OneMonitoring Alert

OneMonitoring Alert

Overview

OneMonitoring is a live patient monitoring and workflow support tool that appears when opening a patient record in EMIS Web.

It brings together:

  • QOF monitoring
  • disease monitoring
  • medicines monitoring
  • patient safety prompts
  • review requirements
  • coding issues
  • out-of-range results
  • year-end requirements

into a single structured alert.

The aim of OneMonitoring is to help users quickly understand:

  • what conditions the patient has
  • what monitoring is overdue
  • what action may be needed now
  • what activity may still need completing before the end of the QOF year

OneMonitoring is designed to support opportunistic care during normal consultations.


Where will I see OneMonitoring?

OneMonitoring automatically appears when opening a patient record.

The alert appears within EMIS Web and updates dynamically depending on:

  • diagnoses
  • medications
  • blood results
  • review history
  • coding
  • QOF eligibility
  • frailty
  • outstanding monitoring

Different patients will therefore see different outputs.


Understanding the Alert Structure

OneMonitoring is divided into four main sections.

1. Registers

This section shows which disease registers the patient is currently on.

Examples include:

  • Asthma
  • COPD
  • Diabetes
  • CKD
  • Heart failure
  • Hypertension
  • Mental health
  • Stroke/TIA
  • Obesity

Where appropriate, the alert may also display:

  • latest review date
  • latest disease monitoring
  • register-related warnings

How should I use this?

Use this section to quickly understand:

  • what long-term conditions the patient has
  • whether reviews have ever been completed
  • whether monitoring may be missing

This section is particularly useful when:

  • seeing unfamiliar patients
  • reviewing blood results
  • completing medication reviews
  • undertaking opportunistic care

2. General Info

This section provides useful background information that may affect patient management.

Examples include:

  • blood pressure targets
  • latest blood pressure
  • home BP information
  • smoking status
  • cervical screening status
  • diabetic foot review information
  • medicines-related monitoring prompts

How should I use this?

This section helps provide consultation context before deciding what action to take.

Examples:

  • understanding whether the patient has a higher BP target because of frailty
  • checking whether smoking status is up to date
  • reviewing whether monitoring related to medication is required

3. QOF Due Now

This section highlights activity that appears to require action now.

This is the most important operational section within OneMonitoring.

It is divided into four subsections.


Time Limited

These alerts relate to activity that needs completing within a specific timeframe.

Examples may include:

  • recent diagnosis follow-up
  • obesity pathway activity
  • new diagnosis monitoring

How should I use this?

These alerts should usually be prioritised promptly because they often relate to:

  • new QOF requirements
  • recent diagnoses
  • early intervention opportunities

Not Done in Last 10 Months

These alerts identify monitoring or reviews that have not been completed recently enough.

Examples include:

  • blood pressure
  • asthma reviews
  • COPD reviews
  • HbA1c monitoring
  • diabetes care processes
  • mental health reviews
  • dementia reviews

How should I use this?

These alerts are useful for:

  • opportunistic completion during consultations
  • booking follow-up appointments
  • prioritising recall workload

Where possible:

  • complete missing activity during the consultation
  • book future monitoring before the patient leaves
  • use PCIT templates to record activity consistently

Out of Range

These alerts identify patients whose latest results are outside target.

Examples include:

  • raised blood pressure
  • HbA1c above target
  • cholesterol above target

How should I use this?

These alerts help identify patients who may need:

  • medication review
  • treatment escalation
  • follow-up bloods
  • clinician review
  • lifestyle advice
  • shared decision-making

OneMonitoring helps prioritise higher-risk patients who may otherwise be missed.


Just Needs Doing

These alerts identify patients where activity appears outstanding but may not yet be overdue.

Examples include:

  • statin requirements
  • anticoagulation requirements
  • heart failure medication requirements
  • cervical screening
  • smoking cessation advice

How should I use this?

These alerts are particularly useful during:

  • medication reviews
  • LTC reviews
  • opportunistic consultations

They help users complete important activity before it becomes overdue.


4. Due by Year End

This section highlights activity that still needs completing before the end of the QOF year.

Examples may include:

  • asthma reviews
  • COPD reviews
  • blood pressure
  • smoking status
  • NDH reviews
  • mental health monitoring

How should I use this?

This section is designed to:

  • reduce end-of-year pressure
  • support proactive planning
  • help practices spread workload across the year

These alerts may not require immediate action but should still be planned appropriately.


How should practices use OneMonitoring?

OneMonitoring works best when:

  • all clinicians understand the alert structure
  • coded templates are used consistently
  • disease reviews are coded appropriately
  • opportunistic care is encouraged
  • monitoring is completed during normal consultations where possible

The tool is particularly effective when combined with:

  • OneTemplates
  • OneLauncher
  • QOF searches
  • PCIT dashboards
  • medicines safety protocols

Using OneMonitoring Alerts

OneMonitoring is designed to support rapid completion of outstanding monitoring and QOF activity directly from the patient record.

Double-click functionality

OneMonitoring alerts can be double-clicked.

Double-clicking the alert launches a supporting template designed to help users:

  • complete missing QOF activity
  • record outstanding monitoring
  • add missing codes
  • document reviews
  • complete care processes
  • record personalised care adjustments where appropriate

The templates are designed specifically for the current contract year and help ensure activity is coded correctly for QOF.

Examples of activity that may be completed through these templates include:

  • blood pressure reviews
  • asthma reviews
  • COPD reviews
  • diabetes care processes
  • smoking status
  • HbA1c monitoring
  • cholesterol management
  • frailty coding
  • obesity pathway activity
  • medication monitoring

Why is this important?

This allows practices to:

  • complete activity opportunistically during consultations
  • reduce end-of-year catch-up work
  • improve coding consistency
  • reduce missed QOF achievement
  • standardise workflows across teams

Rather than simply warning users about missing activity, OneMonitoring is designed to help users immediately action and record the required work.

💡 Tip: Users should become familiar with double-clicking alerts, as this is one of the fastest ways to launch the correct template for the patient’s outstanding activity.


Important Clinical Areas Supported

OneMonitoring supports many clinical areas including:

  • Asthma
  • COPD
  • Diabetes
  • Hypertension
  • Heart failure
  • CKD
  • Mental health
  • Dementia
  • Obesity
  • Stroke/TIA
  • Rheumatoid arthritis
  • Osteoporosis
  • Palliative care
  • Learning disabilities

Frailty-Aware Monitoring

OneMonitoring supports the newer frailty-aware QOF rules introduced in 2026/27.

This means the alert may:

  • adjust blood pressure targets
  • adjust HbA1c targets
  • suppress unnecessary monitoring prompts

where moderate or severe frailty has been coded appropriately.

Correct frailty coding is therefore very important.


Hints and Tips

💡 OneMonitoring is designed for opportunistic care — many alerts can be resolved during unrelated consultations.

đź’ˇ Completing monitoring during the initial patient contact can significantly reduce future workload.

đź’ˇ The tool is most effective when structured templates and coded workflows are used consistently.

đź’ˇ Frailty coding now significantly affects several QOF indicators.

💡 The “Due by Year End” section is designed to help practices avoid end-of-year recovery work.

đź’ˇ Out-of-range alerts can help identify patients needing earlier intervention before deterioration occurs.


Common Uses

Teams commonly use OneMonitoring during:

  • medication reviews
  • LTC reviews
  • blood result processing
  • care navigation
  • opportunistic consultations
  • annual review planning
  • QOF optimisation work
  • medicines safety reviews

System Dependencies

OneMonitoring relies upon:

  • accurate coding
  • coded diagnoses
  • coded blood results
  • coded reviews
  • medication coding
  • structured workflows

The quality of alerts improves significantly when practices consistently use coded templates.


System Trigger

System trigger: Load patient record

Run mode: Always run

Enable trigger for: All users


How to get it

OneMonitoring is included as part of the PCIT toolset and is automatically installed for subscribing sites.

If your practice cannot see OneMonitoring within EMIS Web, please contact the PCIT support team.

    • Related Articles

    • OneRecall Alert

      Introduction The principle behind the system is that the clinicians retain complete control over the “recall loop”. Once they are satisfied that all elements of care have been attended to, clinicians need to code: Chronic disease annual review” ...
    • 2026/27 QOF Contract OneMonitoring — Technical Release Notes

      2026/27 QOF Contract OneMonitoring — Technical Release Notes Summary 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 ...
    • EMIS alert box flickering

      We are aware of a number of instances recently where users experience flickering when trying to view the tooltip information by hovering the mouse over OneResults or OneMonitoring in the red/pink EMIS alert box. The flickering is caused by EMIS being ...
    • 2026/27 QOF support materials: PCIT Templates, OneMonitoring, Handy Protocols and Searches

      2026/27 QOF support materials: PCIT Templates, OneMonitoring, Handy Protocols and Searches Overview Primary Care IT provides a range of QOF support materials to help practices identify outstanding activity, improve coding accuracy and support ...
    • Shingles alert (HP062)

      Shingles Alert (HP062) Overview/Purpose This shingles alert is a protocol alert for EMIS Web, which has been designed to fill the void of a previously active EMIS authored alert. The alert is designed to show users that: The patient is eligible for a ...