[England only] Covid-19 At-Risk Patients

As previously reported, NHS England have written to 900,000 at very high risk patients advising them to stay indoors (shield) for the next 12 weeks.

As directed by NHS Digital, overnight on 23 March, a utility was run on your patient records and any patients falling in the ‘at highest risk’ group as specified by NHS Digital now have the Read code 9d44.00 Risk of exposure to communicable disease (situation) added to their record.

By default the associated History entry for patients identified as at-risk contains the following details:

• Read Term for Characteristic - 9d44.00 Risk of exposure to communicable disease (situation) - note the SNOMED CT Description is used for the terms automatically added to patient records.
• Comment - High risk category for developing complications from Covid-19 infection - Added at NHS Digital request.
• Priority – 3.

IMPORTANT - Previous communications from NHS England advised that practices should await further instruction before contacting affected patients. However, we have now been advised that the original guidance for contacting and reviewing patients is still valid and you should continue to follow NHS England guidance as detailed in their FAQs here. You will see in this guidance that there is also a letter template which we have rendered into a Vision 3 letter template which you can download here.

At-Risk Patients – Phase 2

NHS England have identified additional At-Risk patients as part of phase 2 of this process. This list also includes the reason why the patient has been included in the list. NHS Digital have only just released this list to us (9th April 2020) to allow us to update the patients at your practice. We are working to create and run another utility which will add the clinical term "9d44.00 Risk of exposure to communicable disease (situation)" to the appropriate patient records. The reason why the patient has been identified as at highest risk will also be included in the free text comments.

As part of phase 2, we will also ensure that all at highest risk clinical terms are flagged as priority 1 medical history. This means they will be included in SCR uploads for consenting patients. 

Once the utility has been run, you can review the newly added patients via the Clinical Audit, as detailed below, and once you have received the April 2020 SNOMED CT update, due to start release from 15 April 2020, you can use the following clinical terms to classify the patient risk:

• 14Op.00 Low risk category for developing complication from COVID-19 infection
• 14Oq.00 Moderate risk category for developing complication from COVID-19 infection
• 14Or.00 High risk category for developing complication from COVID-19 infection

Manually Recording a Patient is At Highest Risk.

If you have any patients in this vulnerable category that have not been identified with the term 9d44.00 for any reason, for example, newly registered patients, patients with new at risk diagnoses or patients prescribed drugs by a hospital, Read term 9d44.00 Potential infectious contact must be manually added to their clinical record with a Priority of 1 and "High risk category for developing complications from Covid-19" entered into free text comments.

Reviewing At Highest Risk Patients

You can view the patients who have had the 9d44.00 clinical term added to their record by downloading and importing the latest Coronavirus Clinical Audit from here and reviewing the Patients flagged by NHS Digital as increased risk for developing complications from Covid-19 infection (9d44) group:

The group has an active Reminder of ‘At significant increased risk from COVID-19’.

Dr Tom Hodges-Hoyland
Medical Adviser/Clinical Safety Officer
Vision