every effort is made to validate the software and the importation interface tools. INR RELAY makes no effort to calculate anticoagulant dose adjustments or clinic date intervals. INR RELAY relays information from clinics to patients, and does not create new information. The following restrictions apply to all contracts:

The Vendor disclaims any responsibility for any harm that may arise due to delay, failure of transmission, inaccuracy in transmission of any report. It is wholly the responsibility of the Purchaser to ensure that all INR RELAY reports are accurate and timely; and it is mandatory that the Purchaser undertake adequate validation (and revalidation) as necessary.

The Purchaser is wholly responsible for dealing with patient complaints. The Vendor disclaims any responsibility to deal directly with the Purchaser’s patients. INR RELAY will supply on request the audit activity log to the originating clinic of any patient’s automated activity. The Vendor will co-operate with the Purchaser to rectify any error or omission in transmission, the costs for such rectification to be met wholly by the Purchaser.

The Purchaser agrees to comply with the licence agreements of the client software provided by the Vendor and to keep safe and confidential any patient data on the system. The Purchaser agrees to maintain and keep secure any computer hardware provided by the Vendor, and to insure against any loss, damage or theft. The Purchaser agrees to pay for all running costs of the client software and hardware. The Purchaser agrees not to use the client hardware for any other purpose other than to operate the INR CLIENT system. The Purchaser agrees to pay the Vendor up to £1000 to replace lost, stolen or damaged client hardware or software. The Purchaser agrees to pay to the Vendor within 30 days of receipt of invoice from the Vendor. The minimum term for this agreement is 12 months. After twelve months, either party may terminate this agreement with one months notice, and on termination, the Purchaser will return to theVendor , at no cost to the Vendor , all client hardware and software in good working condition.

On the signing of this agreement, the Vendor agrees to pay the Purchaser £1500 (ex VAT), in consideration of the provision of client hardware and software to the vendor and the creation of a software interface tool to import the Vendor,s data, the said amount is non-refundable.


TERMS AND CONDITIONS

There are two phases to establishing costs: Phase one or setup costs should be paid in advance and cover the costs of writing an interface tool for your system and validation support for twenty eight days. Further setup charges may apply if radical changes are required to printed templates, or after 28 days. Phase two or running costs are calculated according to the amount of use you and your patients make of the system. The more you and your patients use the system, the more you pay us - but also the more you will save by not having to pay postal costs and charges.

COSTS  (ALL IN UK STERLING)
DESCRIPTION UNIT COST  EX VAT UNIT COST INC VAT @ 17.5%
INTERFACING TO INR RELAY FROM DAWN 4S

Note: This includes initial setup interfacing, validation of importation accuracy, and initial template setup for first 28 days of contract. Modification after 28 days if required, will be charged at a rate of £50/hr (ex VAT). Local hospital to cover costs of transmitting INR reports to INR RELAY by PC Anywhere. (Interfacing from other systems POA)

£1500-00 1762.5
RUNNING COSTS
DESCRIPTION UNIT COST EX VAT UNIT COST INC VAT @ 17.5%
DIAL IN (TO 01268 NUMBER - CALLER PAYS NATIONAL RATE) £0.20 0.235
DIAL OUT £0.20 0.235
EMAIL £0.05 0.05875
LETTER CREATION £0.00 0.00
FAX £0.20 0.235


APPENDIX 1

List of field names for import to INR RELAY
Field Description e/d# format~ max char length Example
1 Surname e An 20 Smith
2 Firstname e An 20 John
3 CLINIC NUMBER d Int 10 1234567890
4 DATE OF BIRTH e dd:mm:yy 8 18:10:55
5 address line 1 e An 24 23 Holmgrove Ave
6 address line 2 d An 24 Benfleet
7 address line 3 d An 24 Essex
8 address iine 4 d An 24
9 post code e An 8 SS14 7ML
10 tel number e Int 11 01268 232312
11 drug name e An 16 Phenindione
12 rangelow e N 5 2.5
13 Rangehigh e N 5 4
14 PREVIOUS DOSE d N 5 3.5
15 current test date e dd:mm:yy 8 22:04:01
16 nexttest DATE e dd:mm:yy 8 20:06:01
17 CURENT inr result e n(0.5 - 10.0) 5 3.4
18 Missdays e int (0 - 7) 1 0
19 currentavdose e N 5 3.5
20 currentdosecode* e An 8 4sw13
21 Transcode d a(N/H/T)! 1 H
22 Diagnosis d A 12 DVT
23 P.LastDate1 d dd:mm:yy 8 13:03:01
24 P.Lastinr.1 D N 5 3.2
25 P.Lastdose.1 d N 5 3.5
26 Lastmissdays1 d Int 1 0
27 P.LastDate2 d dd:mm:yy 8 11:02:01
28 P.Lastinr.2 d N 5 1.8
29 P.Lastdose.2 d N 5 3.5
30 Lastmissdays2 d Int 1 0
31 LONGTERM FLAG d a (Y/N) 1 N
32 DUE TO STOP DATE d dd:mm:yy 8 12:07:01
33 DNA FLAG e int (0-3) 1 0
34 Hospname e An 8 Basildon
35 LANGUAGE FREE d An 8 English
36 Monday dose* e N 5 3.5
37 Tuesday dose* e N 5 3.5
38 Wednesday dose* e N 5 3.5
39 Thursday dose* e N 5 3.5
40 Friday dose* e N 5 3.5
41 Saturday dose* e N 5 3.5
42 Sunday dose* e N 5 3.5
43 Free
44 Free
45 Free
46 Free
47 Free
48 Free
49 Free
50 Free
51 free
52 Free

# e= essential d= desirable

~ an= alfanumeric n= numeric(allowing one decimal point) int=integer

a= alfa (characters only) dd:mm:yy = day:month:year

! N=No arrangements H=Home visit by phlebotomist T=Hospital transport

* there are three acceptable ways of recording the current dose:

METHOD A Dose code method - Field 20 mandatory - Dose code table mandatory

METHOD B Individual Daily dose method - Fields 36-42 mandatory No Dose code table

METHOD C Average daily dose method - Field 19 mandatory - No dose code table

Appendix 2: Voicemail.txt sample USER LETTER output from DAWN 4S

- may use dosecode table (Appendix 2) to reference daily doses from dose code value (field 20)

- text following semicolons is for clarification only



<<ALLTRIM(P.surname)>> ;surname (field 1)

<<ALLTRIM(P.Forename)>> ;first name (field 2)

<<ALLTRIM(P.Hosno)>> ;clinic number (field 3)

<<P.DOB>> ;date of birth (field 4)

<<ALLTRIM(P.Address)>> ;address line 1 (field 5)

<<ALLTRIM(P.District)>> ;address line 2 (field 6)

<<ALLTRIM(P.Town)>> ;address line 3 (field 7)

<<ALLTRIM(P.County)>> ;address line 4 (field 8)

<<ALLTRIM(P.PCode)>> ;address post code (field 9)

<<ALLTRIM(P.TelNo)>> ; patient tel. number (field 10)

<<ALLTRIM(P.Antidesc)>> ; anticoagulant name (field 11)

<<ALLTRIM(P.RangeDesc)>> ; rangelow - rangehigh (contains fields 12 & 13)

<<ALLTRIM(P.LabTxt1A)>> ; previous dose (field 14)

<<P.LastAppt>> ; last test date (field 15)

<<P.NextSample>> ; next test date (field 16)

<<P.CurrentInr>> ; current INR (field 17)

<<P.CurrMissX>> ; miss days (field 18)

<<ALLTRIM(P.LabTxtA)>> ; current average dose (field 19)

<<ALLTRIM(P.LabTxtD)>> ; current average dose code (field 20)

<<ALLTRIM(P.Transport)>> ; transport flag (T/H/N) (field 21)

<<.PrimeAC>> ; indication for anticoagulation (field 22)

<<P.LASTDATE1>> ; date of previous INR result (field 23)

<<P.LastInr1>> ; value of previous INR result (field 24)

<<P.LastDose1>> ; previous average anticoagulant dose (field 25)

<<P.MissDayX1>> ; previous value of missdays (field 26)

<<P.LastDate2>> ; date of previous INR result but one (field 27)

<<P.LastINR2>> ; value of previous INR result but one (field 28)

<<P.LastDose2>> ; previous average anticoagulant dose but one (29)

<<P.MissDayX2>> ; previous value of missdays but one (field 30)

<<P.LongTerm>> ; long term anticoag flag (Y/N) (field 31)

<<P.StopDate>> ; termination of treatment date (field 32)

<<P.ConseqDNA>> ; DNA flag (0/1/2/3) (field 33)

Basildon ; name of clinic (field 34)

English ; language (field 35)

<<ALLTRIM(P.LabTxtB)>><<ALLTRIM(P.LabTxtC)>>; (fields 36-42)

                                                                           ; string containing Mon-Sun daily doses

Free  (field 43)

Free   (field 44)

Free  (field 45)

Free  (field 46)

Free  (field 47)

Free  (field 48)

free ; (field 49)

free ; (field 50)

free ; (field 51)

free ; (field 52)


Appendix 5: Examples of Default Print Output from INR RELAY PRINT

Appendix 5a: Example of Report letter to patient: "Report.tem"

***** 01268 593047



INA SUTHERS

17 TYRELL ROAD

20/02/1932

948445237

01268584279

INA SUTHERS      

17 TYRELL ROAD

CREST AVENUE BASILDON

ESSEX SS13 2TE

MISS TWO DAYS THEN TAKE WARFARIN AS SHOWN BELOW
DATE INR MON TUES WED THURS FRI SAT SUN OFFICE USE ONLY
16:07:2001 4.5 3 mg 3 mg 3 mg 3 mg 3 mg 3 mg 3 mg
23:07:2001 DATE OF NEXT BLOOD TEST - MONDAY


WARFARIN TABLETS COLOURS AND DOSES

Brown 1mg; Blue 3 mg; Pink 5 mg

OFFICE USE ONLY

Diag: AF Trans: N WARFARIN @ 3.00mg/day Range: 2.0-3.0

DATE

13/07/2001

04/07/2001

INR

1.70

2.00

DAILY DOSE

3.00

1.97

MISS DAYS

0

0


Appendix 5b: Example of Instructions letter to patient: "Instructs.tem"

HELEN BAILEY

IMPORTANT ANNOUNCEMENT

In future, we will be sending you your INR results and dosage advice by automatic telephone call. This service has been used in other hospitals and found to be as good as - if not better than, faster and cheaper than the post. Please read the simple instructions below and keep them in a safe place (inside your anticoagulant record book) for future reference.


HELEN BAILEY WE CALL YOU

STEP 1: Answer your phone between 4pm and 9pm the day of your test. You will hear an automatic announcement and when you are ready to take down your results, start the message by pressing any key on your tone telephone.

STEP 2: You will hear your date of birth, and if correct, copy into your INR RECORD BOOKLET, your INR result, your dose and date of next blood test.

STEP 3: At the end of the message, you will be asked if you want to hear a repeat of the message (select by pressing the "1" key) and then you may be offered further options.

STEP 4: Hang up the call when requested to do so.

Note: We do not dial out to mobile phones.  If you are using a mobile as your main telephone number, then you will have to dial us to get your result  - see below.

HELEN BAILEY YOU CALL US

STEP 1:DIAL: 01268 524016.

If the system recognises your telephone (if you have your caller identificaton switched on - ask BT or your cable company about this), it will announce your date of birth and your results as above. If the system failed to recognise your telephone number, it will ask you to enter, starting with your UK national area code, your 11 digit telephone number.

STEP 2: You will hear your date of birth, and if correct, copy into your INR RECORD BOOKLET, your INR result, your dose and date of your next blood test.

STEP 3: At the end of the message, you will be asked if you want to hear a repeat of the message (select by pressing the "1" key) and then you may be offered further options.

STEP 4: Hang up the call when requested to do so.


SOME NOTES ON USING THE PHONE SYSTEM

*If you do not answer our first call, the computer will continue to try to call you for three of four attempts until about 9pm. It will try call you the following day if it failed to contact you the same day.

*The computer may call you to notify you if you did not attend as expected or if your result was unexpectedly high.

*If you are dialling us for your result, you should allow sufficient time (about six hours) for the laboratory to test your blood, before phoning us.

*If you phone us too early you will be asked to phone again later, or the next working day.

*You may use dialback (enter "5") if you get an engaged signal.

*Some older phones are "pulse" phones and will not work with this system. This system requires "tone" phones. Some telephones can be switched from pulse to tone. If you have a rented pulse phone, ask if your telephone company will change it to a newer tone phone.

*If the system does not recognise your phone, it may be because your caller identification is switched off. You can have this permanently switched on by contacting your telephone company - but if you prefer not to do this, then you can switch it on for any single call by dialling 1471 before the call.

* If you are hard of hearing, or have another valid reason for not being able to use the phone, please contact us on 01268 593047, or write to us asking us to send you your results by post.

*While every effort is made to keep your information such as your date of birth and your anticoagulant doses confidential, it may be possible for others to secretly obtain this data. If you are very concerned about this, please let us know by phoning 01268 593047 and we can remove you from the system.



Appendix 5c: Example of Requests forms (batch of ten) sent to patient: "Requests.tem"


***** 01268 593047










THERESA MARY FORD

67 BOCKINGHAM ROAD

03/12/1955

4633094274

 

01268446774

THERESA MARY FORD

67 BOCKINGHAM RD

BASILDON ESSEX

SS23 1PF

KEEP THESE INR REQUEST FORMS IN A SAFE PLACE

BRING THIS FORM WITH YOU FOR YOUR NEXT BLOOD TEST

lab use only


DATE OF BLOOD TEST: ..../..../200..






(Use the above space to tell us about any changes in your health; changes in your medications, or forthcoming events such as: dates of operations, dental extractions or holidays; changes in your address or tel number)



Appendix 5d: Example of "Termination letter" sent to patient: "term.tem"

***** 01268 593047









MALCOLM EDWARD

25 ALLWRIGHT ROAD

25/09/1954

 



4768811777

 

07930816348

MALCOLM EDWARD

25 ALRIGHT ROAD     TILBURY 

ESSEX RM17 8XL

*** TREATMENT COMPLETION ***
lab use only
Our records indicate that you are approaching the end of the course of anticoagulation originally prescribed for you. You are due to stop on 06:08:2001. Continue on your prescribed daily dose of WARFARIN until that time - then simply stop taking any further anticoagulant.

You will not need further INR blood tests. If you have any reason to believe that you should be continuing on anticoagulation, check with your GP orhospital specialist, then contact us on 01268 593047 to discuss.

Signed: Dr John Smith

Office use only: Diag: DVT Range: 2.0-3.0

Age: 36 ALERT ? THROMBO SCREEN ??



Appendix 5e: Example of "High INR >8" sent to patient: "rephigh.tem"

***** 01268 593047









MALCOLM EDWARD

25 ALLWRIGHT ROAD

25/09/1954

 



4768811777

 

07930816348

MALCOLM EDWARD

25 ALLWRIGHT ROAD

TILBURY ESSEX

RM17 8XL

*** WARNING ***
lab use only
YOUR ANTICOAGULANT BLOOD TEST IS QUITE HIGH AT THE MOMENT. DO NOT TAKE ANY ANTICOAGULANTS UNTIL YOU HAVE HEARD FROM US. YOUR BLOOD LEVELS OF WARFARIN MAY REMAIN HIGH FOR SEVERAL DAYS SO IF YOU DEVELOP ANY NEW OR WORRYING BLEEDING PROBLEMS SEEK HELP (OR GO TO THE HOSPITAL ACCIDENT AND EMERGENCY DEPARTMENT) STRAIGHT AWAY.

Signed: Dr John Smith

DATE OF NEXT TEST: 03 May 2001


Appendix 5f: Example of "DNA1" sent to patient: "dna1.tem"

***** 01268 593047











ERIC HARRIS

50 ROKETS

15/11/1966


4444771538

07950582892

ERIC HARRIS  50 ROCKETS

BASILDON ESSEX        SS14 2BD

BRING THIS FORM WITH YOU FOR YOUR NEXT BLOOD TEST lab use only
Dear ERIC HARRIS (dob: 15/11/1966)

Unfortunately, you missed your appointment to have your blood tested for anticoagulant therapy. It is important that you attend for a blood test as soon as possible. If you have already attended in the last few days, please ignore this letter.

If you are unable to attend, please inform us on 01268593047.


Signed:
Dr John Smith



5g: Example of "DNA2" sent to patient: "dna2.tem"


***** 01268 593047










ERIC HARRIS

50 ROKETS

15/11/1966



4444771538

07950582892

ERIC HARRIS

50 ROCKETS

BASILDON ESSEX

SS14 2BD

BRING THIS FORM WITH YOU FOR YOUR NEXT BLOOD TEST lab use only
Dear ERIC HARRIS (dob: 15/11/1966)

Unfortunately, you missed your appointment to have your blood tested for anticoagulant therapy. Our records indicate this is the second week that you missed your blood test. It is important that you attend for a blood test as soon as possible. If you have already attended in the last few days, please ignore this letter. If you are unable to attend, please inform us on 01268 593047.

Signed: Dr John Smith



Appendix 5h: Example of "DNA3" sent to patient: "dna3.tem"

***** 01268 593047











ERIC HARRIS

50 ROKETS

15/11/1966



4444771538

07950582892

ERIC HARRIS

50 ROCKETS

BASILDON ESSEX

SS14 2BD

BRING THIS FORM WITH YOU FOR YOUR NEXT BLOOD TEST lab use only
Dear ERIC HARRIS (dob: 15/11/1966)

Our records indicate this is the third week that you have missed your blood test. It is not safe to continue on anticoagulants without regular blood tests and we may have to stop your treatment for this reason. Please contact us immediately on 01268 593047 discuss this further. Ignore this letter if you have attended in the last few days.

Signed: Dr John Smith




Appendix 7:
Example of a dosecode lookup table which must be completed if you opt for the
dose code method of transmitting dose (field 20) information

 
CODE MON TUES WED THURS FRI SAT SUN
4sn01 0 0 0 0 0 0 0
4sn02 h* 0 h 0 h 0 h
4sn03 h h h h h h h
4sn04 h 1 h 1 h 1 h
4sn05 1 1 1 1 1 1 1
4sn06 1 1h 1 1 1 1h 1
4sn07 1 2 1 1 1 2 1
4sn07 1 2 1 1 1 2 1
4sn08 1h 1h 1h 1h 1h 1h 1h
4sn09 2 1 2 2 2 1 2
4sn10 2 2 2 2 2 2 2
4sn11 2 3 2 2 2 3 2
4sn12 2h 2h 2h 2h 2h 2h 2h
4sn13 3 2 3 3 3 2 3
4sn14 3 3 3 3 3 3 3
4sn15 3 4 3 3 3 4 3
4sn16 3h 3h 3h 3h 3h 3h 3h
4sn17 4 3 4 4 4 3 4
4sn18 4 4 4 4 4 4 4
4sn19 4 5 4 4 4 5 4
4sn20 4h 4h 4h 4h 4h 4h 4h
4sn21 5 4 5 5 5 4 5
4sn22 5 5 5 5 5 5 5
4sn23 5 6 5 5 5 6 5
4sn24 5h 5h 5h 5h 5h 5h 5h
4sn25 6 5 6 6 6 5 6
4sn26 6 6 6 6 6 6 6

Note: This is a truncated list. The full list in Basildon has 780 rows. This type of list is only necessary if you have opted for Method A to transmit dose information. You will need to keep us updated of any modifications you make to this list.

* h indicates "½"


Appendix 8: INR RELAY CONFIGURATION FORM

SETTINGS FOR: BASILDON CURRENT NEW
Date of completion of this form: 18TH June 2001  
Short name (Must be 8 characters) Basildon  
Hosp Addr 1 Nether Mayne  
Hosp Addr 2 Basildon  
Hosp Addr 3 Essex  
Hosp Addr 4 United Kingdom  
Post Code SS16 5NL  
Local Clinic Autocall number 01268 593047  
Local Clinic Tel number (For patients Enquiries etc) 01268 593047  
Local Clinic Number (For local clinic administrator) 01268 593020  
Local Clinic Doctor Name Dr John Smith  
Local ClinicEmail number (Max 36 characters) jsmith@aol.com  
Local Clinic Administrator Name Anthony Smith  
Purchase Order Number (mandatory) PN1234567  
SUPPLIED BY: INR RELAY CURRENT NEW
Technical Support Tel 01268 593016  
Tech Support Email plcervi@pacehealthsystems.com  
Transmission Tel Number 01268 598203  
Patient Tel Number 01268 524016  
PC Anywhere Remote User name BASILDON  
Dial out option - (Set to No during validation phase) Yes  
OPTIONS AT TIME OF IMPORT (Yes/No) : CURRENT NEW
Create Patient Report Letters: Set to YES if you want us to create a patient report letters for those patients flagged for letters (example Appendix 5a). Setting to NO suppresses all patient report letters. Yes  
Create patient instructions letter. This will cause an instructions letter (Appendix 5b) to be sent to any new patient as they join the system. Only sent once per newly entered patient. Yes  
Send Fax on import No  
Send email on import No  
Create termination letter on import Setting YES will cause a "Termination letter" (Appendix 5d) to be sent to patients on the date when treatment termination is due. Yes  
Create letter to patients with high INR >8.0   This will cause a special report letter to go to patients with INR>8 as a failsafe (Appendix 5e) Yes  
Create letter to all non-attenders No need to set to YES, if DIAL OUT is on (Appendix 5f 5g 5h) No  
Create letter to third time non attenders Yes is a useful precaution - failsafe (Appendix 5h) Yes  
OPTIONS OFFERED TO PATIENT AT TIME OF PHONE CALL CURRENT NEW
Tel Call to offer confirmatory printed report letter:  If set to YES will allow the caller to ask for a confirmatory letter to be sent during the telephone call No .
Tel Call to offer batch of request forms   If set to YES will allow the caller to ask for a batch of 10 preprinted request forms (Appendix 5c) to be sent. Only choose YES if you need to use request forms. (requested by caller during the telephone call) Yes  
Tel Call to offer caller permanent letters If set to YES will allow the caller to select to permanently receive confirmatory report letters (appendix 5a). Setting to YES could be quite expensive !. No  
Tel Call to offer caller suppression of all dialouts. If set to YES, the patient will be able to select not to be phoned (DIAL OUT OFF). The patient will still be able to phone in. No  

 



Terms and Conditions:

Vendors: Basildon and Thurrock NHS trust

Purchaser: Local clinic name: .................................................................

Date of contract: .................................................................

The vendor disclaims any responsibility for any harm that may arise due to delay, failure of transmission, inaccuracy in transmission of any report. It is wholly the responsibility of the Purchaser to ensure that all INR RELAY reports are accurate and timely; and it is mandatory that the purchaser undertake adequate validation (and revalidation) as necessary.

The Purchaser agrees to comply with the licence agreements of the client software provided by the Vendor and to keep safe and confidential any patient data on the system. The Purchaser agrees to maintain and keep secure any computer hardware provided by the Vendor, and to insure against any loss, damage or theft. The Purchaser agrees to pay for all running costs of the client software and hardware. The Purchaser agrees not to use the client hardware for any other purpose other than to operate the INR CLIENT system. The Purchaser agrees to pay the Vendor up to £1000 to replace lost, stolen or damaged client hardware or software. The Purchaser agrees to pay to the Vendor within 30 days of receipt of invoice from the Vendor. The minimum term for this agreement is 12 months. After twelve months, either party may terminate this agreement with one months notice, and on termination, the Purchaser will return to theVendor , at no cost to the Vendor , all client hardware and software in good working condition.

On the signing of this agreement, the Vendor agrees to pay the Purchaser £1500 (ex VAT), in consideration of the provision of client hardware and software to the vendor and the creation of a software interface tool to import the Vendor,s data, the said amount is non-refundable.

The Purchaser is wholly responsible for dealing with patient complaints. The vendor disclaims any responsibility to deal directly with the Purchaser's patients. INR RELAY will supply on request the audit activity log to the originating clinic of any patient's automated activity. The Vendor will co-operate with the Purchaser to rectify any error or omission in transmission, the costs for such rectification to be met wholly by the Purchaser.

The Purchaser agrees to pay to the vendor within 30 days of receipt of invoice from vendor.


Signed: ........................................................... For the Purchaser



Signed: ............................................................. For the Vendor


CONTACTS
Postal Address Dept Haematology                                                                                        Basildon & Thurrock NHS Trust                                                               Nether Mayne                                                                                                    Basildon                                                                                                           Essex   UK SS16 5NL                     
Telephone 0044 (0) 1268 593016
Fax 0044 (0) 1268 593020
Email plcervi@pacehealthsystems.com
   
OUR  TEAM  
Dr Paul Cervi Consultant Haematologist
Dr Tony Everitt Consultant Chemical Pathologist
Mr Bob Duck IT Manager
Mrs Kath Roche Secretary
Mr Chris Luff Anticoagulant clinic administrator