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Patients Stuck on QOF Mental Health (MH) Indicators
Patients Stuck on QOF Mental Health (MH) Indicators
This article is aimed at SystmOne GP users.
The Problem
The Problem
A patient in remission from a mental health condition should only appear on the MH register. They should not be active requiring actions on MH indicators. e.g. MH002 for care plans.
If a patient is stuck showing as red on QOF Timeline despite remission being recorded, there is a data quality issue in the record that needs attention.
Why this happens
Why this happens
QOF uses episodicity on MH diagnosis codes to understand a patient's journey. The rule is simple:
The first diagnosis of an MH episode must be marked New episode
Without this, QOF cannot correctly interpret any remission codes that follow - so the patient stays on the indicator reports indefinitely.
The Fix
The Fix
Find the original diagnosis
Open the patient's record and go to the QOF Alerts & Analysis node
Within the node, view the Clinical Data by [Read] Code Cluster tab.
Look at the MH cluster to review the diagnosis and remission history.Check for missing episodicity
If the original diagnosis is not marked 'New episode', that's the problem.Add the missing episodicity
Right-click the original diagnosis code → Episodicity → New Episode
The Journal entry will now show (New Episode) next to the code. On the QOF Alerts & Analysis screen, an icon will confirm this.
The patient should now appear grey (exempt) on QOF Timeline for indicators; however, they will correctly remain on the QOF register.
Common scenarios (Click to expand)
Common scenarios (Click to expand)
Patient has had multiple episodes or conditions
Patient has had multiple episodes or conditions
The start of each episode needs its own 'New episode' marker. Duplicate or repeated diagnoses within a single episode can be left without episodicity, or marked 'Ongoing episode' — this doesn't affect QOF as long as the first entry in that episode is correctly marked.
Patient record only contains a remission entry — no original diagnosis
Patient record only contains a remission entry — no original diagnosis
Ideally, back-date an diagnosis to the appropriate historic date before the remission code and mark it 'New episode'.
If there is genuinely no evidence of when the original diagnosis was made, mark the remission entry itself as 'New episode'. QOF will treat this single code as both the diagnosis and the remission entry. For good records keeping, consider adding a note explaining that no original diagnosis date could be located to explain the dual-purpose code.
A patient relapses
A patient relapses
Should a patient require any treatment for this condition. Add a new MH diagnosis more-recently than the last remission entry and mark it 'New episode'.
This will place the patient back onto the active QOF indicators for monitoring.
Summary for coders
Summary for coders
First/new diagnosis? - Mark as 'New episode'.
Remission entry? - No episodicity needed - Do not record as 'New episode'.
Relapse (treatment required) - Re-add diagnosis later than most-recent remission entry and mark this diagnosis as 'New episode'
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