This release is a structural update to the OneMonitoring alert logic to align it with current QOF requirements. The OneMonitoring alert has been reviewed concept by concept, with the main changes driven by QOF v51 register changes, revised frailty handling, new obesity, heart failure and DM037 requirements, and updates to specific indicator logic.
The release affects register display, general information prompts, QOF “Due Now” logic, “Out of range” logic, “Just needs doing” logic and “Due by year end” alerts.
This update includes changes across:
OneMonitoring register logic has been updated to use the current QOF v51 register concepts where required.
The asthma “no review ever” logic has been amended to use the v51 asthma register. The base asthma register display remains unchanged, as it already uses current asthma diagnosis and treatment in the QOF timeframe without an age dependency.
COPD register logic has been updated to match v51 business rules. The “COPD but no review ever” concept has also been amended to use this v51 COPD register logic.
Heart failure register output now includes information to highlight patients on the heart failure register who do not have reduced ejection fraction recorded.
Gestational diabetes has been added separately from NDH, so GDM patients can be surfaced distinctly rather than being hidden within NDH logic.
Obesity register logic has been refreshed. The old obesity register has been removed and replaced with v51 compliant rules. A new alert has also been added for patients with previously raised BMI but no BMI recorded in the current QOF year.
Blood pressure target concepts have been amended to reflect the revised frailty handling, so that patients with moderate or severe frailty are excluded from target BP prompts where appropriate.
The previous diabetes-specific concept for patients who are frail or aged 80+ has been rewritten. We now present a broader “no BP target because of age or frailty” message covering diabetes, CHD, hypertension and STIA. The related BP template text has also been updated so the wording is no longer diabetes-specific.
No logic change was required for latest BP, home BP, mirabegron or leflunomide BP prompts. A spelling correction is noted for the ECG antipsychotic alert wording.
The time-limited section has been updated for new and removed indicators.
Asthma alerts for both diagnosis and monitoring have been updated to cope with age 5+ rules.
New obesity alerts have been added for:
OB004 — BMI raised and referral required
OB005 — BMI raised and obesity medication / pharmacotherapy requirement not met
The “not done in last 10 months” section has had substantial logic changes.
BP monitoring logic has been updated to cope with the CD001/CD002 logic, HYP008/HYP009 have been replaced with HYP010/HYP011, and legacy STIA015/STIA016 BP target concepts have been removed.
Diabetes BP logic has been updated to handle frailty. Last BP out of range has also been updated to use the revised CD, diabetes and hypertension target logic.
Asthma review monitoring has been renamed and updated from AST007 to AST015. The nested eligibility and complete-review concepts now use the new asthma register logic.
COPD review monitoring has been updated for the v51 COPD register.
Diabetes HbA1c monitoring has been rebuilt for DM020 and DM021 because older frailty refsets included Rockwood-based logic incorrectly. New PCIT v51 DM020/DM021 achieved and alert-not-achieved concepts have been created.
The previous DM012 foot-check prompt has been removed from OneMonitoring and replaced by the broader DM037 8 Key Care Processes approach. New DM037 concepts have been added for APCR, BMI, BP, cholesterol, eGFR, foot assessment, HbA1c and smoking, including achieved, eligibility, not-achieved and in-last-10-month variants.
NDH monitoring has been renamed from NDH002 to NDH003, with gestational diabetes added into the eligibility logic
The “out of range” section has been updated where the underlying target concepts changed.
BP done in QOF timeframe but high has been amended to reflect CD001/CD002 and the updated hypertension indicators. Diabetes out-of-range tests have also been updated to use the v51 PCIT DM020 and DM021 logic with revised frailty handling.
The “just needs doing” section has been updated for heart failure and prescribing safety changes.
A new alert has been added to support the new heart failure four-pillar therapy requirement for HFrEF patients not on all required therapy. HF003 and HF006E alerts have been removed from the parent concept and alert text because they are no longer in QOF.
The diabetes statin alert has been amended so its nested frailty logic uses correct frailty logic.
STIA007 antiplatelet / anticoagulation logic has been updated. A logic issue was identified and corrected, and ticagrelor contraindication and declined-care concepts have been added.
The “due by year end” section has been updated to align with the same QOF v51 and frailty changes.
BP due-by-year-end logic has been amended to handle the new CD indicators and frailty exclusions. Asthma has been renamed and updated from AST007 to AST015. COPD due-by-year-end logic now uses the v51 COPD eligible concept. NDH has been renamed to NDH003 and updated to include gestational diabetes.
New DM037 due-by-year-end concepts have been added for the 8 Key Care Processes where activity has been completed in the last 10 months but not yet within the QOF timeframe. These cover APCR, BMI, BP, cholesterol, eGFR, feet, HbA1c and smoking.