How do you automate in SystmOne? Why are "Protocol Entry" notes appearing in patient records?

SystmOne allows a high degree of automation through the use of Protocols, whenever someone has retrieved a patient record. We use them to calculate and code things like BMI, KFRE (Kidney Failure Risk Equation) and Cockcroft-Gault. We also use them to auto-send patient messages and even code new or updated diagnoses, such as CKD staging. 

These automation protocols fall into two main categories:

1. Actions that cannot be taken in bulk, e.g. calculations or messages that are tailored to individual patients such as offering a patient a statin and including their latest QRISK score in the message
2. Actions that can be taken in bulk but require staff to action reports manually, e.g. asking patients to complete a full Audit-C after telling us they drink more than 14 units/week

There are often significant numbers of patients where protocols need to be run. When practices first run our systems, they often find hundreds of patients who need a Cockcroft-Gault calculation. Rather than having a member of staff retrieve each record manually, the most efficient method is to have protocols that run in the background whenever anyone is in the record for any reason.

Often, in scenarios where calculations are needed or messages need to be sent, the records are being retrieved anyway—in appointments, following recent results, or just having monthly prescriptions issued.

Another advantage of this approach is the trickle effect - rather than sending out >100 medication review questionnaires at once, they can be sent as records are retrieved.

Protocol Entry Notes

One downside of this approach is that staff get a bit thrown off when they see the system do things they hadn't done themselves. For example, they might save the record and see that a message is being sent to the patient or notice that a calculation has been coded that they haven't done themselves.

To mitigate this and make it clear in the notes, our automation protocols always added a "Protocol Entry" note that explains this. 

Here are a few examples...

• Protocol Entry: Communication sent in background via protocol.
• Protocol Entry: Cockcroft Gault calculated in the background, without user interaction, using actual weight for medication monitoring and safe prescribing. This is based on the latest data in the patient record on SystmOne and doesn't include results in other systems.
• Protocol Entry: KFRE calculated in the background, without user interaction, based on latest eGFR and ACR in SystmOne record. KFRE >5% so will be reviewed from clinical report to consider referral if not already under nephrology.
• Protocol Entry: Heart Failure review coded as complete as all physical checks, including NYHA scale, and medication review have been done in this QOF year.
  

Generally, staff get used to this. It's also worth knowing that it is possible to audit protocols in patient records and see exactly what triggered when these entries.

How do I turn these features on?

This is not turned on by default, but only when a practice opts to use certain automation.

Rather than every practice needing to create and maintain its own protocols, we can add practices to specific features that they would like to enable and ensure protocols are kept up-to-date. 

Any report that "(A/S)" at the end of the name can be automated. If there's automation you're not using and would like to, just let us know.

Will this lead to messages being sent inappropriately?

Any approach to communicating with patients done in bulk or automated risks this. Even if you reviewed every record manually before sending a message to a patient, the record may not be up-to-date, things may not be coded properly, etc.

That said, we take steps to minimise this as much as possible. Many of our automation messages only get sent when the record is saved and when it's not part of a consultation. We also check that certain codes haven't just been added, which might suggest it's not appropriate to send a message, e.g., a bereavement or cancer diagnosis.

Overall, we think the benefits to patients and practices outweigh any negatives, but each practice ultimately makes the decision to use automation.