Check your Patient Counts in EMIS Searches match Practice Toolkit
Why might it be different?
EITHER:
The population you're searching for is different. Your original EMIS search population may be coded for 'Asthma', the Practice Toolkit Recall population may be 100 different codes relating to Asthma' (then we're comparing apples and pear - make sure the Recall population is how you want it)
Practice Toolkit will search for all the specific codes selected in the Recall 'Population' tab. Check these are the same as the search parameters you're using in EMIS
OR:
The Coding in EMIS isn't how it 'should' be (see below)
Conditions need to be flagged as a current 'Medical Problem' - 'Past Problems' and '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 will result in it not being included in Practice Toolkit.
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.
How do I fix that?
Adjust the Practice Toolkit Recall Population Tab (Settings/PRO/Recall List/Population Tab) to the relevant codes for you - if you're comfortable they're correct either edit the EMIS search to match and confirm or roll with there being a slight discrepancy between the two.
To highlight & resolve Problem Coding variations, we've made some helpful start points for searches to help audit your problem coding:
Click below to download an xml file to import these identifier Searches into EMIS
In EMIS, locate and click on the Practice Toolkit folder under Main Menu -> Reporting -> Population Reporting.
Click 'Import' in the top ribbon of the screen, click the ... on the right and find the file you downloaded above to import.
It'll load numerous searches relevant for each condition recall template (let us know any additional, or adjustments to these which may help you)
These searches are designed to help a practice to identify patient who might have been diagnosed with a condition, the condition has been coded, but it hasn’t been coded as a problem.
Run each Search and review any listed patients - we've tried to add relevant information which may help you/clinicians review those patients to see if:
They should have been problem coded (then add the problem flag to resolve on next data sync with Practice Toolkit),
Ignore (but accept the count variation),
Edit the patient notes to remove, evolve, close the diagnosis.
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.
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 Therap” (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.
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