[Feedback from E12 Webinar 2024.05.02] MRI Intervention/Investigation timing options

[pacharanero]

"Some times MRI has already been performed before the Paediatric assessment requested by A&E The platform wouldn’t allow that date to be entered"

@nikyraja @AmaniKrayemRCPCH Do we perhaps need MRI performance date to be allowable to be before the DOFPA?

"there is a long wait for MRI under GA - as there is no option now for not performed yet i am unable to submit the form."

@nikyraja @AmaniKrayemRCPCH Do we perhaps need to add an option for "not yet done"?

"Will the new platform accept dates that precede the first assessment, for things like MRI, psychology, diagnosis of autism etc?"

Similar to the first question, do we need these things to be able to be entered as performed before the DOFPA?

[AmaniKrayemRCPCH]

This is related to issue #904

We need to consider how this affects KPI 5. Will an MRI that occurs just before the FPA pass the KPI? How about if the MRI is 10 years before the FPA date?

We can set a cut off? e.g. MRIs that happen in the year prior to FPA still meet the KPI. Or we can rely on the judgement of the clinicians entering the data? Presumably they'd only enter an MRI if they know it is a relevant and recent enough investigation for that CYP's epilepsy.

Alternatively, we say that we're only interested in the first year of care and won't consider MRIs prior to FPA. This may mean that some CYP that have had appropriate investigations don't meet the KPI, but we acknowledge that there are limitations to the audit design. 100% KPI attainment may not always reflect optimal care.

Thoughts? @nikyraja @coldunk

[nikyraja]

Thanks All. Have discussed this with @coldunk, and we have decided:

• MRI dates before the first assessment is okay, but still needs to be after the DOB
• KPI 5 can include all MRI dates within the first year of care, including those before the first assessment date (and then the 6 week timeframe can be applied)
• We can add a option for when and MRI isn't achieved. I think you have already added this button on the staging site, and this looks good thank you! Can the wording of the button please be updated to "MRI not achieved yet"?

So I think the next steps would be to update the data validation for the MRI question to allow dates before FPA, add the not achieved yet button and then check that the KPI calculations aren't excluding dates before FPA. I don't imagine they would but it would be good to check.

Note, that this can be done after the KPI export download #895 issue has been resolved.

[nikyraja]

After discussing the above in the sprint call (10/05/24), please can we instead:

• Re word the MRI question to 'Has an MRI been achieved'
• Keep the two date boxes
• Allow dates before FPA for both, but after DOB
• Not add a further option to say 'MRI not achieved yet'
• Keep all of these as mandatory questions

This should therefore not affect the KPI calculations. To confirm, for an eligible CYP to pass the KPI, they must 1) select 'yes' to 'Has an MRI been achieved' - selecting 'no' would be a fail 2) the input date must be within 6 weeks of request

We can add additional wording to the tooltip to clarify this for users. I will add the wording here/create another issue asap for this.

Thanks all!

[eatyourpeas]

I have made all those changes in a branch. Just to be sure E12 are happy with all dates (not just MRI), I would be grateful if you could confirm this table as what is needed?

Model	Date	mandatory	earliest allowable date	other flags
Registration	first_paediatric_assessment_date	Yes	date_of_birth
Episode	seizure_onset_date	Yes	date_of_birth
Syndrome	syndrome_diagnosis_date	Yes	date_of_birth
Comorbidity	comorbidity_diagnosis_date	Yes	date_of_birth
Assessment	consultant_paediatrician_referral_date	Yes	date_of_birth
Assessment	consultant_paediatrician_input_date	Yes	consultant_paediatrician_referral_date
Assessment	paediatric_neurologist_referral_date	Yes	first_paediatric_assessment_date
Assessment	paediatric_neurologist_input_date	Yes	paediatric_neurologist_referral_date
Assessment	childrens_epilepsy_surgical_service_referral_date	Yes	first_paediatric_assessment_date
Assessment	childrens_epilepsy_surgical_service_input_date	No	childrens_epilepsy_surgical_service_referral_date
Assessment	epilepsy_specialist_nurse_referral_date	Yes	first_paediatric_assessment_date
Assessment	epilepsy_specialist_nurse_input_date	Yes	epilepsy_specialist_nurse_referral_date
Investigations	eeg_request_date	Yes	date_of_birth
Investigations	eeg_performed_date	Yes	eeg_request_date
Investigations	mri_brain_requested_date	Yes	date_of_birth
Investigations	mri_brain_reported_date	Yes	mri_brain_requested_date
AntiepilepsyMedicine	antiepilepsy_medicine_start_date	Yes	first_paediatric_assessment_date	is_rescue = False
AntiepilepsyMedicine	antiepilepsy_medicine_stop_date	No	antiepilepsy_medicine_start_date	is_rescue = False
AntiepilepsyMedicine	antiepilepsy_medicine_start_date	Yes	first_paediatric_assessment_date	is_rescue = True
AntiepilepsyMedicine	antiepilepsy_medicine_stop_date	No	antiepilepsy_medicine_start_date	is_rescue = True
Management	individualised_care_plan_date	Yes	first_paediatric_assessment_date

[nikyraja]

Thanks Simon! All of those are correct, so happy for you to merge into live.