Introducing the EMIS
Risk Stratification Tool
Dr Kevin Yee, GP & EMIS Project
Clinical Lead with EMIS
Representatives Paul Davis and
Debbie Pope
An explanation of the plan
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New Risk Stratification Tool in EMIS Web for Bromley
QAdmissions Algorithm – designed by GPs in
conjunction with academics
Clinical risk prediction tool
To help ID patients at high risk of unplanned care or
admissions – Vision compatible version being developed
in parallel
Previous Risk Strat Tool ran into problems due to IG
issues and sharing of patient identifiable data – new tool
utilising practice data only and stays within the practice
Anticipated roll out from July 2014
Variables used in the QAdmissions
Algorithm FYI
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_ Sex
_ Age
_ Alcohol use
_ Atrial fibrillation
_ Congestive cardiac failure
_ Use of anticoagulants (more than two prescriptions in the last six months)
_ Use of antidepressants (more than two prescriptions in the last six months)
_ Use of antipsychotics (more than two prescriptions in the last six months)
_ Cancer
_ Asthma or chronic obstructive pulmonary disease
_ Use of corticosteroids (more than two prescriptions in the last six months)
_ Cardiovascular disease (heart attack, angina, stroke or transient ischaemic attack)
_ Epilepsy
_ Falls
_ Chronic liver disease or chronic pancreatitis
_ Malabsorption (including Crohn’s disease, ulcerative colitis, coeliac disease, steatorrhoea, blind loop
syndrome)
_ Manic depression or schizophrenia
_ Non-steroidal anti-inflammatory drugs (NSAIDs)
_ Chronic renal disease
_ Diabetes
_ Venous thromboembolism
_ Body mass index
_ Haemoglobin < 11g/dl
_ Ethnicity
_ Emergency admissions in the last year
_ Abnormal liver function tests
_ High platelets
_ Smoking status
_ Location and deprivation
Interim arrangements
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Developing an Interim Risk Strat Tool based
upon the QAdmissions algorithm to be
implemented by April 2014 – whilst EMIS is
completing QAdmissions, CCG interim step as
precursor, to engage GPs in the process
 Clinical Coding Sub-group agreed codes
based upon the algorithm but with local
variables and weighting based on ProMISE
learning
 Key variables weighted, linked to age, gender,
polypharmacy, etc.
 Build and testing the search with our EMIS
support resource ongoing
Interim Risk Tool Variables
Factors used to calculate a score for men and women to ID patients
at risk of an emergency admission.
Patients with a medication review overdue by more than 6 months and
receiving more than 2 acute or repeat medications.
Score out of 5.
Demographics
Qualification
Score
COPD (exclude asthma as already included
above)
COPD (exclude asthma as already included
above)
4
Plus oral corticosteroids
for 6 months (> 1
issue last 6
months)
5
Total score multiplied by age
Sex
Final Score will be multiplied by 1.1 if
male
Age
65 Plus (Current age)
Factor
Qualification
Level of Alcohol
Units; Male>= 21, Female >14
1
Atrial fibrillation /
atrial flutter
CHADS2 Score > 1 and not on
warfarin/not
using anticoagulants/NOACS
5
Cardiovascular disease
Score
CCF
5
Anxiety/depression
4
More than 3 months (more than 3
issues in last 6 months)
1
Antipsychotics
More than two prescriptions in the last
6 months
2
Dementia
5
PVD
5
Asthma
2
Asthma
Cardiovascular disease (heart attack/angina)
4
Covered above
Cardiovascular disease (stroke/transient
ischaemic attack)
Epilepsy
Use of
Antidepressants
Plus oral corticosteroids for 6
months (> 1 issue last 6
months)
5
5
5
Fit in last 12 months
3
In last 5 years
4
F25 Fit frequency, last fit, exception in last 12
months
Falls
THE LIST GOES ON
ACCORDINGLY
Eg pt with highest risk
score in my practice
Severe psychosis and
Depression; T2dm; ihd;
Af not on warfarin; Ccf
Expected Benefits
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Improved patient care
 Reduce GP time spent on unplanned
appointments
 Reduced costs to NHS
 New Unplanned Admissions DES requires
regular risk profiling and proactive care
management. This enhanced service will be
funded using funding from the QP scheme in
QOF (100 points) and the funding from the Risk
Profiling DES.
Operational arrangements
 EMIS
and CCG advice & support
 Practice training
 Fair Processing Notice/Patient
engagement
 Early adopters to test
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Will you be an early adopter?
Contact Ellen Baldry, Project Support Officer
Bromley Clinical Commissioning Group
1st Floor
Beckenham Beacon
379 - 397 Croydon Road
Beckenham BR3 3QL
Ellen.Baldry@bromleyccg.nhs.uk
01689 866172
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Any Questions?