The Primary Care IT QRISK3 Calculator Template finally integrates a well known and NICE recommended cardiovascular risk assessment tool into EMIS Web.  It allows clinicians to estimate a patient’s 10-year risk of cardiovascular events based on the latest evidence-based algorithm. It supports decision-making by automating calculations using patient data already within EMIS, saving time and enhancing clinical accuracy. 

The QRISK3 Calculator facilitates evidence-based preventative care by:

• Streamlining risk assessments, reducing errors, and saving time.
  
• Supporting informed decision-making, aligning with clinical guidelines for cardiovascular risk management.
• Incorporating the influence of systolic blood pressure (SBP) variability, by estimating the standard deviation of the SBP. 
  
• Standard Deviation of SBP is almost always overlooked when performing a QRISK3 estimation,
  
• This is usually due to the complexity of a manual standard deviation calculation. 
  
• SBP variability always adds something to the overall cardiovascular risk percentage.

The calculator is reproduced from the open-source C++ QRISK3 algorithm and adapted for use within EMIS. While the calculator provides robust risk estimates, it may differ slightly from the online version due to the use of EMIS’s Townsend score lookup.

How to use the QRISK3 Calculator

1. Launch the template from OneLauncher > OneCalculator.
   
2. Launch the template from protocol HP015 Lipid Management.
   
3. Use within the OneTemplate Non-Prescriber when performing NHS Healthchecks

Update Demographics and Clinical History

1. Check the Demographics are recorded and correct.  Update them if not.
   
2. Check the Clinic Information data entry panel:
3. The template will identify and advise when historical conditions, medications and values are found.
   
4. You can add to what has already been found in the notes for any item, for example, updating Smoking status.
   

Using the Check Boxes 

1. Some items will display text "Found in records and will be automatically included in the QRISK3 calculation", e.g.
   

            

1. All check boxes will add a suitable code to the records today. 
1. The code is used by calculator to run the calculation, even if evidence wasn't previously found in the notes.
   
2. Examples include
   
1. "Atrial fibrillation" : 49436004 Atrial fibrillation
2. "On blood pressure treatment" : 308116003 Antihypertensive therapy
   
3. "Do they have migraines?" : 161481007 H/O: migraine 
   
4. "Rheumatoid arthritis?" : 161567008 H/O: rheumatoid arthritis
   
5. "Systemic lupus erythematosus (SLE)?" : 55464009 Systemic lupus erythematosus
   
6. "Severe mental illness?" : 1823861000006101 Mental health disorder confirmed
7. "Atypical antipsychotic medication?" : 408490001 Antipsychotic drug therapy
   
8. "Regular steroid tablets?" : 297280007 Oral steroid therapy
   
9. "A diagnosis of or treatment for erectile disfunction?" : 860914002 Erectile dysfunction
   
3. We have deliberately chosen codes that won't impact your disease registers, except where it is important that they do. 
   
4. Reminder, if the text text "Found in records and will be automatically included in the QRISK3 calculation" is shown, you won't need to tick the box.
   
5. Important, if text "Found in records and will be automatically included in the QRISK3 calculation" is not shown, and you think the element is true, you must tick the box. You cannot rely on the blue date last coded date to include the element in today's calculation. 
   
6. Similarly, you may see text "Found in records and will be automatically included in the QRISK3 calculation" when there is no blue date last coded date noted, this is because the calculator picks up on many different codes and prescribing patterns. 

When entering data to the template, you cannot rely exclusively on the traditional blue date last coded column on the right of the template.  Instead, use the supporting text. 

Examinations and Investigations

1. Most values will pull through from the notes. 
   
2. We encourage you to add up to date values for Weight, Height and Blood Pressure, ideally from today.
   

The Calculator

1. There are two Calculate buttons and both calculate a QRISK3 score.
2. The fi​rst calculates the score with a Systolic Blood Pressure Standard Deviation of "0".  This is commonly what people enter onto the online calculator, by leaving the box blank.
3. The second calculates the score with our estimate for the Systolic Blood Pressure Standard Deviation.  This will always give a higher score than the first option as any variability increases the risk.  
   
4. You can choose either or both calculations, although choosing both may lead to some confusion in the records.
   
5. If you choose the second score, with our estimate for the Systolic Blood Pressure Standard Deviation, you will see on the template a little about how this was calculated, e.g.
   
   Unfortunately, EMIS does not save this to the notes, so consider copying and pasting it into your consultation for later. 
   
6. If you wish, you can compare the calculation from the template with the online version.  We have added a hyperlink to make this easy and a third place for you to record a QRISK3 score 1085871000000105 QRISK3 cardiovascular disease 10 year risk calculator score

MHRA | Class 1 Medical Device

The QRISK3 calculator in EMIS is a registered Class 1 Medical Device under UK regulations. It is designed to support clinical decision-making and complies with relevant safety and usability standards. While it has been validated to ensure accuracy, clinicians are reminded to use their professional judgment when using and interpreting results. Further integrations may alter its classification under medical device regulations.

System Dependencies

When to use it?

It is recommended for use by a clinician whenever they are juggling new cardiovascular risk variables, including

1. New and latest lipid results
2. New blood pressure values or treatments
3. New BMI calculations
4. New conditions that affect cardiovascular risk
1. Smoking status
2. Diabetes
3. Family history
4. Chronic Kidney Disease
5. Atrial Fibrillation
6. Migraines
7. Rheumatoid Arthritis
8. Systemic lupus erythematosus (SLE)
9. Severe Mental Illness or treatments
10. Regular steroid tablets
11. Erectile dysfunction
    

A Note on Systolic BP Variability Estimation

Clinicians should be familiar with:

• The importance of cardiovascular risk assessments.
• The role of SBP variability in risk estimation.
• When to use or omit the SBP SD in calculations.