By this stage, the Patient Recall Optimiser (PRO) is live and working for your Practice.
If you want to ensure 100% coverage for all patients we'd recommend following our Coding Searches audit process.
If you have bad data going in, you'll get bad data out... Lets make it good data in and good data out.
This normally impacts between 2% and 3% of patients
needing some kind of adjustment to their coding.
Generally an admin task, could be 2nd on, or usual GP if you prefer.
Coding Searches audit process
Use our pre-made Coding Searches to help identify any patients which need minor adjustments;
Click below to download an xml file to import these Identifier Searches into EMIS
In EMIS, Main Menu -> Reporting -> Population Reporting, locate and click on the Practice Toolkit folder.
Click 'Import' in the top ribbon of the screen, click the "..." dots on the right and find the file you downloaded above to import.
Click on the main 'Coding Searches' folder to then run all searches in the folder.
It'll load numerous searches relevant for each condition recall template (let us know any additional, or adjustments to these which may help you) Always happy to jump on a call - use the help widget in the bottom right of the screen in Practice Toolkit to chat/organise a sharescreen call
1) Admin - Check all patients have NHS Numbers
In the searches downloaded, locate the NHS Number search and run it (if you haven't already)
The patients listed won't be imported into Practice Toolkit as they MUST have an NHS Number input.
To Resolve:
Input or find their NHS Number and add into EMIS.
wait until tomorrow for Auto Sync (England), or re-sync data manually from Settings/Clinical Integration and click the 'Upload Patient Data' button.
2) 'Problem' Coding
Conditions need to be flagged as a 'Medical Problem', Significant, Active and Past will all be imported, only 'Non-Clinical Problems' will be ignored. This is to avoid a patient being asked in for a review of a condition which they user to have is no longer relevant or a medical problem for them.
If a diagnosis has been made but not flagged as a problem this patient will not be included in that recall.
The only exception is the 'Care Home Annual Review' recall - where this may not be identified as a 'medical problem' and so the most recent coding of 'In a Care Home' or 'No longer in a care home' is used for eligibility.
Medications must be 'current' for them to be included in the Practice Toolkit recall - again this is to avoid situations where a patient used to be on the medication but isn't currently being prescribed and so not relevant for recalls.
Denosumab is an unusual case as it's so easy for it to become non-current. See specific supporting search below.
To Resolve:
Click on each of the Problem searches in turn - they will highlight ONLY patients where they have coding relating to a condition but NOT have it flagged as a problem.
Find each Patient in EMIS and search for condition, then right click to 'Make Problem'
OR
Edit the patient notes to remove, evolve, close the diagnosis.
This could be undertaken as an admin task, tasks by 2nd on, or usual GP etc - however you see fit.
Tweaking the Searches
You might need to edit a search and report to match the codes that you are currently using in your practice.
To edit a search, select a recall and click ‘Edit.’
Rule 1 finds the patient with the code anywhere in the notes (Care History and Problems)
Rule 2 excludes patients who have the Code as a Problem.
The output will be a list of patient who have the code in the notes, but the code has not been flagged as a 'Problem'
To remove or add codes,
double click ‘Clinical Codes’ within Rule 1, and add and remove the codes as needed.
Then, double click the ‘Clinical Codes’ within Rule 2, and make the same changes to the codes here as you did in Rule 1.
Click ‘Save and Close.’
Next, select on the associated report, and then ‘Edit.’
under Coded Problem, double click ‘Clinical Code’
double click ‘Clinical Code’ again, and make the same changes that you made earlier to Rule 1 and Rule 2.
After making the changes, click Ok, and then ‘Save and Run.’ Your search and report has now been edited.
3) Medications - Denosumab
The Denosumab (Prolia) Search is slightly different, as it identifies all the patients who have ever had a Prescription for Denosumab.
As Denosumab is only given once every 6 months, it can be especially hard to recall, as the drug can move from ‘Current’ to ‘Past’ in EMIS. (Practice Toolkit only address 'current' medications to avoid reviews for medications not prescribed anymore)
To reduce the risk of missing a Denosumab recall, you can discuss different strategies with your clinical team, such as
Code all patients who are on Denosumab with “Denosumab Therapy” (code 700139004) as a Problem – and then base your recall around this code - and resolve this problem is they no longer require it.
Add Denosumab prescriptions to ‘Automatics’ rather than Acute to avoid them becoming past - again, edit this if they no longer require it.
4) Asthma Recall
Asthma is something of a unique recall – difficult to diagnose if resolved or not, behaves differently for each patient, patients commonly grow out of it - it’s therefore common to have historic coding which may no longer be relevant.
BUT where searches are also linked to use of medications (focusing on patients actively issued inhalers) it could mean patients where a renewal was missed or coded differently ‘fall off’ the current Asthma Recall approach. We’d recommend adopting the more resilient approach of recalling based on Asthma being a diagnosed medical condition.
However, this will require some remedial coding to ensure all patients relevant to recall for Asthma (and only those patients) are being recalled. This will be of particular impact for patients who would be coming in for Asthma only (less relevant if they are coming in for something else as well as Asthma)
Check whether 'Asthma Resolved' is in the 'Exclusion Criteria' of the Asthma Recall in Practice Toolkit: Settings/PRO Recall List
Open the Asthma folder in our Coding Searches (downloaded from the top).
All the searches will have the patient info, date of the last Asthma Review, and date of last Salbutamol inhaler issued and the date of the last preventer inhaler issued, to help you/others judge if it should be a problem or be resolved.
Open “'Asthma' not coded as a problem”
This search will ONLY highlight patients who have been coded with ‘Asthma’ (and/or child codes) somewhere in their notes but not also flagged as a ‘Problem’ (and not have Asthma Resolved coded since)
Actions - take for ALL Patients in this list:
Search for each patient in EMIS, open patient, Care History, Text Search for 'Asthma' to make it easier to view:
Make ‘Asthma’ (and/or child codes) a 'Problem',
OR
evolve the asthma coding to ‘Asthma Resolved’ (as a problem) to avoid any future confusion.
Open “'Asthma resolved' not coded as a problem”
This search to ONLY highlight patients who have been coded with ‘Asthma’ (as a ‘Problem’) AND ‘Asthma Resolved’ coded (but not as a ‘Problem’)
Actions - take for ALL Patients in this list:
Update the ‘Asthma Resolved’ coding to flag as a problem (and ideally evolve the original Asthma problem),
or delete the Asthma Resolved coding to avoid any future confusion.
Open "Asthma Resolved then Re-Diagnosed"
This search will ONLY highlight patients who have Asthma coding reused again after (re-diagnosis) a previous Asthma Resolved.
Actions - take for ALL Patients in this list:
Search for each patient in EMIS, open patient, problem tab, text search (in top ribbon) for 'Asthma' to make it easier to view (click on each problem to see history):
Right click on 'Asthma Resolved', change status and select 'Not a Problem' (so that the patient will be included into the Asthma recall)
OR
Ignore patient (the Asthma Resolved will exclude the patient from Asthma Recall), to tidy up coding would you could make Asthma 'Not a Problem' or Group, Combine or Evolve the coding into the Asthma Resolved.
Open “Asthma Register”
This search will highlight ALL patients coded with Asthma as a problem, Excluding any with Asthma Resolved as a problem. This should match the Practice Toolkit Recall list (if the EMIS upload has been re-run manually and then uploaded)
Actions - only SOME of these patients need attention - the majority of patients should be retained on this list. It could be there are a lot of patients which need some form of clinical review.
Sort by the last Asthma Review date columns to show in date order
Patients have been reviewed recently but not been issued medication – probably should be reviewed and will be in the next recall.
Outcome = do nothing/move to next patient
Patients have not been reviewed recently but have been issued medication recently – probably should be reviewed and will be in the next recall
Outcome = do nothing/move to next patient
Patients where neither the review AND medication have not been covered recently – consider:
if these patients should be coded to Asthma Resolved (as a problem) or have the initial Asthma removed?
OR
communicated with (they'll be automatically reviewed in the next recall and may be surprised to find they 'have Asthma')
We’d recommend re-checking search 1, 2 and 3 after doing 4 to ensure all ‘Asthma Resolved’ added are added as problems.
Next->
(2nd Pilot Session) PRO - Deciding your workflows
(2nd Pilot Session) Day-to-Day Guide for Recall Admins
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Set Up 1: Recall Logic (ASAP)
Set Up 2: Optimisations (1st Pilot Session)
Set Up 3: Sync/Upload Clinical Data (1st Pilot Session)
Set Up 4: EMIS Data Accuracy (Between Pilot Sessions - optional)