V20.2 Release Notes

V20.2 is a limited release for enterprise customers, containing major changes to medication management, new features, and extensive maintenance updates and bug fixes.

Prerequisites

Because of the schema changes associated with the medications changes, all existing customers should run the following report before upgrading to V20.2 and resolve any issues: Unprescribed Regular Medications.

Note: If you have any custom reports that use medications tables or views directly, ensure you check Database Schema changes. If you are affected, discuss migration options with Communicare Support.

Medications changes

Communicare V20.2 consolidates major changes to the way medications are recorded and handled in Communicare.

Prescribing has been split into three new actions:

Write a Prescription - use when you want to print a prescription and give it to a patient to fill outside your health service
Create a Medication Order - use when you want to administer or supply medication from within your health service
Record Medication History - use when you want to record any medication the patient may have taken, but that was not provided by your health service

Write a Prescription

Write a Prescription is the new workflow for recording a medication that can be printed and given to the patient.

To write a prescription, in the clinical record, select Medication > Add Medication > Write a Prescription tab.

The user interface has been streamlined to make adding a medication much easier. For example, to reduce the number of clicks when adding a medication, the PBS authority details section is now in the main window.

For more information, see Write Prescriptions.

Create a Medication Order

Create a Medication Order is a new workflow that streamlines the process of adding a medication that will be supplied or administered within the health service under circumstances that don't require a printed prescription form.

To create a medication order, in the clinical record, select Medication > Add Medication > Create a Medication Order tab.

When Medication Management is enabled in System Parameters, medication orders are required to administer or supply a medication.

Because a written prescription is not required, the user interface is greatly simplified and only contains the information required. For example, there is no requirement to select the payment scheme and enter any PBS details as medications orders are considered to be private.

Medication orders also contain the verbal or written telephone order workflow which is now displayed in the main window when appropriate.

For more information, see Create Medication Orders.

Record Medication History

We've added the ability to create Medication History items for a patient, so that you can add medications provided by another health service to a patient’s clinical record.

To record medication history, in the clinical record, select Medication > Medication History.

Certain actions, like prescription printing and repeating, are not available for Medication History items. Users for whom the Medication View module is enabled and who belong to a User Group with Medication History system rights can use this option. When recording a medication history item, all users can browse medications, regardless of their Scope of Practice.

For more information, see Medication History.

Administer & Supply

With the introduction of Medication Orders, dispensing a medication is no longer required to record the administration or supply of medication.

We have merged the Supply and Administration windows into a single window called Administer & Supply, which shows all administration and supply actions performed in a single service. This makes it easier for customers who typically supply medication but may administer a single dosage before the patient leaves.

To administer or supply a medication, in the clinical record, select Medication > Administer & Supply.

Imprest recording has been separated from the recording of administration and supply quantity. We have introduced the concept of Open Stock which refers to an item of medication that has been opened and had some of its contents removed. You can now record New Open Stock when you open a pack or bottle of medication to administer or supply some of the contents and have stored the medication back in the drug cupboard or fridge. You can also record Open Stock Finished when the provider finishes off a bottle or pack of medication that was previously opened.

Administration now allows you to record multiple administration attempts and reasons for failure, such as if the patient reacted to the medication and vomited. Administration attempts over the last 24 hours are always shown to give you an insight into how much medication is currently in a patient's system.

For both administer and supply records, you can now record decimal quantities and units.

For more information, see Administer and Supply Medication.

Finalise Prescriptions

Instead of printing prescriptions, prescribers can now finalise prescriptions to generate a script number. If required, prescribers can then print the prescriptions. Non-prescribers cannot finalise prescriptions.

To finalise medications after you have added them, in the clinical record, on the Summary > Medication Summary tab, click Finalise Prescriptions.

For more information, see Finalise Prescriptions.

Medication Requests

Medication requests combine a patient's medications into a bulk-order prescription specifically for sending to a pharmacy for dispensing.

Medication requests can be used to request the filling of a patient's prescriptions. Once dispensed, they are returned to the health service for supply to the patient directly. Instead of printing individual prescriptions, you can print a medication request which is the equivalent of a single batch prescription.

If you stock your patient's medications at your health service, or are the health provider for a remote site that stocks medications for your patients, you can use medication requests to help manage the patient's medications. This is particularly useful for rural and remote health services who operate under the S100 scheme.

Medication requests are not enabled by default. Enable medication requests on the File > System Parameters > Prescription Forms tab.

For more information, see Medication Requests.

Active Ingredient Prescribing

To meet the Active Ingredient Prescribing legislation (2019), mandatory from 1 February 2021, generic prescribing is now mandatory in Communicare by default.

The legislative changes require the inclusion of active ingredients on all Pharmaceutical Benefits Scheme (PBS) and Repatriation PBS (RPBS) prescriptions, except for handwritten prescriptions, medicinal items with four or more active ingredients and a number of other specified items included in LEMI and LMBC.

Prescribers may continue to include a brand name on prescriptions wherever clinically necessary for their patient. When you prescribe by brand, the format of the medication displayed in and printed from Communicare is now as follows:

generic strength form (BRAND_NAME)

The list of excluded medicinal items (LEMI) and list of medicines for brand consideration (LMBC) lists are also observed.

Prescriptions created before the introduction of active ingredient prescribing are displayed according to the new rules if doing so does not change the original intent of the prescriber.

For those medications on the LEMI, prescriptions created before the upgrade are displayed as intended by the original prescriber. However, if a prescription is represcribed or reprinted, the format abides by the new rules for prescriptions, except for medications that are represcribed in bulk. For these medications, if they were prescribed by active ingredient before the upgrade and are on the LEMI, they are represcribed by active ingredient.

For more information, see Active Ingredient Prescribing.

To meet the requirements of the legislation, set your Prescribing Options to Generic Prescribing. For more information, see Prescribing options in System Parameters - Clinical .

COVID-19 Immunisation clinical item changes

To allow COVID-19 immunisations to be uploaded to the AIR, we've added two new fields to the Immunisation clinical item. Clinicians can:

Use the Serial Number field to record the serial number of the vaccine. For COVID-19 immunisations you can make inclusion of a serial number mandatory. For more information, see Clinical Item Type Properties.
Use the Administered overseas field instead of the Performed at current encounter place field to indicate historical immunisations that were performed overseas.

Adjusting Medications

We've added the ability to change the duration or until date of a medication and the comments. This feature is useful when a provider tells the patient to take more or less of a medication they have already been prescribed as a reminder to review the medication at an appropriate time.

For more information, see Adjust Medications.

Bulk Stop

If you have full or once-off prescribing rights, you can stop multiple current or expired regular and once-off medications simultaneously.

To stop multiple medications, in a patient's clinical record, on the Summary > Medication Summary tab, click Stop Medications.

For more information, see Stop Multiple Medications.

Medication Confirmation message

We have introduced a new feature that allows a message to be displayed before recording a medication in Communicare. This message is useful for displaying a disclaimer or other information that a practitioner must confirm before adding a medication. It appears once per clinical record session. Set the message in File > System Parameters > Appearance tab.

For more information, see System Parameters - Appearance.

(V20.1) Scope of Practice changes

In previous releases, Communicare had two ways for determining if a verbal telephone order was required when adding a medication: either by configuring the provider and selecting the drug schedules that required verbal orders; or by marking the provider as Exempt if Standing Order and publishing a single standing order formulary. Any medications on that Standing Order formulary would not require a verbal order for the configured provider.

We have made the following changes in this release:

Renamed Standing Order to Scope of Practice
Added the ability to have multiple Scope of Practice formularies. Each user group can be configured to use only the Scope of Practice formularies as required for their roles. Set the Scope of Practice for a user group on the File > User Groups > Scope of Practice tab.
The VTO drug schedules now work in combination with the Scope of Practice formularies. For example, you could select everything except S2 and S3, then configure a Scope of Practice formulary with a single S8 drug. This would allow the provider to order all S2 and all S3 medication as well as the single S8 drug without requiring a verbal order.

For more information, see Scope of Practice.

Regular medications

Regular medications now support program rights.

Medication Summary changes

The changes to medications management have resulted in slight changes to the medications included in the Medication Summary:

All active, regular medications are displayed, even if they are duplicates
All stopped, regular medications are displayed until their stopped date, even if they are duplicates
Expired regular medications are displayed if they are the most recent regular medication by product, form, and pack
All once-off medications and medication history items are displayed until their stopped or expiry date
Deleted medications are not displayed

Clinical decision support

In Communicare V20.2, we've extended clinical decision support.

Pregnancy interactions

When you add a new pregnancy to a patient, Communicare checks the patient's active medications for interactions with a pregnancy and warns of any possible interactions. Any resulting interactions are displayed in the interactions window and require the clinician to note the warnings. For more information, see Pregnancy Interactions.

When adding a medication to a patient who is marked as pregnant, Communicare now checks for any interactions with the generic components of that medication. Any resulting interactions are displayed in the interactions window and require the clinician to note the warnings. For more information, see Medication Warnings.

Pregnancy interaction checking only applies to female patients.

Note: Each interaction has its own pregnancy category. It is possible for a medication to have a different pregnancy category to its specific interactions. It is also possible for a medication to have a high pregnancy category, but not have a pregnancy category. It is the clinician's responsibility to check the pregnancy category of the medication as well as any specific interactions.

Clinical record changes

(V20.1) Patient banner

We have enhanced the patient banner at the top of the Clinical Record to better emphasise important clinical information and allow clinicians to have this information follow them wherever they are in the clinical record screen.

The patient banner now includes the following information:

Patient name
Date of birth
Age
Sex
Communicare's Patient ID
Medical Record Number (where provided and configured)
Health Care Homes status (where enabled)
Pregnancy status - click to go to the Obstetrics summary
Medication Alert status - displayed if the patient has alerts. Click to go to the Medications Alerts section of the Clinical Record summary.
Allergies and Adverse reactions - lists as many allergies as possible. Click to go to the Adverse Reactions section of the Clinical Record summary.
Actions List:
- Active verbal orders
- Unreviewed documents
- Open investigation requests and unreviewed results
- Whether or not the patient has immunisations recorded

(V20.1) Structured alerts

Medical alerts have traditionally been stored as free text against a patient’s clinical record and there has been no way to easily report on alerts or control the data entered in them. In V20.1 we introduced a new Clinical Item class type of Alert to allow health services to control what information they capture for an alert. This new clinical item can be used to capture any data that a health service may like and can be used in recall rules to create clinical workflows within your practice. Alert clinical items have an additional status property used to track the state of the medical alert for the patient. These statuses are:

Active - the alert is current and requires consideration by the health service.
Inactive - the alert is no longer current but may have an impact on future encounters.
Resolved - the alert is closed and no longer requires consideration by the health service.
Entered In Error - the alert was documented in error, either because the history was reported incorrectly or it was entered in error.

In addition to the clinical item type, health services can now enable the Structured Alerts module in System Parameters to replace the free text alerts area with a pane that lists all Alert clinical items and their current state.

Note: If you enable structured alerts, the alerts already entered in free text are not migrated to the new alert clinical items. If you would like to migrate your existing alerts, please give us a call and we can discuss the best approach for your implementation. Communicare's Professional Services team will scope and implement this feature as a separate, paid service.

The Alerts and Other Information Control system module has been renamed to Security on Alerts to clearly state what it does. This option continues to allow users to restrict access to view the Medical Alerts section of the clinical record.

For more information, see Alert information.

(V20.1) Reasons for Visit

We have introduced Reasons for Visit to support our customers varied reporting needs. This new functionality is visible on the Progress Notes tab of the Clinical Record and allows the practitioner to record up to four reasons for visit for the encounter. The practitioner can use any combination of the following options within the same encounter:

Clinical items - any condition clinical items recorded against the patient, and any other clinical items that were created during the current service.
General lookup values - using custom datasets. Discuss with Communicare Support if you want to use the option.
Free text

Enable Reasons for Visit on System Parameters > Clinical tab, Clinical Record Features section.

For more information, see Reasons For Visit.

(V20.1) SNOMED Codification for Clinical Item Types

You can now map a SNOMED concept to a clinical item type.

To map a SNOMED concept to a clinical item type, in the Clinical Item Type Maintenance window, click Advanced and enter the SNOMED concept you want to use. Concepts are validated after entry and return the Concept Name, Version and Code system using FHIR.

To make it easier to find the correct SNOMED concept, you can open SHRIMP, a free online browser of SNOMED terms provided by the CSIRO.

We've also updated the Central Clinical Items to include the SNOMED concept. If you have cloned these items, the concept will not be updated against your cloned item. In these cases it is best to copy the concept over from the item that was cloned, however if you have a large volume of cloned clinical items that you would like to update, please contact us to discuss how to proceed.

Minor enhancements

V20.2 includes the following minor enhancements:

In the Documents and Results window, we've added a new filter for selecting providers. The Select Provider window captures all providers with results in the selected date range.
You no longer need to manually enable Appointment Session Templates after you have created them.
The Letter Writer now has three additional Latest Qualifier options: Label Only, Value Only, Label and Value (available in earlier releases).
The Speciality Type description now includes and TSI.
When recording a patient's death, you can now indicate that you have verified the patient's death.
Investigation results now display OBX-8 abnormal flags.
You can now jump to the Medication summary from the Medications button menu.
You can now create a once-off medication for supply from a regular medication. In the Medication Summary, right-click a regular medication and select Create once-off medication order.
In the Medication Summary, you can now see the Medication History icon in the legend bar.
If you don't have Administration Rights, you can no longer access System Parameters.
We've updated the message displayed when a document has been removed from a patient's record to make it clearer.
The medical record identifier from the lab is now included in the investigation results.
Your Communicare password is now limited to 8 characters.
On the patient banner, we've renamed gender to sex.
For the Offline Client, we've included the Patient Consent table and added support for medications with verbal orders.
For Medical Objects, we now show clinical information in the result header, support FT indenting and handle HL7 escape.
If medication requests are enabled, you can supply medication request patient-specific inventory to a patient.
On the Medication Summary, you can now see what type a medication is, a prescription (#script_number), medication order (Order) or medication history (History).
Inventories, medication requests and medication grouping are included when patient records are merged or unmerged

V20.1 includes the following minor enhancements:

You can now mark clinical items as read-only to prevent them from being edited in Communicare. This feature is useful for integrations where the record may belong to an external system.
Enterprise customers can record additional patient identifiers for a patient, such as an extra MRN or identifiers from other systems. Use these identifiers in the Patient search to find a patient. For enterprise customers, Enable Extended Identifiers is set on the File > System Parameters > Patient tab.
If you have integrated with an Enterprise Master Patient Index, you can now search for patient details in the EMPI before adding the patient to Communicare. This feature is enabled with the EMPI Search module in System Parameters. If you would like to integrate your EMPI, please contact our Communicare Support.
We've split Printer Assignments for investigations into two settings Investigations - Pathology and Investigations - Imaging. This means that you can use different printers or trays when printing investigation requests for pathology or investigation requests for imaging. To use this feature, in File > Printer Assignments, set the printer and tray for each option.
We've added new options to File > Appointments. Appointments now include: Appointment Facilities, Requirements and Public Holidays.
You can now modify the message displayed when a user logs into the Communicare. Select File > System Parameters > Appearance tab and in the Login Message field, enter the message displayed in the Important text area in the Communicare login window.
We've added 7 new kin types and the ability to record extra kin information in Patient Biographics. To enable extra kin information, select File > System Parameters > System and set Structured Contacts.
Note: Do not enable this option without first contacting Communicare Support. Existing data may be lost if it is not first migrated. If your health service would like to use structured contacts, contact Communicare Support. Communicare's Professional Services team will scope and implement this feature as a separate, paid service.
Also in Patient Biographics, you can have custom fields added to the Additional tab. If you would like custom fields, please contact Communicare Support. Communicare's Professional Services team will scope and implement this feature as a separate, paid service.
We've added 33 new specialty types.
We've been working with Medical-Objects to improve incoming results.
We've added a new central clinical item: Assessment;Indigenous Risk Impact Screen known as IRIS.
For AIR upload changes:
- Extend immunisation clinical items to support serial number capture
- Extend AIR upload to include serial number
- Extend AIR upload to include identifier details
- Extend AIR upload to include overseas administered fields
- Update logic pack for client adapter and end to end test
- Make Serial no mandatory false for two COVID-19 vaccines
- Investigate how to stop clinical item closing on carriage return for serial number>

Central Data changes

The following changes have been made to Central Data items:

Healthy Under 5 Kids (HU5K) checks updated for 2019 specifications: 4 week check introduced, GP follow up introduced, new ASQ TRAK item included.
Cervical screening - enhancements to the dataset as recommended by IRIS Education
Addition of Results;bowel cancer screening, Results;prostate cancer screening and Results;breast cancer screening to complement the existing Results;cervical screening items. Recall protocols can be set up with the existing ICPC2-PLUS terms of Screening;bowel cancer, Screening;prostate cancer and Screening;breast cancer.
Two new drawing qualifiers of odontograms for adults and children have been added and can be attached to local clinical items as desired.
The options for the Pulse rate assessment and Pulse rhythm qualifiers have been adjusted.
All hyperlinks from central clinical item definitions have been reviewed and updated or removed if appropriate.

Database Schema changes

The schema for medications has changed to support the new streamlined approach to regular medications as well as support for different types of medications.

Note: If you have any custom reports that use the following tables or views directly, discuss migration options with Communicare Support.

Table 1. Database schema changes
Schema	Description
PAT_PRESCRIPTION	MEDICATION_TYPE 1 = Medication Prescriptions 2 = Medication Orders 3 = Medication History Items REGULAR_MEDICATION True or False to indicate if the medication is a regular medication Also applies to Medication History items
PAT_REGULAR_MEDICATION_VIEW	This view still displays the latest active regular medications Regular medications are now just normal PAT_PRESCRIPTION records and can be identified by REGULAR_MEDICATION = T The view now includes all the columns from PAT_PRESCRIPTION
PAT_REGULAR_MEDICATION	Renamed to PAT_REGULAR_MEDICATION_DEPRECATED to prevent access to stale data.
PAT_REG_MED_PRESCRIPTION_VIEW	Deprecated and will be removed in a future release. If you use this view, contact Communicare Support.
FORMULARY	IS_STANDING_ORDER has been renamed to IS_SCOPE_OF_PRACTICE
PROVIDER	EXEMPT_STANDING_ORDER seems has been renamed to USE_SCOPE_OF_PRACTICE
PROVIDER_ORG_VIEW	EXEMPT_STANDING_ORDER seems has been renamed to USE_SCOPE_OF_PRACTICE
MED_SUPPLY	PACKAGE_TYPE_ID has been removed

Bug fixes

The following bugs have been fixed in V20.2:

Test WACHS performance fixes
Modifying incoming referrals causes error
Fix performance related issue on joining PAT_REGULAR_MEDICATION_VIEW
Error on adding medication of greater than 120 length in letter writer
Fix migration script V20.2 branch
AIR claims fail on using Other Vaccination Provider
Fix issue when delete Immunisation Progress Note
Serial number with invalid characters saved in Detail tab
Fixed the status tag missing from the Detail tab
Fixed error when saving medication as default because of long names
Extended CDA document generation to correctly classify extemporaneous medications
In medication details, printed prescriptions, CDA documents and so on, we've fixed a problem with the display of MIMS data that contains superscript or subscript text. This text is now displayed in square brackets. For example, B[12].
For CDA documents, such as Event Summary, we've fixed a problem with the way in which extemporaneous medications were encoded in the XML file.
We've fixed an error that occurred when you attempted to open the Patient Summary report if you had prescribed medications with very long names.
We've fixed an error which caused incorrect matching of the provider for investigation results. The error occurred for results and documents received via HL7 if the recipient was not in the preferred location in the message. The provider was typically returned as unknown.
We've fixed an issue with investigation results, which resulted in errors if long comments were added to the results when they were reviewed before they were sent to QRIS.
Fixed issues causing the clinical item definition editor not to work
Fixed issue that allowed users to undecease a patient without removing contribution factors list
Fixed issue that allowed encounter program numbers to be editable in Encounter Programs user interface
Fixed issues in service recording where the patient arrived date is cleared under some circumstances
Fixed issues with 'Bring to Front' toolbar not working when letter template is focused
Fixed issues with provider created recalls being deleted when editing a recall rule
Medical imaging request form launched from clinical item now respects default imaging configuration
Fixed issue where Extemporaneous Preparation name allowed duplicate values
Fixed issue with care plan size checking limit being calculated incorrectly.
Fixed issue with inappropriate timestamp being used for service provider times shown in progress notes tab investigation.
Fixed issue with referrals with comment not appearing as 'Referrals - Reason'.
Fixed issue with verbal orders allowing the same provider to be used for both Authorising Clinician & Checking Person.
Fixed issue with 'Bring to Front' toolbar not working when Adverse Reactions open.
Fixed error when entering large Extemporaneous Preparation names.
Fixed issue where status <Reviewed> appears for attachment even though 'Reviewed' checkbox is not set.
Fixed issue where Patient kin grid does not support double-click to open.
Fixed issue with medications missing in Formulary Maintenance when deleted from MIMS.

Deprecated features

The following features have been deprecated:

Reform Prescriptions - reform prescriptions are not in use by any Communicare customers and will be unavailable for use in V20.2 and later. The options in system parameters will be removed in future releases.
(V20.1) Organisation management (i.e. multiple organisations) - each customer must have only a single organisation. Adding and deleting is also disabled.
(V20.1) Dispensing a Medication

Installation Requirements

.Net 4.5.2 or later
HQBird 2.5.9 is now an external dependency. Firebird 2.5 and earlier is no longer supported.