AI Care Navigator

The AI Care Navigator, an evolution of Patchs AI, gives your practice greater control over patient request processing.

By combining the capabilities of the five Patchs AI modules, it offers a more integrated, comprehensive, and powerful solution.

Practices can now set tailored actions based on AI outputs, making triage automation smarter. For example, you could use the AI Care Navigator to:

Send a self-book link to patients with routine knee pain for an in-person appointment with your First Contact Physio.
Signpost a patient identified with non-urgent depression to your local IAPT service.
Direct a patient who is under-18 and who has an ear infection to their local pharmacist under the Pharmacy First scheme.

These abilities will be rolled out on a staggered basis. Initial actions will include the ability to send a message or questionnaire to a patient.

The AI Care Navigator will continue to evolve, enabling features like auto-assigning request types to specific clinicians. Practices that used Topic AI Questions will now use the AI Care Navigator, which replaces and enhances Topic AI Questions, offering all the same functionality and more.

Existing Patchs AI Modules in the AI Care Navigator

The following AI modules are currently available to combine in the AI Care Navigator:

Urgency AI: flags patient requests as urgent or emergency as soon as they are submitted.
Assign AI: assigns requests to a ‘Clinical’ inbox if they need input from a clinician.
Topic AI: works out the clinical topics of a patient request and can be used to ask patients further questions before they submit their request.

Coming soon:

Face-to-Face (F2F): highlights requests that may need an in-person consultation.
Signpost AI: signposts patients to urgent or emergency care services.

How to Use the AI Care Navigator

1. Go to your Feature Settings page

If you have one of the relevant AI modules already enabled, you will see a box to enable the AI Care Navigator:

Once you have enabled it by checking the tick-box, the AI Care Navigator will appear as an additional tab on your Feature Settings page.

2. Go to the AI Care Navigator tab

From this tab, you can set up tailored behaviours.

Click Add new action:

3. Create rules

Create rules by selecting one or more 'If' values using the dropdown menu.

Besides different AI outcomes, demographic details —specifically age and gender, can also be part of the inclusion criteria to enhance the relevance of each questionnaire to specific patient groups.

You can add as many conditions ('If' values) as you like.

Screenshots Editing.png

4. Select an action

When you have selected all the conditions required to create the rule, select an action. You can send a:

Then, select an action:

Example 1:

Example 2:

For example, you may want to create a rule in which a patient identified as having knee pain is sent a standardised questionnaire. To do this, select Send message template from the Action field dropdown menu. Then choose the questionnaire template you wish to use.

5. Additional Options

You will see two additional options when selecting 'Send message template' as an action. Check the relevant tick-box:

i) 'Patients can decline to complete these questions if they think it’s not relevant to their request'.

This will be ticked by default so patients can decline to answer the questionnaire if they think it's irrelevant to their request.

If you untick this box, patients must complete the questionnaire to proceed. However, be aware that research shows that this may lead patients to:

Submit a different request to avoid detection by Topic AI, risking inaccurate symptom reports.
Call your practice, leading to longer wait times and care delays.
Potentially not seek care at all.

ii) "Apply to all requests'.

If you tick this option the question will be asked to all patients every time they submit a request.

For example, if you want all patients to answer questions about their smoking status or alcohol intake, you can tick this box for the ‘Smoking status’ and ‘AUDIT-C’ questionnaires.

Note: Each question or questionnaire is only asked once in a request.
For example, if multiple conditions are met in the same request that are associated with the same question/questionnaire, the patient will not receive that question/questionnaire multiple times.

Sending a Message Template

The AI Care Navigator lets you select from over 90 clinical topics and use standard or custom templates when patients submit a Patchs request.

Patients can skip questions they find irrelevant because research evidence and our own experience shows that patients will not use online consultations if they are asked too many irrelevant questions.

Screenshot_2022-08-08_at_12.17.29_copy.png

Message Templates Sent by Default

There are certain templates we recommend as standard in the table below.

Please note some of these will trigger the Urgency and Signpost AIs if certain answers are given by patients.

Where possible, we try to recommend questionnaires that have an extensive evidence base and usage in clinical care (e.g. PHQ-9, asthma control, FeverPAIN).

Topic	Message	Urgency + Signpost AI triggers
Abdominal pain (for female)	Abdominal pain – female questionnaire	Emergency if the patient has: Severe pain Haematemesis Urinary retention Pregnancy complications Bowel obstruction Maleana Haematuria Urgent if the patient has: Vomiting Dysphagia PR bleeding Pain on palpation Dysuria Weight loss Urinary frequency
Abdominal pain (for male)	Abdominal pain – male questionnaire	Emergency if the patient has: Severe pain Haematemesis Urinary retention Bowel obstruction Maleana Haematuria Urgent if the patient has: Vomiting Dysphagia PR bleeding Pain on palpation Dysuria Weight loss Urinary frequency
ADHD	ADHD self report scale questionnaire	Nil
Alcohol	AUDIT	Nil
Anxiety	GAD-7 questionnaire	Nil
Asthma	Asthma control questionnaire	Nil
Autism	Autistic Spectrum Quotient questionnaire	Nil
Back pain	Back pain (history + red flags) questionnaire	Emergency - if patient has any red flag symptoms
Contraceptive Pill (COCP)	Combined Oral Contraceptive Pill (COCP) Review	Emergency – if systolic blood pressure is 170 mmHg or diastolic blood pressure is 115 mmHg. Urgent – if results suggest stage 2 hypertension i.e. systolic blood pressure is 150 mmHg or higher, or diastolic blood pressure is 95 mmHg or higher.
COPD	COPD Review	Nil
Conjunctivitis	Conjunctivitis - Child and adult (1 year and over) questionnaire or Conjunctivitis - Baby (under 1 year) questionnaire	Nil
Cough	Cough questionnaire	Emergency - if patient indicate they are breathlessness or coughing up blood.
Dental	Dentist Re-direction advice	Nil
Depression	PHQ-9 questionnaire	Emergency - if patient answers positively to final question about self-harm or suicide
Diarrhoea	Diarrhoea questionnaire	Emergency if: Severe difficulty breathing Severe abdominal pain Confusion Not urinated for more than 24 hours Urgent if: Bloody diarrhoea Diarrhoea more than 6 times a day Vomiting Constant tummy pain not relieved by diarrhoea Not urinated for 12-24 hours
Earache (0-17 years)	Earache - child questionnaire	Emergency if the patient has: Facial paralysis Photophobia Urgent if the patient has: Fever Inflammation Nausea or vomiting Hearing changes Ear foreign body Fluid Headache Balance issue
Earache (18 years and over)	Earache - adult questionnaire	Emergency if the patient has: Facial paralysis Photophobia Urgent if the patient has: Fever More than a week to duraction Inflammation Nausea or vomiting Hearing changes Ear foreign body Fluid Headache Balance issue
Earache (1 to 17 years, NOT emergency)	Pharmacy First message for acute otitis media (if enabled)	Nil
Gastro-Oesophageal Reflux (GORD, Indigestion)	Gastro-oesophageal Reflux (GORD, Indigestion) questionnaire	Emergency if the patient has: Haemetemesis Urgent if the patient has: Dysphagia Reduced appetite
Headache (1-11 years)	Headache - child questionnaire	Emergency if: Headache severity is 9-10/10 Headache started suddenly Blurred or double vision or loss of vision White part of eye turned red High temperature (fever) Neck pain or stiffness New rash since headache started Head injury in the past 5 days Drowsy, confused, or constant lack of energy Problems speaking or remembering since headache began Problems with swallowing, balancing, or walking since headache began Urgent if: Headache severity is 7-8/10 Vomiting since headache started Zigzag lines or flickering lights with vision problems Noticed a squint or inability to look upward since headache started Light sensitivity Loss of feeling (numbness) or weakness in arms or legs since headache started Headache when waking up in the morning Headache wakes you up during sleep Headache getting worse day after day Headache worsens with coughing, sneezing, or changing position Jaw pain when eating or sore/tender scalp
Headache (12 years and over)	Headache – young person and adult questionnaire	Emergency if: Headache severity is 9-10/10 Headache started suddenly Loss of vision Eye symptoms: watering/red, eyelid droop/swelling, nose run/blockage High temperature (fever) Neck pain or stiffness New rash since headache onset Dizziness Head injury in the last 3 months Feeling drowsy or confused Problems speaking or remembering since headache began White part of eye turned red Average systolic BP ≥170 mmHg or diastolic BP ≥115 mmHg Urgent if: Headache severity is 7-8/10 Vomiting since headache started Vision issues: zigzag lines, flickering lights, blurred/double vision Light sensitivity Numbness, weakness, or tingling in arms or legs since headache Headache worsens with coughing, sneezing, or changing position Headache wakes you up at night Jaw pain when eating or sore/tender scalp Average systolic BP ≥150 mmHg or diastolic BP ≥95 mmHg
Heart palpitations	Palpitations questionnaire	Emergency - if the patient has: Palpitations multiple times per day Chest pain Shortness of breath Syncope or pre-syncope Urgent - if the patient has: Palpitations once per day Palpitations lasting longer than a few minutes or for hours An irregular heart rhythm Palpitations triggered by exercise or strenuous activity Previously been diagnosed with a heart condition A family history of sudden cardiac death
Hip pain	Oxford Hip Score	Nil
HRT	HRT Review	Emergency – if systolic blood pressure is 170 mmHg or diastolic blood pressure is 115 mmHg. Urgent – if results suggest stage 2 hypertension i.e. systolic blood pressure is 150 mmHg or higher, or diastolic blood pressure is 95 mmHg or higher.
Impetigo (1 year and over, NOT emergency)	Pharmacy First message for impetigo (if enabled)	Nil
Insect Bite (1 year and over, NOT emergency)	Pharmacy First message for infected insect bite (if enabled)	Nil
Knee pain	Oxford Knee Score	Nil
Medication review	Medication review questionnaire	Nil
Periods - Heavy (Menorrhagia)	Periods - Heavy (Menorrhagia) questionnaire	Emergency – if the patient answers ‘Yes’ to the question: ‘Do you feel short of breath after doing normal activities?’ Urgent – if the patient answers ‘Yes’ to: ‘Are you currently pregnant?’ ‘Do you bleed in between periods?’ ‘Do you bleed after having sex?’
POP	POP Review	Emergency – if systolic blood pressure is 170 mmHg or diastolic blood pressure is 115 mmHg. Urgent – if results suggest stage 2 hypertension i.e. systolic blood pressure is 150 mmHg or higher, or diastolic blood pressure is 95 mmHg or higher.
Prostate	IPSS questionnaire	Nil
Rash	Rash questionnaire	Emergency if the patient has: Almost all body is covered in rash Severe pain Petechial rash Difficulty breathing Anaphylaxis Confusion Photophobia Urgent if the patient has: More than half of body covered in rash Worsening rash Moderate pain Bleeding Fever
Shingles	Shingles (Pharmacy First) questionnaire	Emergency if the patient has: Meningitis symptoms Encephalitis symptoms Myelitis symptoms Facial never paralysis Hutchinson's sign Visual symptoms Red eye Immunosuppression Urgent if the patient has: Non-truncal involvement Moderate or severe pain Moderate or severe rash A rash that is spreading Severe eczema
Shingles (18 years and over, NOT emergency)	Pharmacy First message for shingles (if enabled)	Nil
Sinusitis	Sinusitis (Pharmacy First) - Adults questionnaire	Emergency if the patient has: Periorbital or frontal bone swelling Reduced vision Signs of meningitis Severe headache Numbness, weakness or tingling in arms or legs New speech or memory problems Urgent if the patient has symptoms for more than 10 days and: Their symptoms are worsening Has a high temperature Has purulent nasal discharge Has jaw or dental pain Is immunosuppressed
Sinusitis (12 years and over, NOT emergency)	Pharmacy First message for sinusitis (if enabled)	Nil
Shortness of breath	Shortness of breath (SoB) questionnaire	Emergency if the patient has: Severe SOB SOB developed over the last 24 hours Chest pain, tightness, or heaviness Cyanosis Confusion Urgent if the patient has: Previous relevant respiratory or cardiovascular diagnosis SOB developed over the last 1 week Oedema Palpitations Haemoptysis PND Recent long journey
Sick note	Sick / Fit note details questionnaire	Nil
Skin lesion	Attach photo + warning	Nil
Skin lesion	Skin lesion questionnaire	Nil
Sleepiness	Epworth Sleepiness Scale	Nil
Smoking	Smoking status questionnaire	Nil
Snoring	Epworth Sleepiness Scale	Nil
Sore throat	FeverPAIN questionnaire + Attach Photo (tonsils) question	Urgent - if patient scores 4 or more on the FeverPAIN questionnaire
Sore Throat (5 years and over, NOT emergency)	Pharmacy First message for sore throat (if enabled)	Nil
Tired All the Time	Tired All the Time questionnaire	Urgent if the patient has: Unintentional weight loss Fevers or night sweats Lymphadenopathy
Urinary Tract Infection (UTI) - male or female	Urinary Tract Infection (UTI) – male or female questionnaire	Emergency – if the patient answers ‘Yes’ to: 'Can you see blood in your urine?’ Urgent – if the patient answers ‘Yes’ to the following questions (and ‘no’ to the above question): Are you feeling more confused? Do you have new pain in your side or upper back? Do you feel like you want to be sick or have you actually been sick (vomited)? Do you have a high temperature (fever)?
Urinary Tract Infection (UTI) - female, 16-64 years, NOT emergency	Pharmacy First message for UTI (if enabled)	Nil
Vaginal discharge	Vaginal discharge questionnaire	Nil
Vomiting, Diarrhoea and vomiting	Vomiting questionnaire	Emergency if the patient has: Not passed urine for over 24 hours Meningitis symptoms Severe abdominal pain A head injury Possible poisoning Haematemesis Urgent if the patient has: Been vomiting for more than a week Unable to keep fluids down in the last 12 hours Not passed urine for 12-24 hours Moderate abdominal pain

Sending a Self-book Link

The AI Care Navigator lets patients book their own appointments. By setting up rules, you can send them self-booking links, making it easy for them to choose a time and reducing the workload for your staff.

Find out more about this here: Sending Self-book Link Using AI Care Navigator

Change Action Order

You can change the order in which actions, including message templates, are presented to patients (if a rule is met) by dragging them up and down the list.

Screenshot_2022-06-16_at_12.28.33.png

Clinical Safety

You are responsible for the clinical safety of any AI Care Navigator actions you create. Because AI is not 100% accurate (nothing is):

Urgency AI may highlight a request that is urgent when it's not, or miss an urgent request (though this is much less likely)
Assign AI may suggest a request needs clinical input when it doesn't, or suggest it doesn't when it does
Topic AI may think a patient has mentioned a clinical topic when they haven't, or miss a clinical topic they have mentioned

The order of the AI Care Navigator rules is important

If a rule triggers a questionnaire that can mark a patient request as either 'urgent' or 'emergency', then only rules for 'urgent' or 'emergency' requests will be triggered after that.

We have set up the default AI Care Navigator for Pharmacy First so that rules for questionnaires, like the UTI questionnaire, are triggered before the Pharmacy First message. That way, Pharmacy First messages are not triggered in medical emergencies.

If you’re adding an action for patient requests that are NOT 'urgent' or 'emergencies', make sure rules that trigger relevant questionnaires go first.

For example, if you want to offer patients with back pain (without red flags) a self-book link for a First Contact Physio:

Set the 'Back pain (history + red flags)' questionnaire to trigger first
Then, set the rule that triggers a self-book link

This ensures that if the questionnaire identifies a red flag emergency, the self-book link won’t be sent.

AI Care Navigator

Existing Patchs AI Modules in the AI Care Navigator