Local READ Code Formularies and Templates

EMIS NUG conference 6th September 2001

Dr Amrit TakharDr Amrit Takhar

General Practitioner General Practitioner

Wansford , PeterboroughWansford , Peterborough

www.wansford.co.ukwww.wansford.co.uk

How many READ codes?

READ version 2READ version 2

(5 byte)(5 byte)

=107,000=107,000

Outline of todays session:

Why coding is important?Why coding is important? READ codes – facts and tipsREAD codes – facts and tips READ code formulariesREAD code formularies

DevelopmentDevelopment ImplementationImplementation MaintenanceMaintenance

EMIS templates EMIS templates Future developmentsFuture developments

Why use READ codes?

Data quality – Data quality – improving standards of careimproving standards of care income generation (IOS claims)income generation (IOS claims)

Clinical GovernanceClinical Governance Audit and ResearchAudit and Research Decision support systemsDecision support systems Communication between systemsCommunication between systems

Why use READ codes?

Link to Templates, Protocols & ProdigyLink to Templates, Protocols & Prodigy Link to previous consultations using same Link to previous consultations using same

code code Activate drug warnings, interactions, Activate drug warnings, interactions,

contraindications contraindications Referral letters with coded details Referral letters with coded details

automatically addedautomatically added Helps ensure claim for items of serviceHelps ensure claim for items of service

What are the Read Codes?The Read Codes are a comprehensive list of The Read Codes are a comprehensive list of

terms intended for use by all healthcare terms intended for use by all healthcare professionals to describe the care and professionals to describe the care and treatment of their patients. They enable the treatment of their patients. They enable the capture and retrieval of patient-centred capture and retrieval of patient-centred information in natural clinical language information in natural clinical language within computer systems. within computer systems.

Anatomy of a READ code

G304.G304.

READ code facts

Developed by Dr James Read, GP, Developed by Dr James Read, GP, Loughborough 1982Loughborough 1982

Purchased 1990 by NHS and mandatory for Purchased 1990 by NHS and mandatory for GP accredited systems but not in hospitalsGP accredited systems but not in hospitals

Merger with Snomed system scheduled to Merger with Snomed system scheduled to form worldwide coding systemform worldwide coding system

Anatomy of a READ code

5 characters5 characters

G…. Chapter heading ( circulatory diseases)G…. Chapter heading ( circulatory diseases)

G3… Ischaemic heart diseaseG3… Ischaemic heart disease

G30.. Acute Myocardial infarctionG30.. Acute Myocardial infarction

G303. Acute inferoposterior infarctionG303. Acute inferoposterior infarction

My choices of codes will then be as follows

Circulatory System Disease(G.....)

Hypertensive Disease(G2)

Benign Essential Hypertension(G201)

Secondary Hypertension(G24)

Acute MI (G30)

Ischaemic Heart Disease(G3)

Angina Pectoris (G33)

TIA (G65)

Cerebrovascular Disease(G6)

Stroke and CVA unspecified (G66)Subarachnoid Haem. (G60)

Level One Codes

Level Two Codes

Level Three Codes

READ code chapters

Symptoms Chapter 1 Examination Chapter 2 Investigations Chapters 3-8 Administrative Chapter 9 Diagnoses Chapters A-S Medication Chapters a to s

Chapter ContentsChapter ContentsA Infectious/parasitic diseasesA Infectious/parasitic diseasesB NeoplasmsB NeoplasmsC Endocrine/metabolicC Endocrine/metabolicD Blood diseasesD Blood diseasesE Mental disordersE Mental disordersF Nervous system/sensesF Nervous system/sensesG Circulatory systemG Circulatory systemH Respiratory systemH Respiratory systemJ Digestive systemJ Digestive systemK Genito-urinary systemK Genito-urinary systemL Pregnancy/childbirth/puerperiumL Pregnancy/childbirth/puerperiumM Skin/subcutaneous tissueM Skin/subcutaneous tissueN MusculoskeletalN MusculoskeletalP Congenital anomaliesP Congenital anomaliesQ Perinatal conditionsQ Perinatal conditionsR Ill-defined conditions/working diagnosesR Ill-defined conditions/working diagnosesS Injury/poisoningS Injury/poisoningT Causes of injury/poisoningT Causes of injury/poisoning

What do all the abbreviations in the Read Codes mean?

EC Elsewhere classified EC Elsewhere classified FH Family history FH Family history H/O History of H/O History of NEC Not elsewhere classified NEC Not elsewhere classified NOS Not otherwise specified NOS Not otherwise specified O/E On examination O/E On examination OS Other specified OS Other specified

Chapter headings0 Occupations

1 History/symptoms

2 Examination/signs

3 Diagnostic procedures

4 Laboratory procedures

5 Radiology/medical physics

6 Preventative procedures

7 Operations and procedures

8 Other therapeutic procedures

9 Administration

What does it mean when a term starts [V], [X] etc? These markers are used to indicate the sort of These markers are used to indicate the sort of

ICD/OPCS cross-mapping which is attached to the ICD/OPCS cross-mapping which is attached to the Read Code. Read Code.

[M] Morphology of neoplasms (ICD) [M] Morphology of neoplasms (ICD) [SO] Site of (OPCS) [SO] Site of (OPCS) [V] Supplementary factors influencing health status or [V] Supplementary factors influencing health status or

contact with health services other than for illness (ICD) contact with health services other than for illness (ICD) [X] Terms which have been added to the Read Codes in [X] Terms which have been added to the Read Codes in

order to ensure that every ICD-10 code is cross-mapped order to ensure that every ICD-10 code is cross-mapped to from a Read Code. to from a Read Code.

Pitfalls

Context vs. coding:- Context vs. coding:-

Angina ?Angina ? = have they got angina. = have they got angina.

AnginaAngina [G33] [G33] ?? [Free text] = this patient [Free text] = this patient hashas angina angina

Finding the right code

Formulary benefits

Avoidance of unsuitable codesAvoidance of unsuitable codes Data searching and audit much simplerData searching and audit much simpler Simplify picking options when selecting a Simplify picking options when selecting a

code code Sets scene for data transfer between Sets scene for data transfer between

practicespractices Raises awareness of codingRaises awareness of coding

Formulary – how to

Written version on paper, on website, in Written version on paper, on website, in excelexcel

Create your own hierarchy in EMISCreate your own hierarchy in EMIS TemplatesTemplates Synonym access (@Synonym access (@

Wish list:Wish list:

Import/export a Code formulary optionImport/export a Code formulary option

Formulary by Synonym access

@OM@OM Acute Right Otitis Media, Acute Right Otitis Media,

Acute Left Otitis Media, Acute Bilateral Acute Left Otitis Media, Acute Bilateral Otitis Media etcOtitis Media etc

@URTI has various pharyngitis/tonsillitis@URTI has various pharyngitis/tonsillitis

@Heart @Heart

@Mental@Mental

Formulary – choosing your codes

Look at the existing formulariesLook at the existing formularies Liverpool Liverpool SCIMP (Scotland)SCIMP (Scotland) Sunderland (modified SCIMP list)Sunderland (modified SCIMP list) York – DR Mike JonesYork – DR Mike Jones

Get local agreement – PCT IT strategyGet local agreement – PCT IT strategy Build on recent initiatives eg READ codes in Build on recent initiatives eg READ codes in

CHD NSFCHD NSF

READ code prioritiser (GPASS)

READ code browsers

http://www.cams.co.uk/browsers.http://www.cams.co.uk/browsers.htmhtm

Suite of browsers, including: Suite of browsers, including: Tree Browser Tree Browser Read Code Comparison Tool Read Code Comparison Tool Read Codes GP4-byte, Version 2 and Version 3 Read Codes GP4-byte, Version 2 and Version 3 Read Code Subset Wizard Read Code Subset Wizard Beginner's User Manual Beginner's User Manual

Implementation options

READ code formularyREAD code formulary Paper versions, alphabetic, and by specialityPaper versions, alphabetic, and by speciality Top 100 , laminated for desktop useTop 100 , laminated for desktop use Training in READ code structure, terming, Training in READ code structure, terming,

hierarchical searchinghierarchical searching Encouraging hospital use – autoread coding Encouraging hospital use – autoread coding

xmlxml Minimum data setsMinimum data sets

EMIS templates

Data entry forms invaluable forData entry forms invaluable for Saving timeSaving time Standardising data recordingStandardising data recording Clinical promptsClinical prompts

Can be shared between practicesCan be shared between practices

EMIS templates

Disease managementDisease management Health promotionHealth promotion Maximise IOS incomeMaximise IOS income Consultation recordsConsultation records Links possible to READ codes and Links possible to READ codes and

protocolsprotocols

Template options

Code entry dependent on age and sexCode entry dependent on age and sex Add or insert entriesAdd or insert entries Add diagnosis as problem titleAdd diagnosis as problem title Insert an existing templateInsert an existing template Simple eg Cervical smear. ImmsSimple eg Cervical smear. Imms Complex eg component of NSF protocolsComplex eg component of NSF protocols

Template sharing

Can be exported from EMIS (CO) to floppy Can be exported from EMIS (CO) to floppy diskdisk

Can be printed or stored as text fileCan be printed or stored as text file Library of templates of NUG websiteLibrary of templates of NUG website Main pitfall is to ensure compatible version Main pitfall is to ensure compatible version

of READ ( 4 byte or 5 byte)of READ ( 4 byte or 5 byte)

Sharing templates

CO, TT, CO, TT,

A (export to floppy)A (export to floppy)

B (import from floppy)B (import from floppy) Ensure the floppy goes in the server A Ensure the floppy goes in the server A

drivedrive Make sure you know the read codeMake sure you know the read code

for the title of each template.for the title of each template.

READ version 3

270,000 codes 270,000 codes The new file structure which forms Version 3 uses The new file structure which forms Version 3 uses

the actual Read Code simply as a label for the term. the actual Read Code simply as a label for the term. Hierarchy position thru relational tables. Hierarchy position thru relational tables. Infinite number of levels of detail and allows codes Infinite number of levels of detail and allows codes

and their terms to be moved to form a hierarchical and their terms to be moved to form a hierarchical structure which reflects current clinical thinking.structure which reflects current clinical thinking.

Each term can have qualifiersEach term can have qualifiers

READ version 3

Qualifiers allow addition of detail to "core terms". Qualifiers allow addition of detail to "core terms". For example; Inguinal herniorrhaphy using sutures For example; Inguinal herniorrhaphy using sutures may be qualified by;may be qualified by;

PriorityPriority - -ScheduledScheduled Revision statusRevision status --Repair of Repair of

recurrencerecurrence Terms are also available for providing the context Terms are also available for providing the context

of a core term, i.e. the goal of treatment, expected of a core term, i.e. the goal of treatment, expected finding or actual finding and certaintyfinding or actual finding and certainty

The Future of coding

Changing to SNOMED CTChanging to SNOMED CT Improved formulary creation and sharingImproved formulary creation and sharing Code transfer between hospitals and GPsCode transfer between hospitals and GPs

( starting in pathology EDI)( starting in pathology EDI)

Todays session:

Why coding is important?Why coding is important? READ codes – facts and tipsREAD codes – facts and tips READ code formulariesREAD code formularies

DevelopmentDevelopment ImplementationImplementation MaintenanceMaintenance

EMIS templates EMIS templates Future developmentsFuture developments

Visit this webpage for linksVisit this webpage for links

www.wansford.co.uk/codeswww.wansford.co.uk/codes

EmailEmailAmrit@btinternet.comAmrit@btinternet.com