1. Local READ Code Formularies and Templates EMIS NUG conference 6 th September 2001 Dr Amrit Takhar General Practitioner Wansford, Peterborough www.wansford.co.uk

2. How many READ codes? READ version 2 (5 byte) =107,000

3. Outline of todays session: Why coding is important? Why coding is important? READ codes – facts and tips READ codes – facts and tips READ code formularies READ code formularies  Development  Implementation  Maintenance EMIS templates EMIS templates Future developments Future developments

4. Why use READ codes? Data quality – Data quality –  improving standards of care  income generation (IOS claims) Clinical Governance Clinical Governance Audit and Research Audit and Research Decision support systems Decision support systems Communication between systems Communication between systems

5. Why use READ codes? Link to Templates, Protocols & Prodigy Link to Templates, Protocols & Prodigy Link to previous consultations using same code Link to previous consultations using same code Activate drug warnings, interactions, contraindications Activate drug warnings, interactions, contraindications Referral letters with coded details automatically added Referral letters with coded details automatically added Helps ensure claim for items of service Helps ensure claim for items of service

6. What are the Read Codes? The Read Codes are a comprehensive list of terms intended for use by all healthcare professionals to describe the care and treatment of their patients. They enable the capture and retrieval of patient-centred information in natural clinical language within computer systems.

7. Anatomy of a READ code G304.

8. READ code facts Developed by Dr James Read, GP, Loughborough 1982 Developed by Dr James Read, GP, Loughborough 1982 Purchased 1990 by NHS and mandatory for GP accredited systems but not in hospitals Purchased 1990 by NHS and mandatory for GP accredited systems but not in hospitals Merger with Snomed system scheduled to form worldwide coding system Merger with Snomed system scheduled to form worldwide coding system

9. Anatomy of a READ code 5 characters G…. Chapter heading ( circulatory diseases) G3… Ischaemic heart disease G30.. Acute Myocardial infarction G303. Acute inferoposterior infarction

10. 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) Cerebrovascul ar Disease(G6) Stroke and CVA unspecified (G66) Subarachnoid Haem. (G60) Level One Codes Level Two Codes Level Three Codes

11. 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

12. Chapter Contents A Infectious/parasitic diseases B Neoplasms C Endocrine/metabolic D Blood diseases E Mental disorders F Nervous system/senses G Circulatory system H Respiratory system J Digestive system K Genito-urinary system L Pregnancy/childbirth/puerperium M Skin/subcutaneous tissue N Musculoskeletal P Congenital anomalies Q Perinatal conditions R Ill-defined conditions/working diagnoses S Injury/poisoning T Causes of injury/poisoning

13. 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

14. Chapter headings 0 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

15. What does it mean when a term starts [V], [X] etc? These markers are used to indicate the sort of ICD/OPCS cross-mapping which is attached to the Read Code. These markers are used to indicate the sort of ICD/OPCS cross-mapping which is attached to the 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 contact with health services other than for illness (ICD) [V] Supplementary factors influencing health status or contact with health services other than for illness (ICD) [X] Terms which have been added to the Read Codes in order to ensure that every ICD-10 code is cross-mapped to from a Read Code. [X] Terms which have been added to the Read Codes in order to ensure that every ICD-10 code is cross-mapped to from a Read Code.

16. Pitfalls Context vs. coding:- Context vs. coding:- Angina ? = have they got angina. Angina [G33] ? [Free text] = this patient has angina

17. Finding the right code

21. Formulary benefits Avoidance of unsuitable codes Avoidance of unsuitable codes Data searching and audit much simpler Data searching and audit much simpler Simplify picking options when selecting a code Simplify picking options when selecting a code Sets scene for data transfer between practices Sets scene for data transfer between practices Raises awareness of coding Raises awareness of coding

22. Formulary – how to Written version on paper, on website, in excel Written version on paper, on website, in excel Create your own hierarchy in EMIS Create your own hierarchy in EMIS Templates Templates Synonym access (@ Synonym access (@ Wish list: Import/export a Code formulary option

23. Formulary by Synonym access @OM Acute Right Otitis Media, Acute Left Otitis Media, Acute Bilateral Otitis Media etc Acute Left Otitis Media, Acute Bilateral Otitis Media etc @URTI has various pharyngitis/tonsillitis @Heart@Mental

24. Formulary – choosing your codes Look at the existing formularies Look at the existing formularies  Liverpool  SCIMP (Scotland)  Sunderland (modified SCIMP list)  York – DR Mike Jones Get local agreement – PCT IT strategy Get local agreement – PCT IT strategy Build on recent initiatives eg READ codes in CHD NSF Build on recent initiatives eg READ codes in CHD NSF

27. READ code prioritiser (GPASS)

28. READ code browsers http://www.cams.co.uk/browsers.htm Suite of browsers, including:  Tree Browser  Read Code Comparison Tool  Read Codes GP4-byte, Version 2 and Version 3  Read Code Subset Wizard  Beginner's User Manual

32. Implementation options READ code formulary READ code formulary Paper versions, alphabetic, and by speciality Paper versions, alphabetic, and by speciality Top 100, laminated for desktop use Top 100, laminated for desktop use Training in READ code structure, terming, hierarchical searching Training in READ code structure, terming, hierarchical searching Encouraging hospital use – autoread coding xml Encouraging hospital use – autoread coding xml Minimum data sets Minimum data sets

33. EMIS templates Data entry forms invaluable for Data entry forms invaluable for  Saving time  Standardising data recording  Clinical prompts Can be shared between practices Can be shared between practices

34. EMIS templates Disease management Disease management Health promotion Health promotion Maximise IOS income Maximise IOS income Consultation records Consultation records Links possible to READ codes and protocols Links possible to READ codes and protocols

37. Template options Code entry dependent on age and sex Code entry dependent on age and sex Add or insert entries Add or insert entries Add diagnosis as problem title Add diagnosis as problem title Insert an existing template Insert an existing template Simple eg Cervical smear. Imms Simple eg Cervical smear. Imms Complex eg component of NSF protocols Complex eg component of NSF protocols

39. Template sharing Can be exported from EMIS (CO) to floppy disk Can be exported from EMIS (CO) to floppy disk Can be printed or stored as text file Can be printed or stored as text file Library of templates of NUG website Library of templates of NUG website Main pitfall is to ensure compatible version of READ ( 4 byte or 5 byte) Main pitfall is to ensure compatible version of READ ( 4 byte or 5 byte)

40. Sharing templates CO, TT, A (export to floppy) B (import from floppy) Ensure the floppy goes in the server A drive Ensure the floppy goes in the server A drive Make sure you know the read code Make sure you know the read code for the title of each template. for the title of each template.

46. READ version 3 270,000 codes 270,000 codes The new file structure which forms Version 3 uses the actual Read Code simply as a label for the term. The new file structure which forms Version 3 uses 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 and their terms to be moved to form a hierarchical structure which reflects current clinical thinking. Infinite number of levels of detail and allows codes and their terms to be moved to form a hierarchical structure which reflects current clinical thinking. Each term can have qualifiers Each term can have qualifiers

47. READ version 3 Qualifiers allow addition of detail to "core terms". For example; Inguinal herniorrhaphy using sutures may be qualified by; Priority -Scheduled Revision status-Repair of recurrence Qualifiers allow addition of detail to "core terms". For example; Inguinal herniorrhaphy using sutures may be qualified by; Priority -Scheduled Revision status-Repair of recurrence Terms are also available for providing the context of a core term, i.e. the goal of treatment, expected finding or actual finding and certainty Terms are also available for providing the context of a core term, i.e. the goal of treatment, expected finding or actual finding and certainty

49. The Future of coding Changing to SNOMED CT Changing to SNOMED CT Improved formulary creation and sharing Improved formulary creation and sharing Code transfer between hospitals and GPs Code transfer between hospitals and GPs ( starting in pathology EDI)

50. Todays session: Why coding is important? Why coding is important? READ codes – facts and tips READ codes – facts and tips READ code formularies READ code formularies  Development  Implementation  Maintenance EMIS templates EMIS templates Future developments Future developments

51. Visit this webpage for links www.wansford.co.uk/codes EmailAmrit@btinternet.com