Templates are a great way to standardise practice in your clinical team – so basically to make sure everyone is asking the same questions or using the same codes and diaries in specific clinical scenarios. An example is to create a COCP template to make sure all prescribers are asking about the most important UKMEC contraindications like migraine with aura.
But today, for the abnormal LFT enthusiasts among you – prepare for something awesome.
1. Add Folder
As always, we start with the EMIS ball in the top left hand corner and go to resource publisher. Click on protocols and templates, and this is where templates live. It’s worth pointing out that EMIS has a lot of their own templates – like a QRISK 2, PHQ-9, and often QOF related templates but we will be creating our own template today. And to use a template, when in a consultation – click on run template and choose the template you want.
Back to the resource publisher, as always, go to your practice and go to your folder – if you don’t have one, right click on your practice and add folder.
2. Add Template
Then add template. We will start with adding the problem code that the Fib-4 calculator pertains to. We use the abnormal liver function tests code.
3. Custom Calculation
Then in common components – choose custom calculation. Let’s add the parameters. As you can see from this website – this is the mathematical formula for the Fibrosis-4 score index. Let’s add all four parameters, starting with age – bear in mind EMIS calculates age in days, so to get years we have to multiply this by this 0.00273973.
Next make sure you add the exact codes for AST, Platelets and ALT – and the trick to getting this right is described in this video here, you basically want to copy the concept IDs. (3 mins mark)
Finally when you are putting in the formula – make sure you click on the pop-ups that appear.
( Age*0.00273973*Ast ) / ( Platelets*sqrt(Alt) )
4. Add Diary
Once that is done, you can add some guidance in the interpretation box below.
Less than 1.3 (over 65 years over 2.0) -- Low Risk, repeat in 3 years. 1.3 and over ( over 65 years 2.0 and over) --> Refer to Liver Clinic
The last bit is adding a diary if the Fib-4 score is normal – for 3 years. Repeat Fib-4 in 3 years Test templates and activate and you are sorted!