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Overview

Cinapsis  enables you to communicate with selected specialists by mobile device, desktop PC and by landline, and integrates all this into a single clinical record which is accessed in the usual way via your practice clinical record system. It has been adopted in Gloucestershire for use in two key clinical situations:

1. Urgent Care: To enable clinicians to discuss potential admissions directly with relevant GHFT receiving specialist prior to admission. The purpose of this is to ensure that the patient gets the most appropriate care in the most appropriate place for their particular situation and condition, which is very often not ED. The positive impact of these discussions on patient flow throughout the system has been quite marked and we believe is of great benefit to all concerned.

2. Dermatology Advice and Guidance: To enable clinicians to seamlessly use their mobile device’s high quality camera to obtain dermatological advice and guidance. Each practice has also been provided with dermatoscopes and mobile phone adaptors for use when dermoscopic images might be helpful.  Responses to advice in the form of pdf’s are returned both to the referring clinician and to the patient’s own practice, ensuring that cases do not get overlooked and also that we clinicians get the maximum benefit from the specialist’s guidance.

FAQs

This is an FAQ on Cinapsis – please continue to send in queries to us and we will endeavour to answer them as promptly as possible, the project team contact details are included below:

Why should I use Cinapsis?

Cinapsis should help you to ensure that your patients get the care they need in the place that is best for them. This may be direct admission onto the appropriate specialist unit (such as AMIA and hence avoiding ED), a booked attendance on the appropriate specialist unit for the intervention or investigations they need, or continuing management in primary care if that is more appropriate and you are happy with the recommendation. This should give you better support, give your patient a better experience and help the system to cope through better and more appropriate patient flow.

Who should use Cinapsis?

All primary care clinicians wishing to arrange a medical admission into Gloucestershire hospitals should use Cinapsis to discuss their cases with the receiving specialist.   Those wishing to take advantage of teledermatology will also find it easier to use than e-Referrals service because it integrates with your smartphone camera, either on its own or together with a dermoscope. 

When should I use Cinapsis?

We are encouraging clinicians to use Cinapsis prior to sending a patient to hospital for any acute medical, paediatric, frailty or respiratory problem, as well as for tele dermatology. More specialities will come online in the early New Year, including T&O, General Surgery and potentially Gynaecology.

Will Cinapsis will take me longer than using SPCA?

No, it shouldn’t. We have worked very hard to make using Cinapsis and easy and fast as possible, for example by building finger-print smartphone login into the software.

From our own direct measurements and observations the average Cinapsis call takes between 4 and 5.8 minutes. This is made up as follows:

  1. 21 seconds for the average call to be answered
  2. 3.5 minutes for the average call duration
  3. 2 minutes if an ambulance needs to be booked via the built-in professionals’ direct access ambulance control number built into Cinapsis.

This compares very favourably with the average SPCA call, which together with waiting times and discussion takes approximately 15 mins.

Will SPCA be going completely?

No, it will continue to offer all the services it currently provides such as managing potential acute surgical admissions and rapid response queries. As outlined above, there will be occasions when it will also manage an acute medical admission where use of Cinapsis has either failed or not been possible.

How do I register to use Cinapsis?

You will need an NHS email address and preferably a mobile smartphone.

There are three easy ways to get started:

  1. If you work within a practice, E-mail your practice manager who can start the registration process for you, or:
  2. E-mail a request to the CCG team glccg.cinapsis.enquries@nhs.net stating which practice(s) you work at, or:
  3. Use your browser to go to the Cinapsis.org website and request a new account via the ‘No account yet?’ > ‘Sign Up’ on-screen options. An email is then sent to the CCG Cinapsis administrator who will manage it for you.

On-board (register) your Cinapsis account by clicking on the link in the e-mail sent to you by Cinapsis.  If the link fails please ask your team administrator to send you a new invitation to on-board. 

A mobile phone will be required for on-boarding your account as a verification code will be sent to you.  Once on-boarded future verification codes (i.e. resetting your password) can be sent to your e-mail address or your mobile phone

Save Cinapsis log on page to your favourites on your desk top PC https://app.cinapsis.org/login/auth             

Download the Cinapsis app to your mobile phone

If your mobile phone has biometrics enablement, activate finger print recognition for speedier logging on

Use a PC/tablet web browser and a land telephone or you can use the Cinapsis app on your mobile phone to make a A&G requests

Mobile phone signal problems - enable Wi-Fi calling on your mobile phone, your mobile provider will have instructions on setting this up

Save the Cinapsis telephone number to you phone 0203 322 4757

Are there any tutorial videos I can use?

There are a number of tutorial videos which can be accessed from the Cinapsis homepage once logged in.

I work at several practices, how do I manage this?

Each practice you work at has to approve your registration for IG reasons. Once you are registered at one practice, it is a single click process for a practice manager to approve you at their practice, via their Cinapsis.org administration page.

If you are registered at more than one practice, whenever you use Cinapsis you will need to select the practice the patient is registered at from a list, to ensure that the records get back to the patient’s correct practice.

What records are kept when I have made a call?

The voice call is recorded and saved on the Cinapsis secure remote server which has been approved by NHS Digital. Cinapsis also creates a ‘Post Event Message’ in pdf format which is automatically e-mailed to the referring clinician (you!)as well as to the  patient’s practice and to the specialist unit concerned via their secure clinical e-mail addresses.  In the practice the PEM will be processed just like any other clinical correspondence and will be filed in the patient’s records.  Any image used as well as a link to the voice recording is stored in these PEMs. This link can also be used to see images in their original resolution on the Cinapsis server.

What is a ‘Call-back’?

If you are not in a hurry for a response, or if your call does not connect for whatever reason, you can request a ‘call-back’.  If so, the specialist will receive a message and will call you back via Cinapsis and they should respond within 20 minutes.  Please note that you will need a mobile phone to use this service, and please remember to cancel a call-back request if it is no longer needed, via Cinapsis.

Can I do a ‘Test call’ to try it out or to practice with?

Yes, you can do this at any time.  If you select the menu option (like a hamburger: top left) >  > Training: 

What if I have a poor mobile phone signal?

While in your consulting room, either connect your mobile phone via the practice Wi-Fi, or use Cinapsis via your browser and use the landline number to make your call. If you are really unable to use Cinapsis then SPCA will still be available.

Will it work with my smartphone?

The minimum requirement for iOS 12 or above (Apple) or Android 5.0 'Lollipop' or above.

What if I don’t have a mobile ‘smartphone’?

You can still use Cinapsis when you are in surgery via your browser and landline. When out visiting you will either need to return to the surgery to make the call, or use the SPCA as at present. 

What if I need to book an ambulance for my patient?

Many patients do not require transport services but if they do it can be done quickly and easily by using the direct access professionals’ ambulance telephone number for Cinapsis cases, either via Cinapsis itself, or by direct dial using 0300-369-0096 (for calls that require an urgent pick up within 1-4 hours). These calls are picked up very quickly and should take no more than 4 mins.

The SWASFT call handler will ask you the following mandatory questions:

  • Is the patient breathing?
  • Is the patient conscious?
  • What is the patient’s address?
  • How old is the patient?
  • Is the patient male or female?
  • Does the patient have a life threatening condition?
  • What is the reason for transport?
  • Is the patient at risk to infection?
  • What is the approximate weight of the patient?
  • What DOB?
  • Does the patient need assistance onto the transport?
  • Is anyone accompanying the patient?
  • Where is the patient going to?
  • What is the best number to contact GP/caller on if needed?

Who do I contact if I have a query or a problem?

Cinapsis Enquiries Email: glccg.cinapsis.enquries@nhs.net  

OR

Dawn Eden 
Project Manager, Advice and Guidance Software Implementation
Tel:  0300 421 1773
dawn.eden1@nhs.net

OR

Helen Brock
Commissioning Manager - Urgent Care
Tel: 0300 421 1829
helenbrock@nhs.net

Urgent Care

Acute Medicine
The Acute Medicine service was the 1st service to go-live on Cinapsis and continues to prove to be successful.  It is available 8am – 8pm.

Acute Respiratory
A respiratory consultant is now available for direct calls and call backs for acute referrals via Cinapsis.

An icon for this specialty was added to the Cinapsis service selection screen on Monday 12th August 2019.  The service will be available from Monday to Friday 8:30 to 5pm.   

Please remember to use Cinapsis for respiratory hot clinic, acute paediatrics and acute medicine services if you have an appropriate patient.  

With over 300 referrals made using Cinapsis in Gloucestershire so far the project continues to develop and we are planning to add more acute services over time.  

Acute Paediatrics
Paediatrics are now offering direct phone advice and support to GPs for acute paediatric referrals through Cinapsis. The dedicated daytime Paediatric Assessment Unit (PAU) consultant is able to take calls and accept referrals through Cinapsis on weekdays between 9am and 5pm.  We hope to expand this service in due course to cover extended hours seven days a week. 

If your practice is registered to use Cinapsis, we hope you will use this for any urgent paediatric referrals during this time. Cinapsis should provide a much better channel of communication between GPs and the on call team than old fashioned bleeps. When making a referral through Cinapsis, there is an option to call direct. Please note that the specialist may be on another call or walking through a zone where the reception temporarily drops; you will have the option to dial again or can select a call back (the specialist will have the maximum of 20 mins to call you back). Dr Thomas Kus, Consultant Paediatrician, and his team, will be on call and look forward to taking your calls.

If your practice is not registered, please contact the service using the bleep through switchboard as usual. Please note that safeguarding calls and referrals for neonates with postnatal weight loss or prolonged jaundice should still go via switchboard.  Advice & Guidance is offered for non-urgent queries via ERS.

Orthopaedics
The Trauma & Orthopaedic Cinapsis Trial continues until Friday 28 June. The on-call registrar and consultant will be able to take Cinapsis acute T&O referrals on weekdays between 8am and 6pm during the trial. Dr Will Mason, Specialty Director for Orthopaedic Trauma, and his team look forward to taking your calls.

If your practice is not registered with Cinapsis, please contact the service using the bleep through switchboard as usual.

Frailty Assessment Service
The service is available Monday to Friday 8am to 6pm and aims to identify and assess frail (primarily older) people, who are attending the emergency department with a medical problem.

The ED experience for a frail dependent person can often be challenging. Where trauma is not the major issue, the frailty team can potentially provide fast comprehensive assessment and they have excellent links with community services.

Cinapsis is an addition to the service, offering telephone advice and/or arranging ambulatory urgent care assessment the same or next day.

The frailty service currently sees around 350 people a month, discharging more than half of them after assessment. The addition of Cinapsis could help to avoid an exhausting visit to ED, or minimise the time spent there.

 

Planned Care

Dermatology
From 16 September 2019, Cinapsis is being expanded to offer a bespoke teledermatology advice and guidance (A&G) service. Cinapsis combines an Information Governance (IG) compliant solution for capturing images using a smartphone with a secure end-to-end A&G platform to allow GPs to quickly and easily seek specialist advice on skin conditions from local dermatologists. Please note that the existing A&G service offered via e-RS remains available as usual; if you are unable to use the Cinapsis service please continue to use e-RS A&G in the usual way.

Please note that unlike other Cinapsis services that are already available, the teledermatology service is a written advice service rather than a telephone advice service. 

Key benefits of Cinapsis compared to the existing dermatology A&G service include:

  • it provides a solution to support image capture using smartphones that is IG compliant and easy to use, making it easier for GPs using their own smartphone
  • it simplifies the process of transferring images from the phone and into A&G as all images captured through Cinapsis will be instantly available within the system to add to the advice request
  • it is quick and easy to use with fewer menus to navigate in order to make an A&G request
  • dermoscopy images can also be taken with a smartphone camera by using a smartphone dermoscopy adaptor

  • Referrer may make use of training mode on the Cinapsis mobile apps
    • click on the burger icon (3 lines) top right-hand corner and select training
  • Tutorial videos are available within Cinapsis showing how to use the clinical services. We can also offer demonstrations of how to use the system on request.
  • The Speech bubble on Cinapsis homepage will open an online help facility for technical issues
  • Once you have downloaded the latest Cinapsis app to your mobile phone you will be able to activate finger print recognition for speedy logging on
  • Cinapsis promotional video - https://youtu.be/aA-15MpG2aE

Access

Cinapsis can be accessed via its web interface at https://app.cinapsis.org/login/auth, an Apple iPhone, or an Android mobile device.

Registration

To register you need an NHS.net email address and a mobile device.

You can start the registration process in one of three ways:

  1. Email a request to the CCG Cinapsis Team - glccg.cinapsis.enquries@nhs.net
  2. Email your Practice Manager who will start the process for you.
  3. Request a new account via the Cinapsis.org website https://app.cinapsis.org/login/auth and select ‘No account yet? Sign Up’  > select the practice, etc. Once completed, an email will be sent to the CCG Cinapsis Administrator.

Once you are registered with one practice you will need to be approved by each practice you are working at. This can be done by the Practice Manager via a single-click process on the online Cinapsis Admin page.

Once registered at more than one practice you will be offered a list of practices you are registered to when you log on to Cinapsis. It is important that you select the correct practice for your patient to ensure that the records get back to the right place.

The Cinapsis App

The Cinapsis App must be downloaded from the relevant App store.

Keeping your Cinapsis App up to date

Your Cinapsis App will need to be periodically updated and improvements and fixes are released. We would strongly advise you to enable your device to allow automatic app updates. This can be done on most devices via the device’s system settings.

Resetting your password

Password resetting can be done by all users with a Cinapsis account

Go to the Cinapsis home page on the app or a PC https://app.cinapsis.org/login/auth

Select ‘Forgotten your password?’

Enter your username (nhs.net e-mail address) and select ‘OK’.  You will receive an e-mail with a link to reset your password.

Outcome correspondence

Cinapsis automatically generates a Post Event Message (PEM) in the form of a pdf. This is generated as soon as the specialist has completed the ‘Outcome’ of an A&G request, whether by phone or online.  This PEM is then sent to the patient’s practice’s secure generic e-mail address so that it can be processed along with the practices daily clinical correspondence.  A copy is also sent to the referrer’s ‘Inbox’ within Cinapsis (accessible via the menu icon , top right on the Cinapsis App screen).

iPhone bug fix

Some iPhone users recently reported that when they used Cinapsis to make a ‘Direct Call’ to a specialist the call did not connect. We have investigated this issue which was due to an Apple iOS (operating system) upgrade. The fixed version of Cinapsis for iPhones is version 2.3.36, which has now been uploaded onto the Apple AppStore.

Users who have set their iPhone to update their Apps automatically (via ‘Settings’, see under technical, below) will have been automatically updated and will not have noticed the bug unless they used Cinapsis. Those who rely on manual App updates will need to update their Cinapsis App in the usual way via the AppStore.