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ℹ️ Introduction
This article explains how to set up, review, maintain, and update the Continuity of Care RAG Status using the Ardens resources within EMIS Web. By the end of this guide, you will understand how to activate the required protocols, identify patients requiring review, maintain the registers, and record or update a patient’s RAG status.
Background
The Continuity of Care RAG model helps practices identify and manage patients according to their level of continuity need using a Red, Amber, Green (RAG) approach.
The Ardens resources support practices by:
Identifying patients who require a RAG status
Highlighting patients needing review
Providing alerts and templates within the patient record
Supporting ongoing register maintenance and data quality
How Ardens Can Help
Ardens has developed a number of Continuity of Care resources to support patient segmentation and the ongoing management of each group. These resources enable prioritisation, regular review, and the updating of RAG status as required.
For an overview of the resources, including background and clinical context, please refer to the Continuity of Care RAG - Overview support article.
⚙️Initial Setup
To set up the practice to use the Continuity of Care RAG model and ensure clinicians can begin recording the RAG status.
Activate Protocols
Click the EMIS ball (menu)
Select Configuration > Resource Publisher
Navigate to Shared folders > Ardens Live National Content > Optional Protocols (inactive by default) > Continuity of Care (Foundry Model)
Right-click on each of the following protocols and select Status > Activate
RAG / Continuity of Care Alert: Displays the patient’s latest RAG status in the pink alert box.
Continuity of Care: Patient Segmentation: Prompts clinicians to update the RAG status when saving a consultation (optional)
The protocols will now be active
Once activated, the protocols will become active immediately.
Review Patients with no RAG Status Recorded
Go to Population Reporting
Expand Ardens Searches
Select 1.37 Administration - Risk Strat > Continuity of Care RAG > Registers folder
Run the report folder
We recommend prioritising the Predicted reports, as these identify patients without a recorded RAG status.
To update the patient's RAG status:
Open the patient record
Navigate to the pink alert box where you will see the alert Continuity of care: UNKNOWN
Double click the alert to launch the template
In the Update RAG status section, select the appropriate status
Select Save Template
The patient’s alert will update automatically once saved.
🚦 Ongoing RAG Status Reviews
We recommend practices review and maintain the Continuity of Care registers monthly.
Register Maintenance
Select 1.37 Administration - Risk Strat > Continuity of Care RAG > Registers folder
Run the report folder
Continue to review and action:
Predicted reports
RAG Status: Unknown / Not Recorded reports
Update the patients RAG status where appropriate
Data Quality Reviews
Select 1.37 Administration - Risk Strat > Continuity of Care RAG > Data Quality folder
Run the report folder
For the top three reports (Record RAG Status as not previously recorded but predicted):
These patients have never had a RAG status recorded
Review the record and update the RAG status (follow the same steps as Initial Setup)
For the bottom three reports (Review RAG status as recorded XX but predicted):
Review each patient and decide whether the suggested RAG status should be recorded
Review RAG Status
Select 1.37 Administration - Risk Strat > Continuity of Care RAG > Data Quality folder
Run the report folder
Advise clinicians to complete a clinical review for these patients and update the RAG status accordingly
📃 Updating RAG Status
For clinicians to record the patient's current RAG status in line with best practice guidance.
Using a Consultation
Open the patient record and click Run Template
Search for the Continuity of Care Ardens template and double click to launch
Review the current RAG status displayed and update with the appropriate status
Complete the Care Team or Special Note / Key Message section if required
Click Save Template.
Using a Protocol
Open the patient record
The current RAG status is displayed in the pink alert box
Double-click the alert to open the Continuity of Care Ardens template
Update the RAG status if required and save
🔎 Viewing RAG Status
All practice staff can easily view a patient’s current RAG status.
Open the patient record
The Continuity of Care alert in the pink box displays the patient’s current RAG status
❓FAQs
How often should the Continuity of Care searches be reviewed?
We recommend practices review the registers and data quality searches monthly.
What does the “UNKNOWN” RAG status mean?
This indicates that a patient has not yet had a Continuity of Care RAG status recorded.
🏫 Additional Support
To further your understanding of the risk stratification tools and how to make the most of Ardens resources:
For an overview of the resources, including background and clinical context, please refer to the Continuity of Care RAG - Overview support article
Watch our Continuity of Care webinars for EMIS Web and SystmOne
Explore more helpful resources on our Support Site
Book training for your GP Practice, PCN or ICB
Contact our Support Team for support in real time