Alerts and Flags in PIP

What Flags are

Flags highlight information that a user should be aware of before or during an encounter with a patient. In Core, they cover a range of concerns — clinical risk, safeguarding, access and communication needs, and other alerts recorded by the patient's care team.

Flags are notifications, not instructions. They tell you that something has been recorded somewhere in the patient's records. They do not replace your own assessment, your professional judgement, or a conversation with the patient.

Where Flags come from

Core assembles Flags from three distinct sources. The source determines who maintains the Flag and how any error is corrected — see section 5.

Dynamically created Flags

Core generates these itself. When Core retrieves data from a connected source system and finds a defined condition, observation or combination of codes, it raises a Flag automatically.

These Flags do not exist in the source system. They are derived by Core from data that does, and they will change if the underlying data changes.

Flags retrieved from source systems

Where a connected source system holds Flags of its own and exposes them technically, Core retrieves and displays them as recorded.

Availability varies by system and by configuration. The absence of a Flag from a particular system does not mean no Flag exists there.

Reasonable Adjustment Flags (Patient Flags Service)

The Reasonable Adjustment Flag is a national record held on the NHS Spine that indicates a person requires reasonable adjustments, and may include details of relevant impairments and the key adjustments that should be considered. It exists to support organisations' legal duty under the Equality Act 2010 to make services as accessible to disabled people as they are to everyone else, and was built into the Spine so that these details can be recorded, shared and viewed wherever the person is treated.

Core retrieves these via the NHS England Patient Flags API. Access is governed by NHS Identity and Role Based Access Control, so only staff with the relevant permissions can see the information the Flag contains.

NHS England documentation: https://digital.nhs.uk/services/patient-flags-service/reasonable-adjustment-flag

3. Where Flags appear in Core

The banner is for immediate awareness. The Journal entry is where you go for the detail behind a Flag — including, where available, its source, its category and when it was recorded.

4. Accuracy — please read

Core does not author, validate or curate Flag content. It presents what is recorded in source systems and in the Patient Flags Service.

This means Flag content may be inaccurate, out of date, duplicated, inappropriately worded, or entered against the wrong patient, as a result of user error or misuse in the originating system. Dynamically created Flags may also be create for data that is itself incorrect.

Treat Flags accordingly:

• Verify anything clinically or operationally significant against the record and, where appropriate, with the patient.
• Be alert to language in a Flag that is judgemental, stigmatising or otherwise inappropriate. Report it — do not simply work around it.
• Do not assume the absence of a Flag means the absence of a risk or a need.
• Apply your organisation's normal confidentiality standards when a Flag is visible on screen in a shared space.

Querying or correcting a Flag

First identify the source of the Flag (visible on the Journal entry). The route differs.

Dynamically created Flags and Flags retrieved from source systems

Either:

• Contact your local manager for the Core service; or
• Complete a data quality concern form within Core, if your Core service uses one.

Core displays these Flags; it does not own them. The correction has to be made either to the source data or to the rule that generated the Flag.

Reasonable Adjustment Flags (Patient Flags Service)

Amend or delete these in the National Care Records Service (NCRS). Core does not provide the capability to update the Patient Flags Service.

NHS England publishes a user guide covering how to create, view, update and delete a Reasonable Adjustment Flag in NCRS.

You will need an NHS Identity (CIS2) and the appropriate Role Based Access Codes. If you do not hold the necessary permissions, refer the correction to a colleague who does — for example a member of the relevant clinical team, or your organisation's NCRS lead. Do not leave an incorrect national Flag in place because you cannot amend it yourself.

Urgent concerns

Where a Flag reveals a safeguarding concern, an immediate patient safety risk, or content that appears to be a confidentiality breach, follow your organisation's existing incident and safeguarding procedures. The routes above are for data quality, not for escalation.

Further reading

• Reasonable Adjustment Flag (NHS England Digital) — https://digital.nhs.uk/services/patient-flags-service/reasonable-adjustment-flag
• Reasonable Adjustment Digital Flag training (e-learning for healthcare) — https://www.e-lfh.org.uk/programmes/reasonable-adjustment-digital-flag/
• Accessible Information Standard implementation guidance (NHS England) — https://www.england.nhs.uk/long-read/accessible-information-standard-implementation-guidance/