Cinapsis - Revolutionizing Eyecare with Electronic Referral System

dominic@cinapsis.org
www.cinapsis.org
NHS England and Improvement Midlands Region
EeRS – Midlands Deployment
2023
Objectives
Cinapsis – Brief Overview of the team
What is EeRS
Expected Benefits
Proposed delivery approach
Q&A
Brief Introduction to Cinapsis
 
Relevant Senior
Contacts
Recent Project
Delivery Success
Examples
Interfacing
Dominic Markham
Head of Delivery
Anca Leucon
Training and Support Lead
Bath, Swindon & Wiltshire ICS
- Multiple Services
120 Services (planned & urgent care)
Handling urgent & planned care from
Ambulatory Care, MoD, GP’s,
Community Providers
2422 Users
Called out as Exemplar deployment by ICS
Live within 3 months from
commencement, replacing incumbent
provider with no operational disruption
Ongoing transformation programme
Positive user feedback
Cambridgeshire & Peterborough
ICS
- EeRS
Deployed successfully on time as one of
the first EeRS providers to market
Demonstratable continued improvement
to tailor and develop the solution in
response to customer feedback
Cinapsis were a member of the Alpha
team, working in partnership with  NHSE
and a small working group to define the
PMS API specification
Positive feedback from SP’s & Optoms
Cheshire & Merseyside ICS
- Teledermatology
Fully live in Liverpool, with active roll
outs in Cheshire and Merseyside
Supporting a reduction in avoidable
demand by up to 50%
Demonstratable evidence of continued
improvement
Positive user feedback in Acute and
Primary Care
Building Better HealthCare Award
Finalist 2022
Mick Vought
Product Manager
Mike McSweeney
Information Governance Lead
Bruce Richards
Head of Engineering
Dr Owain Rhys Hughes
CEO
Carl Woodroffe
Business Development
Manager
Georgia Kingston
Head of Marketing
EPS/PAS
(FHiR/HL7)
PDS
NHS
App
eRS
NHSE
EeRS API
EMIS
Systmone
Systmone
Community
NHS DLP
MESH
Rahman Malik
UX Design Lead
William Lee
CTO
 
What is an Electronic Eyecare Referral System (EeRS)?
 
Put simply:
 
EeRS systems help bring Ophthalmology into the digital age, removing paper based or unsecure
processes from the patient journey and empowering experts in eyecare to better manage patient
care
 
Cinapsis’ EeRS system can support both referrals and advise and guidance, helping clinicians better
communicate, learn and to deliver the best patient outcomes.
 
 
Lets have a look at a recent BBC Look East clip (under 4 mins):
 
 
To see a demo of Cinapsis, register here:
 
Live TV
Cinapsis Demo
Indicative Cinapsis EeRS Referral Process with eRS interface
 
Triage case & select
Outcome on
Cinapsis
Optical Practice
(Referrer)
GP Practice
SP
Booking Team
SP Ophthalmologist
Referral
required
Patient
Patient visits
clinician &
presents
symptoms
Patient informed
N
Y
GP
Optical
Practice
Select destination for
outcome, complete
referral / A&G form
request & attach
images on Cinapsis
Cinapsis Case
Outcome sent
as Cinapsis
Case / Alert &
email
As per current
process
Visit
to
eRS
SP
Secretarial Team
Booking team logs in
with Smartcard and
releases referrals from
Cinapsis to eRS
*
Patient booking
completed by booking
team
***
*Note – Can be done as a
batch task
Outcome letter sent
into Cinapsis inbox
& nominated
practice nhs.net
account
Action taken
GP
 received 
copy
of outcome letter
(if GP details
available)
Emailed (if details provided
to Cinapsis) – new MESH
enabled integration will
capture all GP’s
&
Uploaded to
patient encounter
Outcome
letter
emailed
**
&
UBRN added
to Outcome
letter
**Note – action by secretary may not be required if booking
team update encounter. Process can be automated via
EPR/PAS integration if required(not procured)
Patient informed
***Note – For referrals, start
date will need adjusting to
case start date until NHSE
deliver enhanced API
Expected Benefits
Reduce patient
delays
Local DOS - support
right first time data
sets
Education
(e.g. signposting,
A&G)
Reduce/Eliminate
avoidable
referrals
Multi directional
flows
Fully electronic
flow (reduced IG
& clinical risk)
Send valuable
clinical Imaging e.g.
Full volumetric OCT
Free up GP time
Improved
visibility for
Referrer & SPs
High quality data/insight (support strategic decision making across ICS & SP Orgs)
Enable better use
of community
resources
Improved QoL
outcomes
User friendly
platform, saving
clinicians time
Etc…
Proposed Delivery Approach
 
Transition
Proposed Approach to Delivery (Prince 2)
PLANNING &
DESIGN
GO LIVE
TRAINING
TESTING
IMPLEMENTATION
Identify & engage core project
team
Identify referrer
organisations/contacts - initiate
early phase comms
Demo session(s) with core
stakeholders e.g. Service
Providers, LOC, Community
Providers, GPs, etc.
Outline service design (inc. DOS
structure) and integration
requirements captured based
on agreed scope
Submit any development needs
Refine & approve detailed ToR
& Plan
Agreement to proceed to
Delivery
DPIA approved and DPAs signed
by SP’s & Optom Practices
participating in project testing
CSO review/approval
Build to specification, with
iterative workshops to refine SP
requirements
Functional requirements
approved
Reporting requirements
approved
Interfacing requirements
approved
*Registration of Interest
communications distributed
Agreement to proceed to
Testing
Iterative feedback and
refinement to EeRS
solution based on user
feedback
UAT/Functional Testing
completed & approved
Live environment ready
Cinapsis Project to Support
Handover
Agreement to proceed to
Training
Optometrist webinar
events / online learning
SP training Webinars
(Admin/Clinical)
ICS Training on Cinapsis
ICS Dashboards
Training collateral shared
/Knowledge Base access
Bespoke onsite training (if
required)
Technical/ Operational
Readiness Sign Off
Launch Comms issued
Agreement to Go Live
Participating organisations
enabled for live use
ICS & Operational Acute
Service staff monitor
utilisation via Cinapsis
Dashboard
Collaborative work to drive
uptake/registration
Cinapsis Support engaged
to assist users with Issues,
or additional training
needs
Continual Review &
Improvement
Agreement to proceed to
next delivery
Control gates
COMMERCIAL
AGREEMENT &
INITIATION
Contractual agreement and
approval
Cinapsis and Authority
appoint Programme
Manager & Sponsor
Identify in scope ICS’
Indicative ToR & Plan
agreed
Risk Management
approach agreed
Trigger recruitment of
additional Project, Training
and Implementation
resources
Agreement to proceed to
Design
Delivery
*Flexibility in the phase
this is triggered in
Design
Pre-Implementation
E
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Cinapsis/ICS PM - Identify Trust Resources & on-board to NHSEM
EeRS Project Team
Cinapsis - Webinar for Trust/ICS Project Teams
ICS IG Lead /Cinapsis- Complete DPIA & Data Sharing Agreement
ICS CSO - Complete Clinical safety Case Report
SP IT - whitelist app.cinapsis.org & check firewalls are open, deploy
Toolbar to booking team members for eRS Integration activity
Cinapsis - Set-up Development, Test & Production environments
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ICS – Update onboarding tracker with basic referrer details
LOC/ICS – Engagement Comms
Cinapsis - Webinar with Practice Mgrs to demonstrate EeRS platform
Practice - Register interest with Cinapsis and return signed DPA
Cinapsis – Add lead Practice Admin and arrange training
Cinapsis - Training delivered to Optometrists (Group Webinars and/or
on demand modularised training)
All - Service go-live supported by User Comms
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Cinapsis - Engage Trusts & Practices to identify IT/EPR Systems
Cinapsis/SP PM/IT - Prepare e-RS integration processes
Cinapsis/SP PM/IT - Carry out e-RS system integration
Cinapsis/SP PM/IT - Carry out PAS/EPR integration roll-out
Cinapsis - Facilitate activation for Optom PMS integration
(availability dependent on PMS supplier build status)
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ICS - Identify Clinical, Service, IT, BI and booking lead for each SP
Cinapsis - Webinar to demo EeRS platform & how to configure the service
SP - Complete ‘Service On-boarding’ form
Cinapsis – Workshops to refine service with Clinical & Service Leads
Cinapsis – Add Lead users
SP – Add remaining clinical/admin users
Cinapsis/SP/LOC - Peer Groups feedback – Cinapsis update/log changes
Cinapsis - Training webinar delivered to Clinician & Admin Users
All - Service go-live supported by User Comms
Summary of Activity
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How can I get my Optometry Practice ready?
The process will be quite simple when you join and more information will be shared by the project team.
To help ready your practice, two key activities will be to:
1) Ensuring your practice is DSPT compliant
Optom Practices can use the Quality in Optometry website to walk through the accreditation and submission process. This is recommended as the journey and required steps are clearly laid out as a
walk through. Link: 
Quality in Optometry – Login
Alternatively, further information is available here (you can also submit your DSPT registration directly through the DSPT portal if preferred): 
https://www.dsptoolkit.nhs.uk/Help
2) Identifying a stakeholder in your organisation to approve a Data Processing Agreement
The project team will share the Data Processing agreement with you when Cinapsis is commissioned into your area
Proposed Roll Out Plan
 
Proposed Roll out Plan
Pilot 2
Live Aug ‘23
Pilot 1
Live July ‘23
Planning &
Design
Implementation
Testing
Training
Pilot 1 ICS
Transition
High level plan based on tender requirements from NHSE England and Improvement
Midlands Region tender (contract signed end Feb ‘23)
Initiation start date dependent on ICS readiness to start and commercial approval (below
dates are estimates
Roll out can be expedited if required
Pre-
implementation
Pilot 2 ICS
Transition
Pre-Transition
Activity
Pre-Transition Activity
Phase 3 (3XICS)
Transition
Pre-Transition Activity
Phase 3
Live March ‘24
Phase 2
Live Feb ‘24
Phase 2 (3XICS)
Transition
Pre-Transition Activity
Phase 1
Live Jan ’23
Phase 1 (3XICS)
Transition
Pre-Transition Activity
Phase 2 Review & Assess Pilot
Phase 1-3 Go/No-Go
Sept ‘23
Pilot
Full Roll Out
Start
Mid Mar 23
Lessons Learnt from EeRS Deployments
 
Resource - Lessons
Project resources 
- should be assigned by each ICS to support the programme roll out
Clinical and Operational leads within each SP 
will be required, as well 
as booking team representation 
to support testing and configuration of eRS integration and end to end workflow
A 
senior sponsor per Service Provider 
is also advised, to act as a change ambassador
SP job planning 
– Operational and clinician leads should consider job planning to ensure pathways are resourced
SP ICT and Integration resource 
is in high demand, presenting a risk for EPR integration. We recommend provisional discussions are undertaken with Service Providers IT leadership to
identify any risks and ensure the required teams are made available to support interoperability deployment, testing and go live
SP project management/change teams – 
If relevant, activity should be mapped in for them to support technology roll out in line with normal processes
Commissioning/Service Ownership – To truly realise benefits, SP’s and commissioners should appoint ownership to monitoring performance once in BAU
Managing Change - Lessons
Current ways of working – 
There is often a lack of understanding in ICBs/SPs of current state - mapping this is vital to successful change. Recommendation work is undertaken by each
area Service Provider to document current ways of working. This will significantly facilitate any project rollout, as well as reducing risks.
Communication -
 Service Provider and LOC engagement with Optoms to encourage uptake is vital, as is considering the closure of dual working e.g. continuing to maintain email A&G,
when user should be encouraged to use the new EeRS service
Advice & Guidance - 
hugely value by Optoms and to improve patient care – if not in place, this should be considered to encourage uptake & help deliver demand elimination
Who are the Optoms
No single complete data source 
- NHSE data can be out of date and LOC data does not always contain a full list of all sites, especially those referring from nearby borders. Relevant
contact data within Optom Practices is also an issue. We recommend the ICBs undertake a joint exercise with NHSE, SP’s and the LOC to amalgamate and cleanse the data source and
contacts of referrers
Technical
RTT
 – A technical limitation of the eRS API means only the UBRN creation date, rather than the case creation date is recorded in eRS. This works well when converting A&G to a referral,
but SP’s may need to include a manual adjustment of the start date for referrals (to align to the date a case was created – data is on the pdf sent via the API and in supplier data). If the SP
workflow auto-converts cases from eRS to their ePR, this action normally involves using the function in eRS to “book outside of eRS” (then enter manually into the ePR) or the SP opening
up the permission for a group of users to adjust the start date once in the EPR. SP’s normally undertake similar workarounds due to multiple processes into the Trust e.g. email referrals,
Dentistry referrals, other A&G systems which are used for referrals (e.g. dentistry, etc)
Any Questions?
 
END
Thank you
 
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Cinapsis is a cutting-edge healthcare technology company offering an Electronic Eyecare Referral System (EeRS) to digitize and streamline ophthalmology referrals. Their innovative platform enhances patient care by facilitating secure communication, guidance, and referrals among eyecare professionals, ultimately leading to improved outcomes. Cinapsis has seen success in various Integrated Care Systems, showcasing significant reductions in avoidable demand and continuous system enhancements based on user feedback. Learn more about their transformative solutions and recent achievements in advancing eyecare services.

  • Healthcare technology
  • Electronic referral system
  • Eyecare innovation
  • Ophthalmology advancement
  • Patient outcomes

Uploaded on Apr 17, 2024 | 5 Views


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  1. NHS England and Improvement Midlands Region EeRS Midlands Deployment 2023 dominic@cinapsis.org www.cinapsis.org

  2. Objectives Cinapsis Brief Overview of the team What is EeRS Expected Benefits Proposed delivery approach Q&A

  3. Brief Introduction to Cinapsis Dr Owain Rhys Hughes CEO William Lee CTO Relevant Senior Contacts Georgia Kingston Head of Marketing Mike McSweeney Information Governance Lead Bruce Richards Head of Engineering Rahman Malik UX Design Lead Dominic Markham Head of Delivery Anca Leucon Training and Support Lead Mick Vought Product Manager Carl Woodroffe Business Development Manager Cambridgeshire & Peterborough ICS - EeRS Bath, Swindon & Wiltshire ICS - Multiple Services 120 Services (planned & urgent care) Handling urgent & planned care from Ambulatory Care, MoD, GP s, Community Providers 2422 Users Cheshire & Merseyside ICS - Teledermatology Fully live in Liverpool, with active roll outs in Cheshire and Merseyside Deployed successfully on time as one of the first EeRS providers to market Recent Project Delivery Success Examples Supporting a reduction in avoidable demand by up to 50% Demonstratable continued improvement to tailor and develop the solution in response to customer feedback Called out as Exemplar deployment by ICS Demonstratable evidence of continued improvement Live within 3 months from commencement, replacing incumbent provider with no operational disruption Cinapsis were a member of the Alpha team, working in partnership with NHSE and a small working group to define the PMS API specification Positive user feedback in Acute and Primary Care Ongoing transformation programme Building Better HealthCare Award Finalist 2022 Positive user feedback Positive feedback from SP s & Optoms EMIS Systmone Systmone Community NHS DLP MESH NHS App NHSE EeRS API EPS/PAS (FHiR/HL7) PDS eRS Interfacing

  4. What is an Electronic Eyecare Referral System (EeRS)? Put simply: EeRS systems help bring Ophthalmology into the digital age, removing paper based or unsecure processes from the patient journey and empowering experts in eyecare to better manage patient care Cinapsis EeRS system can support both referrals and advise and guidance, helping clinicians better communicate, learn and to deliver the best patient outcomes. Live TV Lets have a look at a recent BBC Look East clip (under 4 mins): To see a demo of Cinapsis, register here: Cinapsis Demo

  5. Indicative Cinapsis EeRS Referral Process with eRS interface Patient Optical Practice (Referrer) SP SP GP Practice SP Ophthalmologist Booking Team Secretarial Team Patient visits clinician & presents symptoms As per current process *Note Can be done as a batch task Select destination for outcome, complete referral / A&G form request & attach images on Cinapsis GP Booking team logs in with Smartcard and releases referrals from Cinapsis to eRS* Triage case & select Outcome on Cinapsis Cinapsis Case eRS Visit to Optical Practice & GP received copy of outcome letter (if GP details available) Uploaded to patient encounter Patient booking completed by booking team*** Emailed (if details provided to Cinapsis) new MESH enabled integration will capture all GP s Outcome letter emailed** Outcome letter sent into Cinapsis inbox & nominated practice nhs.net account UBRN added to Outcome letter N Y & Referral required ***Note For referrals, start date will need adjusting to case start date until NHSE deliver enhanced API Outcome sent as Cinapsis Case / Alert & email **Note action by secretary may not be required if booking team update encounter. Process can be automated via EPR/PAS integration if required(not procured) Patient informed Patient informed Action taken

  6. Expected Benefits Fully electronic flow (reduced IG & clinical risk) Education (e.g. signposting, A&G) Enable better use of community resources Multi directional flows Local DOS - support right first time data sets Reduce/Eliminate avoidable referrals Improved QoL outcomes Free up GP time Send valuable clinical Imaging e.g. Full volumetric OCT User friendly platform, saving clinicians time Improved visibility for Referrer & SPs Reduce patient delays Etc High quality data/insight (support strategic decision making across ICS & SP Orgs)

  7. Proposed Delivery Approach

  8. Proposed Approach to Delivery (Prince 2) Control gates *Flexibility in the phase this is triggered in Transition Design Pre-Implementation Delivery COMMERCIAL AGREEMENT & INITIATION PLANNING & DESIGN IMPLEMENTATION TESTING TRAINING GO LIVE Contractual agreement and approval Iterative feedback and refinement to EeRS solution based on user feedback Participating organisations enabled for live use Optometrist webinar events / online learning Identify & engage core project team DPIA approved and DPAs signed by SP s & Optom Practices participating in project testing Cinapsis and Authority appoint Programme Manager & Sponsor ICS & Operational Acute Service staff monitor utilisation via Cinapsis Dashboard SP training Webinars (Admin/Clinical) Identify referrer organisations/contacts - initiate early phase comms CSO review/approval UAT/Functional Testing completed & approved ICS Training on Cinapsis ICS Dashboards Build to specification, with iterative workshops to refine SP requirements Identify in scope ICS Demo session(s) with core stakeholders e.g. Service Providers, LOC, Community Providers, GPs, etc. Live environment ready Collaborative work to drive uptake/registration Indicative ToR & Plan agreed Training collateral shared /Knowledge Base access Cinapsis Project to Support Handover Functional requirements approved Cinapsis Support engaged to assist users with Issues, or additional training needs Risk Management approach agreed Bespoke onsite training (if required) Outline service design (inc. DOS structure) and integration requirements captured based on agreed scope Reporting requirements approved Trigger recruitment of additional Project, Training and Implementation resources Technical/ Operational Readiness Sign Off Continual Review & Improvement Interfacing requirements approved Submit any development needs Launch Comms issued Refine & approve detailed ToR & Plan *Registration of Interest communications distributed Agreement to proceed to Design Agreement to proceed to Training Agreement to proceed to next delivery Agreement to Go Live Agreement to proceed to Delivery Agreement to proceed to Testing

  9. Summary of Activity EeRS Set-up Process (Design Deliver) Cinapsis/ICS PM - Identify Trust Resources & on-board to NHSEM EeRS Project Team Cinapsis - Webinar for Trust/ICS Project Teams ICS IG Lead /Cinapsis- Complete DPIA & Data Sharing Agreement ICS CSO - Complete Clinical safety Case Report SP IT - whitelist app.cinapsis.org & check firewalls are open, deploy Toolbar to booking team members for eRS Integration activity Cinapsis - Set-up Development, Test & Production environments Create EeRS Service (Deliver Transition) Secondary Care Ophthalmologists Create EeRS Service (Deliver Transition) Primary Care Optical Practice Providers (OPP), Community Providers ICS - Identify Clinical, Service, IT, BI and booking lead for each SP Cinapsis - Webinar to demo EeRS platform & how to configure the service SP - Complete Service On-boarding form Cinapsis Workshops to refine service with Clinical & Service Leads Cinapsis Add Lead users SP Add remaining clinical/admin users Cinapsis/SP/LOC - Peer Groups feedback Cinapsis update/log changes Cinapsis - Training webinar delivered to Clinician & Admin Users All - Service go-live supported by User Comms ICS Update onboarding tracker with basic referrer details LOC/ICS Engagement Comms Cinapsis - Webinar with Practice Mgrs to demonstrate EeRS platform Practice - Register interest with Cinapsis and return signed DPA Cinapsis Add lead Practice Admin and arrange training Cinapsis - Training delivered to Optometrists (Group Webinars and/or on demand modularised training) All - Service go-live supported by User Comms EeRSSystem Integration Cinapsis - Engage Trusts & Practices to identify IT/EPR Systems Cinapsis/SP PM/IT - Prepare e-RS integration processes Cinapsis/SP PM/IT - Carry out e-RS system integration Cinapsis/SP PM/IT - Carry out PAS/EPR integration roll-out Cinapsis - Facilitate activation for Optom PMS integration (availability dependent on PMS supplier build status) Key: SP = Service Provider

  10. How can I get my Optometry Practice ready? The process will be quite simple when you join and more information will be shared by the project team. To help ready your practice, two key activities will be to: 1) Ensuring your practice is DSPT compliant Optom Practices can use the Quality in Optometry website to walk through the accreditation and submission process. This is recommended as the journey and required steps are clearly laid out as a walk through. Link: Quality in Optometry Login Alternatively, further information is available here (you can also submit your DSPT registration directly through the DSPT portal if preferred): https://www.dsptoolkit.nhs.uk/Help 2) Identifying a stakeholder in your organisation to approve a Data Processing Agreement The project team will share the Data Processing agreement with you when Cinapsis is commissioned into your area

  11. Proposed Roll Out Plan

  12. High level plan based on tender requirements from NHSE England and Improvement Midlands Region tender (contract signed end Feb 23) Proposed Roll out Plan Initiation start date dependent on ICS readiness to start and commercial approval (below dates are estimates Roll out can be expedited if required Start Full Roll Out Pilot Mid Mar 23 Pilot 1 Live July 23 Pilot 2 Live Aug 23 Phase 1-3 Go/No-Go Sept 23 Phase 3 Live March 24 Phase 2 Live Feb 24 Phase 1 Live Jan 23 Pre-Transition Activity Pre- implementation Planning & Design Phase 2 Review & Assess Pilot Implementation Phase 1 (3XICS) Transition Pre-Transition Activity Testing Pilot 1 ICS Transition Phase 2 (3XICS) Transition Training Pre-Transition Activity Pilot 2 ICS Transition Phase 3 (3XICS) Transition Pre-Transition Activity Pre-Transition Activity

  13. Lessons Learnt from EeRS Deployments Resource - Lessons Project resources - should be assigned by each ICS to support the programme roll out Clinical and Operational leads within each SP will be required, as well as booking team representation to support testing and configuration of eRS integration and end to end workflow A senior sponsor per Service Provider is also advised, to act as a change ambassador SP job planning Operational and clinician leads should consider job planning to ensure pathways are resourced SP ICT and Integration resource is in high demand, presenting a risk for EPR integration. We recommend provisional discussions are undertaken with Service Providers IT leadership to identify any risks and ensure the required teams are made available to support interoperability deployment, testing and go live SP project management/change teams If relevant, activity should be mapped in for them to support technology roll out in line with normal processes Commissioning/Service Ownership To truly realise benefits, SP s and commissioners should appoint ownership to monitoring performance once in BAU Managing Change - Lessons Current ways of working There is often a lack of understanding in ICBs/SPs of current state - mapping this is vital to successful change. Recommendation work is undertaken by each area Service Provider to document current ways of working. This will significantly facilitate any project rollout, as well as reducing risks. Communication - Service Provider and LOC engagement with Optoms to encourage uptake is vital, as is considering the closure of dual working e.g. continuing to maintain email A&G, when user should be encouraged to use the new EeRS service Advice & Guidance - hugely value by Optoms and to improve patient care if not in place, this should be considered to encourage uptake & help deliver demand elimination Who are the Optoms No single complete data source - NHSE data can be out of date and LOC data does not always contain a full list of all sites, especially those referring from nearby borders. Relevant contact data within Optom Practices is also an issue. We recommend the ICBs undertake a joint exercise with NHSE, SP s and the LOC to amalgamate and cleanse the data source and contacts of referrers Technical RTT A technical limitation of the eRS API means only the UBRN creation date, rather than the case creation date is recorded in eRS. This works well when converting A&G to a referral, but SP s may need to include a manual adjustment of the start date for referrals (to align to the date a case was created data is on the pdf sent via the API and in supplier data). If the SP workflow auto-converts cases from eRS to their ePR, this action normally involves using the function in eRS to book outside of eRS (then enter manually into the ePR) or the SP opening up the permission for a group of users to adjust the start date once in the EPR. SP s normally undertake similar workarounds due to multiple processes into the Trust e.g. email referrals, Dentistry referrals, other A&G systems which are used for referrals (e.g. dentistry, etc)

  14. Any Questions?

  15. END Thank you

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