Ardens has created a variety of resources to assist practices with identifying patients who may have Rheumatoid Arthritis, and to support the patients ongoing management once diagnosed. 


Recording Information on the Management of Rheumatoid Arthritis Patients

The Ardens Rheumatoid Arthritis clinical template has been designed to standardise consultations, ensuring clinicians are following the latest national guidelines and recording accurate coding of data. 

 

To locate the template, access the relevant patient record. Open a new consultation and select the Run Template option (if not in consultations, click on the Add button on the EMIS ribbon, followed by Data Using Template option).

 

This will open the Template Picker screen. If you have accessed any templates before, these will display to the left of the screen. Search for the template by typing “rheumatoid” in the search box.

 

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This will return the Rheumatoid Arthritis (Ardens) template (alternatively select the Ardens > Chronic disease templates folder to the right of the screen).


Double click on the template to launch.


 

All of the Ardens Chronic Disease Templates follow the latest NICE guidance and best practice information. They include a QOF page for capturing QOF requirements and review pages to complete a structured review.

 

Any information displayed in red relates to payment purposes such as QOF, PCN DES or local payment. Please note - if the information is relevant for the current financial year you do not need to duplicate this information. 


 

The Initial Diagnosis page can be used for patients without a confirmed diagnosis of RA, this page enables you to record relevant history and record your examination findings.  Please note - the appropriate diagnosis codes for rheumatoid arthritis can be found within the QOF page.

 

 

If you suspect Rheumatoid Arthritis, the patient should be referred for specialist assessment, whilst waiting for the assessment you may consider various initial investigations.  The Initial Investigations page suggests investigations you may wish to perform and displays the results of the last coded entries of these tests.

 

The management for Rheumatoid Arthritis will be primarily in secondary care, however the Management Guidelines page can be used to record data such as a management plan, education around smoking, alcohol and diet. 

 

The Referral page gives NICE guidance on referring and enables you to code that the referral has been done:

 

 

All Rheumatoid Arthritis patients should have a face-to-face review at least once every year, the Annual Review page ensures you are coding that this has taken place as well as providing the clinician with sections to record information around the patient’s perspective, medication and complications.


Patients with rheumatoid arthritis are at a higher risk of fracture, the Fracture Risk Assessment page provides risk assessment tools which will produce a risk estimate for overall risk, and risk of hip fracture.


The Flares of RA page can be used to document details of a suspected flare of RA.


The Review and Recall page enables users to record that the annual review has been completed, it also includes a option to record a future diary date to arrange an interim review – this will link to the Ardens Diary Recall System.  For practices not using a month-of birth recall system there is also the option to enter a diary date in the future to recall patients for their annual review, which can link to our Diary Recall System. For more information on the Diary Recall System, please see our dedicated Support Article.

 

 

The template contains many helpful links and information including links to NICE guidance and link to a printable steroid card within the Management Guidance page and leaflets for your patients within the Resources page.

 

Please note - for patients presenting with multiple long term conditions, you may wish to use the Ardens Multi-Morbidity Templates.

 

Ardens Clinical Safety Alerts

The Ardens Clinical Safety Alerts will flag in real-time important MHRA drug safety and NICE guidance information that maybe missed. The alerts are triggered automatically by certain activity entered in the patient record e.g. entering a particular code or prescribing specific drugs. Further information on the Clinical Safety Alerts included, can be found here.


The NPSA steroid card alert may display for Rheumatoid Arthritis patients when issuing steroid medication and they have not had a steroid card issued within the last 3 years. On closing the alert, you are presented with a multiple-choice question which enables you to issue the card if needed.

 

 

Ardens Rheumatoid Arthritis Searches 

Ardens has provided various searches which may be useful to support practices with the care of RA patients. The searches can be accessed via the Population Reporting module > Ardens Searches folder.


1.1 Chronic Disease (QOF) Recall Syst

This is a month of birth recall system, designed to recall patients for multiple conditions at once.  These searches will ensure your RA patients are attending their annual review.

 

 

For more information, please see our dedicated support article

 

1.2 Ardens Diary Recall Searches

The Ardens Diary Recall System allows practice staff to easily manage diary recalls for ad-hoc tests, including blood tests and interim reviews.  These can be used to ensure your RA patients are called back for any interim RA review that is set for them, or any blood tests required:

 

 

For more information, please see our dedicated support article.

 

1.4 Ardens Clinical Safety Searches

Ardens has created medication related searches to support practices with identifying patients on medication that may need extra care or monitoring. For your RA patients who are issued with DMARDs, within the Medication Related Searches > DMARDs folder, searches will suggest patients to review as they have not had FBC, U&Es and LFTs in last 13 weeks.


You may also find the NPSA Steroid alerts (Ardens) folder useful for RA patients who have recently had multiple issues of steroid medications but have not had a steroid card issued in the last 3 years.

 

 

1.6 Ardens Miscellaneous Review Searches

Within this folder Ardens have created a suite of miscellaneous review searches, the Rheumatoid Arthritis – Care Review folder contains a report showing details of patients who have not had their RA annual review this financial year: 

 

 

 

5.0 Ardens Case Finders

Ardens have provided a suite of searches to support practices to improve data quality and ensure QOF payments are correctly calculated for your RA patients.  These can be accessed via the Population Reporting module > Ardens Searches > 5.0 Ardens Case Finders > Rheumatoid Arthritis folder:

 

 

The searches are reporting on patients that fulfil certain criteria which indicates the patient potentially could be included in the Rheumatoid Arthritis QOF register but are not recorded with the correct diagnostic code. For more information, please see our dedicated Support Article.

 

Rheumatoid Arthritis Document Template

Ardens has created a EMIS version of the Corticosteroid Monitoring document. This maybe useful for your RA patients.


To access the Document Templates:

  • Within a consultation, select the Documents > Create letter option.
  • Outside of a consultation, select the Add > Document > Create letter option.

 

This will display the New Patient letter screen.

 

Click on the magnify glass to search for the document template:

 

 

 

This will display the Find Document Templates screen.

 

Search for the Corticosteroid Management document template using the search box provided, select the relevant document template and click on OK to launch (alternatively double click on the document to open):

 

 

 

The document will load, with the pre-populated information:

 

When completed, click on the File option on the left of the screen, Print (if needed) and Save and Close to save the document to the patients care record.

 

If you require any further assistance on the process above, please contact Ardens support on: support-emis@ardens.org.uk