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EMIS to continue offering QRisk until next year  

EMIS to continue offering QRisk until next year  

IT system supplier EMIS will continue offering the integrated QRisk calculator until June next year, after GPs raised concerns over safety and workload.

In November EMIS notified users of their intention to remove QRisk2, which is licensed by ClinRisk, from EMIS Web.

The supplier said that this was due to ‘a concern regarding the validity of the tools in SNOMED-CT’ as well as the ability to comply with the changing Medicines and Healthcare products Regulatory Agency (MHRA) regulations. 

Now EMIS said it has been working ‘closely’ with NHS England, the authors of the existing tools and the regulatory bodies to address these concerns and ‘work towards standardising the safe implementation of integrated calculators’.

In particular, NHS England has worked with ClinRisk and the academic lead to review and validate the SNOMED-CT code sets against the current Read implementation.

NHS England has confirmed that although there are ‘discrepancies,’ the clinical risk due to any differences in these coding systems is ‘low’ and is ‘outweighed’ by the benefit to patients from maintaining the integrated QTools.

The MHRA has extended the deadline for the UK Medical Device Regulation (MDR) changes to June 2024.

In an email to users, EMIS said: ‘As a result of these changes, we believe that the risk benefit ratio is in favour of not removing the tools and that maintaining the tools in their current format is preferable to maintain patient safety. We are therefore able to continue offering the integrated tools within EMIS Web until June 2024.’

In December last year, EMIS had introduced alert messages notifying users of the intended removal of the tools. It is now making system updates to remove these messages.

It comes as GP practices are expected to move to routinely using QRisk3, an updated version of the risk score that takes into account other factors including migraine and severe mental illness. In recent updated draft guidance on statins, NICE said QRisk3 performed best in assessing cardiovascular risk in a UK population.

The email added: ‘We are awaiting guidance from NHS England on when and how QRisk 3 should be integrated by clinical software suppliers moving forward to ensure ongoing compliance with medical device regulations. We will continue to provide updates as they become available.

‘We understand that integrated QTools are a widely used feature of EMIS Web and we thank you for your patience whilst we have worked with national stakeholders to agree a solution which helps you to deliver safe and effective patient care.’

Professor Azeem Majeed, head of the department of primary care and public health at Imperial College London, said this was good news as estimating CVD risk scores for primary prevention would have been ‘much more laborious and error-prone’ without access to QRisk within medical record systems.

He told Pulse: ‘Given the emphasis the NHS is putting on prevention, this continued support for QRisk is a positive step.

‘Now that we have a temporary solution, I hope a longer-term fix can also be found so that the support for QRisk continues after June 2024.’

Last month, GPs warned that the removal of the QRisk calculator from EMIS at the end of March would lead to increased workload and could also mean fewer patients have their cardiovascular risk assessed.

Meanwhile, EMIS was recently questioned by GPs over a decision to remove its ‘panic button’ feature, with GPs fearing this could jeopardise safety amid increasing levels of abuse. The button is currently displayed in the top right-hand corner of every EMIS Web screen and staff can use it to send an alert to all other PCs that are logged on to EMIS Web.

EMIS said that they had been made aware that certain local network configurations ‘prevent the panic button functionality from operating as designed’ and that following an internal investigation and ‘in-depth technology review,’ a decision was made to remove it for all customers from June.


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Please note, only GPs are permitted to add comments to articles

Azeem Majeed 24 March, 2023 4:51 pm

Currently, the QRISK2 calculator is built into EMIS which makes it very easy to calculate the score. Removing the calculator from EMIS (and SystmOne) would make calculating the QRISK score much more laborious as the data would have to entered manually on an external website. This would take much longer to complete than the current automated method using the inbuilt calculator. There would also be greater risk of mistakes as some data entry errors will be inevitable.

As well as increasing workload for primary care teams, it may also affect primary CVD prevention as fewer patients may end up having their QRISK2 score calculated. We do need clarity from NHS England and the system suppliers such as EMIS and SystmOne about what they are doing to address this problem. Given recent comments by the four UK Chief Medial Officers about the importance of prevention, it’s essential this issue is tackled soon and a solution put in place that helps both primary care teams and patients.

Richard Greenway 24 March, 2023 6:10 pm

Good news.
MHRA need to distinguish between diagnostic tests (like a lab machine that measures blood glucose accurately) and risk calculators which calculate an estimate of RISK (not certainty) of an outcome.

These are there to assist clinicians in making a clinical decision – not in themselves a diagnostic device. If you treat them you get bogged down in risk averse behavious about who’s fault it is if the “wrong” number is generated. Presuming out of the EU we don’t need to slavishly adopt CE mark status for these.

QRISK3, QRISK2, Framingham will give different results from one another. They are not right or wrong. Closer to a weather forecast than a thermometer.
Once they get this -they will be less risk averse about integrating these useful calculators in EMIS.

Anonymous 24 March, 2023 8:51 pm

Easier to update qrisk2 with qrisk3.

But obviously this would cost and probably someone has already decided this is not worth the hassle.