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How does Suvera calculate when investigations are due?

Our philosophy for building AI is: accurate, transparent, and comprehensive.


We've trained our algorithm to understand the following guidelines on investigation frequencies for long-term conditions and high-risk medication monitoring:

  • QOF
  • CQC
  • NICE
  • SPS
  • NHSE
  • BNF
  • BSG
  • MHRA


Our AI is designed to suggest recall for all investigations a patient is due at any point in time, kept updated as the record evolves. Suvera will suggest recall:

  • 2 weeks before it's overdue if the investigation frequency is ≤3 months
  • 1 month before it's overdue if the investigation frequency is >3 months


This ensures every blood test requested is the most comprehensive and accurate for the patient. It moves us towards full automation of proactive care plans for every patient.


For more information about our proactive recall feature where we suggest opportunistically recalling a patient earlier, please see this article.



How we define an active prescription
For most medications, we consider a patient to be 'on' a drug and therefore eligible for recall if either of the following is true:

  • They have an active medication course for that drug. Note: EMIS doesn't supply an end date at the course level, so we rely on course status alone here.
  • They have a medication issue for that drug with an end date in the future. If the issue has no end date (uncommon), we instead check that it was issued within the last 3 months.

A few medications use different rules to better match existing clinical guidance:

  • Azithromycin and oral corticosteroids: more than 2 issues in the last 12 months.
  • Asthma medication (for the "on asthma medication" indicator): an issue within the last 6 months, to align with QOF.



Here are full lists of our logic, in alphabetical order of the indicator we use (medication or condition):


High-Risk Medications Monitoring

  • ACE / ARB = Renal Function every 12 months
  • ADHD meds (Methylphenidate, Lisdexamfetamine, Dexamfetamine, Atomexitine, Guanfacine) = BMI & BP every 6 months
  • Allopurinol = Urate every 12 months
  • Aminosalicylates (5-ASA - Mesalazine, Olsalazine, Balsalazide, Sulfasalazine) = Renal Function every 12 months
  • Amiodarone = LFT, Magnesium, Renal Function & TFT every 6 months
  • Antipsychotics (1st Gen, Risperidone, Paliperidone, Amisulpride, Lurasidone) = Prolactin every 12 months
  • Antipsychotics (All) = BMI, FBC, HbA1c, LFT, Lipids & Renal Function every 12 months
  • Azathioprine = FBC, LFT & Renal Function every 3 months
  • Azithromycin = LFT every 6 months
  • Carbimazole = TFT every 3 months
  • Ciclosporin = BP, HbA1c, LFT, FBC & Renal Function every 1 month
  • COCP = BMI & BP every 12 months
  • Corticosteroids (Oral) = HbA1c every 3 months. BP, BMI, Lipids & Renal Function every 12 months.
  • Denosumab = Calcium, Renal Function & Vitamin D every 6 months
  • Digoxin = Calcium, Magnesium & Renal Function every 12 months
  • Diuretics = Renal Function every 6 months
  • DOAC = BMI & BP every 12 months. FBC, LFT & Renal Function at varying frequencies depending on CrCl & frailty*
  • Dronedarone = LFT & Renal Function every 6 months
  • Febuxostat = Urate every 12 months
  • HRT (systematic oestrogen) = BMI & BP every 12 months
  • Hydroxycarbamide = FBC, LFT, Renal Function & Urate every 3 months
  • Leflumonide = BMI, BP, FBC, LFT & Renal Function every 3 months
  • Levothyroxine = TFT every 12 months
  • Lithium = Lithium Level at varying frequencies depending on patient age, drug interactions, elevated calcium, latest lithium concentration & pregnancy**
  • Lithium = BMI, Calcium, Renal Function & TFT every 6 months
  • Mercaptopurine = FBC, LFT & Renal Function every 3 months
  • Metformin = Renal Function every 12 months. Vitamin B12 every 3 years from year 3 onwards, or every 12 months if the previous result was <200 pg/mL (<148 pmol/L), or on concurrent PPI or H2RA
  • Methotrexate = FBC, LFT & Renal Function every 3 months, and every 1 month in the first 6 months of prescription
  • Minocycline (6th month onwards) = LFT every 3 months
  • Mirabegron = BP every 12 months
  • Mycophenolate = FBC, LFT & Renal Function every 3 months
  • Penicillamine = FBC, LFT & Renal Function every 3 months
  • Phenytoin = Calcium, FBC, LFT, Renal Function & Vitamin D every 5 years
  • Progesterone-only contraception = BMI & BP every 12 months
  • Propylthiouracil = TFT every 3 months
  • Riluzole = FBC & LFT every 12 months
  • Roflumilast = BMI every 12 months
  • Statins = LFT & Lipids every 12 months, and within 3 months on initiation
  • Sulfasalazine (1st year) = FBC, LFT & Renal Function every 3 months
  • Sulfasalazine (2nd year onwards) = FBC, LFT & Renal Function every 12 months
  • Tacrolimus = BP every 3 months
  • Testosterone = FBC, Lipids, LFT & Testosterone Level every 12 months
  • Testosterone (male >45 years old) = PSA every 12 months
  • Theophylline = Theophylline Level every 12 months
  • Valproate = BMI, FBC & LFT every 12 months
  • Warfarin (and other vitamin K antagonists) = INR at varying frequencies depending on the last INR result***



Long-term conditions

  • Abnormal Liver Enzymes = FBC & LFT at varying frequencies based on results ‡
  • Anaemia = FBC at variable frequencies****
  • Atrial Fibrillation = BMI every 12 months
  • Asthma = ACT & Smoking Status every 12 months
  • CHD = BMI, BP, HbA1c, Lipids, Renal Function & Smoking Status every 12 months. LFT when lipids are due.¶
  • Chronic Liver Disease = FBC, INR, LFT & Renal Function every 12 months
  • CKD (All) = BMI, BP & Lipids every 12 months
  • CKD 1+ = Renal Function & uACR at varying frequencies depending on their last GFR and ACR results in accordance with NICE NG203 and NICE CKS †
  • CKD 3+ = FBC, LFT & Lipids every 12 months
  • Coeliac = B12, Calcium, Coeliac Serology, FBC, Folate, LFT, Renal Function, TFT & Vitamin D every 12 months
  • COPD = Smoking Status every 12 months
  • Diabetes (T1 or T2) = BP, Foot Check & Smoking Status every 12 months. FBC & LFT every 3 years, or every 12 months if the patient is 35 or over with a FIB-4 of 2.67 or above.
  • Diabetes (T1) = HbA1c every 6 months and Lipids, Renal Function, TFT & uACR every 12 months
  • Diabetes (T2) = HbA1c, Lipids, Renal Function & uACR every 12 months. HbA1c every 3 months if last result was ≥ 58 mmol/mol (not frail) or ≥ 75 mmol/mol (frail patient)
  • Down's Syndrome = TFT every 12 months
  • Frailty = BMI every 12 months
  • Gestational Diabetes = HbA1c every 12 months
  • Heart Failure = BMI, BP & Renal Function every 6 months
  • Hypertension = BMI, BP & Renal Function every 12 months. BP every 3 months if patient is above target range. Hypertension patients without DM or NHD, but with QDiabetes ≥5.5% or Leicester Risk Score ≥16, also get HbA1c every 12 months.
  • Hyperthyroidism = TFT every 12 months. TFT every 3 months if last result was <0.38 mU/L or >5.5 mU/L
  • Hypothyroidism = BMI & TFT every 12 months. TFT every 3 months if last result was <0.38 mU/L or >5.5 mU/L
  • MASLD / NAFLD = LFT every 3 years
  • MGUS = Calcium, FBC, Renal Function, Serum Free Light Chains, Serum Immunoglobulins & Serum Protein Electrophoresis at varying frequencies depending on progression risk §
  • NDH = HbA1c every 12 months
  • Peripheral Arterial disease = BMI, BP & Lipids every 12 months. LFT when lipids are due.¶
  • Prostate cancer primary care coded = PSA every 6 months
  • SMI (bipolar, psychotic disorders, schizophrenia) = BMI, BP, FBC, HbA1c, LFT, Lipids, Renal Function, Smoking Status & Lifestyle every 12 months
  • Stroke / TIA = BMI, BP & Lipids every 12 months. LFT when lipids are due.¶


* DOAC variable frequencies

FBC, LFT & UE are due:

  • Every 2 months when CrCl is 15-24
  • Every 3 months when CrCl is 25-34
  • Every 4 months when CrCl is 35-44 or frail or ≥ 75 years old
  • Every 5 months when CrCl is 45-54 & not frail & not ≥ 75 years old
  • Every 6 months when CrCl is 55-59 & not frail & not ≥ 75 years old
  • Every 12 months when CrCl is 0-14, or CrCl is 60+ & not frail & not ≥ 75 years old


If the latest eGFR is both lower and more recent than the latest CrCl, it will be used in preference to ensure safe monitoring.


** Lithium variable frequencies

If any of the following apply, Lithium Level is due every 3 months:

  • Age 65+
  • Pregnant
  • Elevated calcium (> 2.6mmol/L)
  • Latest lithium concentration ≥ 0.8 mmol/l
  • Drugs (Diuretrics, NSAIDs, Haloperidol, Carbamazepine, Dapagliflozin, Antidepressants or ACE Inhibitors)

If none apply, Lithium Level is due every 6 months.


*** Warfarin (and other VKA) variable frequencies

If last INR result is ≥ 5, INR is due every 2 weeks. If last INR result is < 5, INR is due every 3 months. We exclude patients who are coded as being monitored by the hospital or are self-monitoring, unless their INR is ≥ 5 or there is no INR result in the last 3 months.


**** Anaemia variable frequencies

Any patient with an Hb result

  • Latest Hb <70 → 2-weekly (Severe) (BSH principles)
  • Latest Hb 70 to below threshold → 4-weekly (Moderate) (NICE CKS IDA 2021, NICE NG231 2024; NICE CKS B12/folate 2024)


Any anaemia (coded anaemia of any kind, including IDA; also infer anaemia where there’s a low Hb and an iron prescription)

  • Latest two Hb results both between threshold and normal → 12-monthly (Mild, stable). For example, anaemia of chronic disease that has been investigated and isn’t expected to resolve. Doesn’t apply to pregnant patients.
  • Latest Hb between threshold and normal → 3-monthly (Mild, on treatment) (NICE CKS IDA 2021). This covers a first mildly low result, a mildly low result after a normal, moderate or severe one, and all pregnant patients.


Coded IDA, latest Hb normal

  • <12 months since remission → 3-monthly (Remission, under 12 months) (BSG 2021; NICE CKS IDA 2021)
  • 12–36 months since remission → 6-monthly (Remission, 12–36 months) (BSG 2021)
  • 36 months since remission → none


Coded non-IDA, latest Hb normal

  • → none (NICE NG231 2024; NICE CKS B12/folate 2024)


Definitions

Normal: male Hb ≥130 g/L, female non-pregnant ≥120 g/L, female pregnant ≥110 g/L. If sex isn’t recorded, the male level is used.

Threshold: 20 g/L below normal (male 110, female non-pregnant 100, female pregnant 90).

Between threshold and normal: at or above threshold but below normal (male 110–129, female non-pregnant 100–119).

Remission: the date of the first normal Hb after the most recent abnormal Hb.


† CKD 1+ variable frequencies

Planner follows this table of frequencies in NICE NG203, which depends on the last GFR and ACR results. If there is no eGFR or no uACR result on record, it is due immediately.


‡ Abnormal liver enzyme variable frequencies

We use these upper limits of normal:

  • ALT 40 for men and 30 for all other patients (women or undocumented)
  • AST 40

Chronic elevation (two consecutive panels with either raised ALT or AST) → FBC & LFT every 3 years
Acute moderate or severe elevation (first panel with either reading ≥2x the upper limit) → FBC & LFT repeat after 1 month
Acute mild elevation (first panel with either reading between 1 and 2x the upper limit) → FBC & LFT repeat after 3 months


§ MGUS variable frequencies

The full panel is due every 6 months if any of the following apply:

  • Paraprotein ≥15 g/L
  • A non-IgG paraprotein (IgA, IgD or IgM)
  • Serum free light chain ratio above 1.65 or below 0.26

If none apply, the panel is due every 12 months. The first check is always due 6 months after diagnosis.


¶ Cardiovascular lipids and LFT frequencies

For patients with CHD, PAD or Stroke/TIA, lipids are due every 12 months.

An LFT is added only when lipids are due and there hasn’t been an LFT in the last 12 months. It provides a baseline in case lipid-lowering therapy needs adjusting. If lipids are up to date, we don’t recall the patient just for an LFT.

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