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Population Manager Register Specific Questions and Answers

For FAQs about Population Manager (general) and Pandemic Searches, click here.

Asthma

Asthma1 – Patients on Asthma register

I have a patient who has a diagnosis of asthma, but they are not displayed on the Asthma register - why?

Check that the patient does not have any Asthma Resolved codes (212G, 21262) in their record, and that they have been given an asthma-related drug (check the criteria for a full list of drugs) in the last 12 months.

Asthma8 – Asthma diagnosed since 01.04.06 and reversibility done

I have a patient who has an alert for peak flow, but this has been done - why?

Check the Look Ahead view in Population Manager. Right-click the required patient in the Patients Not Included section of Asthma8 and select Check Patient. Ensure you have used one of the codes in the Spirometry reversibility positive or PFR – before bronchodilation criteria, either three months before the diagnosis or any time after. Click the blue 'i' icon next to the criteria to see a list of relevant codes.

Atrial Fibrillation

AF4 – New AF with ECG confirmation

I have a patient who has had an ECG, but they are not displayed in either the Patients Included or Patients Not Included section of AF4 - why?:

Use Check Patient within the AF4 denominator search. Was the patient diagnosed before 01.04.08? If so, the criteria states that they are not eligible for an ECG.

I have a patient who has an alert for an ECG, but this has already been recorded:

Check the Look Ahead view in Population Manager. Right-click AF4 and select Check Patient, and then select the required patient. Click the blue 'i' next to ECG: atrial fibrillation criteria and check that you have used one of the codes in the list and that it was entered within either three months before or three months after the diagnosis date.

AF3 – AF on anticoagulation

A patient has an alert for aspirin/warfarin/clopidogrel/dipyridamole usage, but they are currently taking one of these items - why?:

Check the Look Ahead view in Population Manager. Right-click AF3 and select Check Patient, and then select the required patient. Will the patient be due another issue of anticoagulation medication by the Look Ahead date? An easy way to check this is to count six months back from the Look Ahead date and check if the medication has been issued since this date.

Cancer

Cancer3 – Cancer Reviewed since diagnosis

I have a patient who has been diagnosed with cancer in the last six months, but the system is not showing that they need a cancer review - why?:

Check the criteria within the Cancer3 denominator search. The rules state that anyone diagnosed in the last six months is rejected and not placed in the numerator search; this is due to an extended grace period. You can view these patients by changing your Look Ahead view to six months ahead.

CHD

CHD9 – CHD Taking Aspirin or Equivalent

I have coded that a patient is unable to take aspirin, but they still have an alert saying that it is due - why?:

Check the criteria within the CHD9 denominator search. The rules state that the patient should be able to take aspirin, warfarin or clopidogrel. If a contraindication code is entered for one drug only, the system assumes that the patient should still be able to take one of the other drugs. If the patient is unable to take any of these items, a contraindication code is required for each. Check the criteria within the denominator search for a list of suitable codes.

CHD11 – MI since 01.04.03 on ACEi

A patient was given an ACEi less than six months ago, but they have an alert saying that this is outstanding - why?:

Check the Look Ahead date within Population Manager (because the alerts relate to the Look Ahead dates). The rules state that an issue of an ACEi or ARB is required every six months. Will the patient be due another issue by the Look Ahead date? A simple way to check this is to count six months back from the Look Ahead date and check that the patient has an issue after this time.

I have coded that a patient has a history of an ACEi allergy, but they still have an alert saying that this is outstanding - why?:

Check the criteria within the CHD11 denominator search. The rules state that all patients with an MI since 01.04.03 require a record of an ACE inhibitor or AII antagonist usage. If you have said that the patient is unable to take an ACEi, the system still assumes that they are able to take an ARB. If the patient is also unable to take an ARB, you need to record this. Check the criteria within the denominator search for a list of suitable codes.

CHD12 – CHD Given Flu Jab in Last Season

I have 56 patients on my CHD register; why are only 50 of these showing as eligible for a flu jab?

Check the criteria within the CHD12 denominator search. A patient will not be included if they have:

• Registered in the last 3 months.
• Been exception reported in the last 15 months.
• Been diagnosed with CHD in the last 3 months.>
• A record of an influenza vaccination allergy.
• Refused a flu jab in the last 15 months.

Chronic Kidney Disease

CKD3 – CKD and BP 140/85 or less

A patient has an alert for a BP value check, but their last BP was less than 140/85; why?

Check that the patient has not had more than one reading on the same day. If they have, and one of the readings is too high, the highest one is used.

CKD5 – CKD and BP taking ACEi or ARB

There are CKD patients who are on an ACEi, but they are not displayed in either the Patients Included or Patients Not Included section of CKD5 - why?:

Use the Check Patient facility within the CKD5 denominator search. Does the patient have a diagnosis of hypertension and proteinuria? Only patients with CKD, hypertension and proteinuria are eligible for an ACEi.

COPD

COPD12 – COPD and have spirometry

I have a patient who has had a spirometry but they are not displayed in either the Patients Included or Patients Not Included sections of COPD12 - why?:

The criteria states that only patients diagnosed with COPD after 01.04.08 are eligible for a spirometry. Right-click COPD1 and use Check Patient to see when the patient’s initial diagnosis was; if it was before 01.04.08, they are not eligible.

I have a patient who has had a spirometry, but they are not displayed in the Patients Not Included section of COPD12 - why?:

Right-click COPD12 and use Check Patient. The alert window will display the patient’s diagnosis date. Click the blue 'i' icon next to the Salbutamol Reversibility criteria, and ensure that the patient has one of the codes displayed, and that it was within either three months before or one year after the diagnosis date.

COPD11 – COPD on inhalers who have had inhaler technique checked

I have a number of patients who have had their inhaler technique checked, but when switching to the Look Ahead view, the number of patients included drops considerably - why?:

Check the criteria within the denominator search for COPD11. The rules state that patients are only eligible for their inhaler technique checking if they have been given an inhaler in the last six months. The number of patients eligible has probably dropped when switching to the Look Ahead view, because they require another issue of an inhaler.

Dementia

DEM2 – Dementia review done

I have recorded that a patient’s dementia review has been completed (using code 6AB) in the last 15 months, but they are still showing in the Patients Not Included section - why?:

This is usually because the patient has a dementia diagnosis date in their record with a date of Not Known. Right-click DEM1, select Check Patient, and enter the required patient; check that the date of diagnosis is a full date. If not, amend the date in the record, and then allow 48 hours for Population Manager search results to update.

Depression

DEP1 – Chronic disease depression screening

A patient has been exception reported from a chronic disease register, but they still have an alert for depression screening - why?:

DEP1 uses a separate set of exception codes to those used in the chronic disease register. To find the required codes, in the DEP1 denominator search, click the blue 'i' icon next to the criteria Exc depr qual: ind: Pat unsuit.

DEP2 – Depression assessment tool used

I have recorded a PHQ-9 score for a patient, but they still have an alert for the assessment - why?:

Check the Look Ahead view in Population Manager. Right-click DEP2 and select Check Patient, and then select the required patient: the patient’s latest depression diagnosis date is displayed; ensure that the PHQ-9 score was carried out within one month of this date.

Diabetes

DM19 – Patients on Diabetic register

I have a patient who is over the age of 17, with a diagnosis of Diabetes, but they are not appearing on the register - why?:

Check that the patient does not have a Diabetes Resolved code (either 21263 or 212H) in their record. Also check that the patient has a diagnosis code of either C10E% or C10F% (not just C10).

DM15 – Diabetes and Proteinuria or Microalbuminuria on ACEi

I have a patient on an ACEi, but DM15 is showing that there are zero patients; why?

View the criteria for the DM15 denominator search. The criteria states that only diabetic patients with a diagnosis of proteinuria or microalbuminuria are eligible for an ACEi. Do these patients have the relevant diagnoses? Check the criteria for a list of available codes.

Epilepsy

Epilepsy5 – Patients on Epilepsy register

I have a patient with a diagnosis of epilepsy, but they are not displayed on the register - why?:

Check that the patient:

• Does not have an Epilepsy Resolved code (21260 or 212J) in their record.
• Has been issued a drug used in the control of epilepsy in the last six months.
• Is over the age of 18.

Epilepsy8 – Epilepsy who have been fit-free for 12 months

I have patients who fit regularly; why am I being penalised?:

This indicator shows the number of patients who are on the maximum tolerated anticonvulsion therapy and have been fit-free for 12 months. Patients who are on the maximum tolerated anticonvulsion therapy and are still fitting can be coded as such using 8BL3 Pt on max tol anticonvuls ther. This clinical term removes them from the denominator search and they will no longer be eligible for Epilepsy8.

Heart Failure

HF2 – HF since 01.04.06 and echo/specialist confirmed

I have a patient showing in the Patients Not Included section of HF2, but I have recorded that they have had an echocardiogram; why isn’t Population Manager picking them up?:

Right-click on the patient in the Patients Not Included list and select Check Patient. The alert should give details on when the patient was diagnosed. Click the blue 'i' icon next to U-S Heart Scan, and check that you have used one of the codes in this list and that it was entered either up to three months before the diagnosis date or twelve months after.

HF3 – Heart Failure taking ACEi

I have 56 patients on the Heart Failure register, but only 24 are eligible for an ACEi - why?:

Check the criteria within the HF3 denominator search. The criteria states that only patients with a diagnosis of Heart Failure and Left Ventricular Dysfunction are eligible for an ACEi or ARB.

I have coded that a patient has declined an ACEi, but they still have an alert saying that this is outstanding - why?:

Check the criteria within the HF3 denominator search. The rules state that all patients with a diagnosis of HF and LVD require a record of an ACE inhibitor or AII antagonist usage. If you have said that the patient is unable to take an ACEi, the system still assumes that they are able to take an ARB. If the patient is also unable to take an ARB, you need to record this. Check the criteria within the denominator search for a list of suitable codes.

 

Hypertension

 

BP1 – Patients on Hypertension register

I have a patient with a diagnosis of hypertension in their record, but they are not appearing on the Hypertension register - why?:

Check that the patient does not have a Hypertension Resolved code in their record, using clinical term 21261 or 212K.

BP4 – Hypertension and BP check in last nine months

I have a patient who has had a BP check in the last nine months and they are included in the How Am I Driving view, but they have an alert asking for a recent BP reading - why?:

Check the Look Ahead view in Population Manager; is the patient in the Patients Not Included section now? Will the patient be due another BP reading by the time of the Look Ahead date? A way to check this is to count back nine months from the Look Ahead date and check that the last BP reading was after this date.

Mental Health

MH8 – Patients on Mental Health register

I have a patient who no longer has mental health problems. How do I remove them from the register?:

Unfortunately, the criteria does not include any exception or removal codes. Currently, the only way to remove a patient from this register is to remove all of the relevant diagnosis codes from the patient’s record, but EMIS advises that you liaise with your PCT before doing so.

MH4 – Lithium who have Creatinine and TSH checked

I have a patient who no longer takes lithium; why do they have an alert for creatinine and TSH?:

Check the criteria for the MH4 denominator search. The ruleset does not include any Lithium Stopped codes. If the patient has been issued lithium within the last six months, they are eligible for their creatinine and TSH checking.

MH7 – Follow up of non-attending patients

I have no patients that have DNA’d; why have I got zero points and zero per cent?:

The indicator is there to reward practices who follow up patients who have DNA’d, within 14 days. If there are no patients who have DNA’d, no work has been carried out, therefore no points will be awarded.

Palliative Care

PC3 – Patients in need of palliative care

I have recorded that a patient is no longer on the Palliative Care register, but they are still displayed in the Patients Included section - why?:

Unfortunately, the criteria does not include any exception or removal codes. Currently, the only way to remove a patient from this indicator is to remove all palliative care codes from the patient’s record, but EMIS advises that you liaise with your PCT before doing so.

Smoking and Records23

Patients who smoke need to have their smoking status recorded every 15 months for Smoking3 and 27 months for Records23.

Patients over the age of 25 who have never smoked, need their smoking status recording once since their 25th birthday and also after the date of diagnosis for Smoking3.

Patients under the age of 25 who have never smoked need their smoking status recording every 27 months.

Ex-smokers need their smoking status recording every 27 months until three consecutive years.

Stroke and TIA

Stroke13 – Presumptive stroke since 01.04.08 and CT or MRI

I have coded that a patient has had an MRI, but they still have an alert showing that this is outstanding - why?:

Check the Look Ahead date within Population Manager (because the alerts relate to the Look Ahead dates). Right-click the patient in the Patients Not Included section and select Check Patient. The alert should give details on when the patient was diagnosed. Click the blue 'i' icon next to Computerised Axial Tomography and check that you have used one of the codes in this list, and that it was entered either up to three months before the diagnosis date or one month after.

Stroke6 – Stroke/TIA and BP 150/90 or less

A patient’s last BP reading is showing in the Values section as being less than 150/90, but an alert is saying that the last BP reading is too high - why?:

Check that the patient has not had more than one reading on the same day. If they have and one of the readings is too high, the highest one is used.

Stroke12 – Non-haem Stroke/TIA on aspirin or equivalent

I have recorded that a patient is unable to take warfarin, but they still have an alert saying that it is due - why?:

Check the criteria within the Stroke12 denominator search. The rules state that the patient should be able to take aspirin, warfarin, clopidogrel or dipyridamole. If a contraindication code is entered for one drug only, the system assumes that the patient should still be able to take one of the other drugs. If the patient is unable to take any of these items, a contraindication code is required for each. Check the criteria within the denominator search for a list of suitable codes.

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