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/good data out.
Support Searches Audit Process
Use our pre-made Support 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
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.
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 for their Unique Identifier.
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.
Anchor / Duration / Overdue Management
This search is a temporary support until we can enable the much more detailed Overdue/Breach prevention tool. It works in tandem with the https://www.practicetoolkit.co.uk/impact HTML page. No data entered here leave the Practice. Load the 'Impact Assessment' from the Admin search folder into the page for it to impact assess the practice, but also track patients already overdue vs those likely overdue by the next planned annual review appointment (see third tab).
It does assume all patients will have an annual review of their relevant conditions entered in EMIS. We can work with you help adjust or interpret this data.
Ultimately, we'd remind that resolving all patients will automatically occur by just following Practice Toolkit's 12 month planned appointments.
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 used 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.
To Resolve:
Click on each of the Patient List 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 find/search for condition, then right click to 'Make Problem'
OR
Edit the patient notes to remove, evolve, close the diagnosis.
Once completed, wait until tomorrow for Auto Sync (England), or re-sync data manually from Settings/Clinical Integration and click the 'Upload Patient Data' button.
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 includes patients with the code anywhere in the notes (Care History and Problems)
Rule 2 then 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,
In the Search, 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 Patient List, 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.’
3) Medications
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
As Denosumab (Prolia) 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.
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 - This means the Practice may recall a patient who no longer needs it but the coding doesn't reflect that yet.
Equally some Practices will recall patients based on their Asthma coding AND Medications issues (to exclude patients without a current medication), while this is more convenient model it's 'brittle'; when a re-issue may be missed or delayed a patient who should be recalled may be dropped out.
We’d recommend adopting the more resilient approach of recalling based on Asthma being a diagnosed medical condition. However, this will likely 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)
First: Check whether 'Asthma Resolved' is in the 'Exclusion Criteria' of the Asthma Recall in Practice Toolkit: Settings/PRO Recall List
Second: Open the Asthma folder in our Support Searches (downloaded from the top of this article). Currently v1.2 for Northern Ireland and v2 for England/Wales/Jersey
Each search may only be a short list of patients for actioning.
In each search, the date of the last annual review, and date of last salbutamol inhaler issued and the date of the last preventer inhaler issued are also shown, to help you 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
remove 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:
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”
Search to highlight patients coded with Asthma as a problem (and NOT asthma resolved as a problem).
This is to capture patients who may have been missed, or where medication and reviews aren't in sync.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.
Once completed, wait until tomorrow for Auto Sync (England), or re-sync data manually from Settings/Clinical Integration and click the 'Upload Patient Data' button.
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)