2. Objectives of Training To provide you with an overview of MSD Informatics Software. To provide you with sufficient training to be able to use MSD Informatics Software in your practice To answer any questions that you have regarding MSD Informatics and our products

3. Clinical Risk Collaboration with Sandwell PCT & University of Birmingham Produces stratified list of all patients with real or probable >20% CVD risk over ten years CVD Screening Ranking Tool: Filters patient population - –Non CVD / Non Diabetic / Non Hypertensive –Framingham CVD calculator with additional risk for FH and ethnicity; unknown data substituted using ‘look up’ tables (Health Survey for England 2003)

4. Clinical Risk - Definitions CVD Risk Definition used in Clinical Risk –The Framingham CVD Risk Calculator predicts risk from any cardiovascular disease and uses the CHD Framingham score based on death from CHD (sudden or non-sudden), myocardial infarction, angina pectoris and coronary insufficiency and additionally includes stroke, transient ischemia, heart failure and peripheral vascular disease. –This algorithm tends to be higher than those used by JBS2 especially if they are not factoring in Family History and Ethnicity.

5. Clinical Risk - Definitions Excluded Patient Groups –The following patients should not have their risk calculated as they are already considered to be at high enough risk to justify lifestyle and other interventions (antithrombotic, antihypertensive and lipid lowering therapies). Patients with atherosclerotic cardiovascular disease Hypertension (≥160/100 mmHg) with target organ damage Patients with type 1 or 2 diabetes mellitus Renal dysfunction (including diabetic nephropathy) Familial hypercholesterolaemia, familial combined hyperlipidaemia or other inherited dyslipidaemia Patients on Lipid Lowering Therapy

6. Clinical Risk - Definitions The South Asian Male Weighting Definition –Ethnic groups within Britain have differing risk of coronary heart disease (CHD) and cardiovascular disease (CVD) at the same level of risk factors. This calculator uses the Risk Factor accepted by draft NICE Lipid Guidelines 2007 and adjusts for ethnic groups and is based on a re-calibration of the Framingham risk equations. –The Risk is increased by a factor of 1.4 for South Asian men

7. Clinical Risk - Definitions Family History of Premature CHD –A family history of CHD means CHD in a first degree female relative aged under 65 or CHD in a first degree male relative aged under 55. This means younger than 55 years in fathers, sons or brothers or younger than 65 years in mothers, daughters or sisters. –Risk is increased by a factor of 1.5 for individuals with a family history of premature CHD. This follows recommendations in the draft NICE lipid guidelines of 2007. –If a patient has BOTH a Family History and is South Asian then assume a risk factor of 1.5

8. Clinical Risk - Definitions LVH –Left ventricular hypertrophy (LVH) is ascertained from a resting ECG and the calculator will look for the presence of the relevant Read codes. Smoking Status –Smoking status reflects the exposure to tobacco within the last 12 months. The calculator will look for the presence of the relevant Read codes.

9. Training Materials Clinical Risk – How Do I? 1 View Relevant Clinical Notes? 2 Filter Patients? 3 Display Patient Lists? 4 Display Patient Demographics? 5 Display Patient Changes? 6 Display Risk Cohorts? 7 Set-up Mail Merge? 8 Export Data?

10. Training Materials Clinical Audit – How Do I? 1 View Relevant Clinical Notes? 2 Setup Search Filters? 3 Search on Specific Words? 4 Display Patient Demographics? 5 Display Patient Changes? 6 Display Historical Trends? 7 Set-up Mail Merge? 8 Export Data?

11. Training Materials Contract Manager – How Do I? 1 Change from Points to Rolling Points? 2 Prioritise Patients? 3 Display Patient Lists? 4 View Historical Trends? 5 View Indicators in a Disease Area?