How do individual records become updated?

Any updates to SystmOne/TPP are done automatically as soon as RIVIAM receives the outcomes form each clinic. With the app this can be after every vaccination. With the spreadsheet, this would be after each clinic. Updates to CHIS and NIVS happen after the clinics, as they require a download of outcome data from RIVIAM, for each clinic. This file is then manually uploaded to CHIS, NIVS etc.