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PRIMIS Partnerships For Progress March 2004 Clinical Coding for the New GMS Contract Dr Pete Horsfield and Dr Colin Price.

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Presentation on theme: "PRIMIS Partnerships For Progress March 2004 Clinical Coding for the New GMS Contract Dr Pete Horsfield and Dr Colin Price."— Presentation transcript:

1 PRIMIS Partnerships For Progress March 2004 Clinical Coding for the New GMS Contract Dr Pete Horsfield and Dr Colin Price

2 PRIMIS Partnerships For Progress March 2004 Background and chronology June 2003: New GMS contract agreed and published July 2003: 1 st version of data specification issued –Tabular format –Missing codes identified October 2003: Special release of Read codes –Exception reporting –Missing allergies, contraindications etc –Review codes November 2003: 2 nd version data specification –Tabular format –Additional detailed business rules –Sign-off by 4-country body

3 PRIMIS Partnerships For Progress March 2004 Background and chronology (2) January 2004: Routine biannual release of Read codes January 2004: 3 rd version data specification and business rules compiled –Awaiting sign-off by 4-country body July 2004: Read code release and 4 th version 2004 – 2006 Biannual versions tied to Read code release cycle –Minor revisions and corrections only 2006: Major review of QOF

4 PRIMIS Partnerships For Progress March 2004 Interfaces and QA DoH / NPfIT working groups NHSIA conformance testing team 4-Country body Suppliers BMA / GPC Original (clinical) authors of indicators RCGP User groups

5 PRIMIS Partnerships For Progress March 2004 Exception reporting Exception from entire domains Exception from single indicators

6 PRIMIS Partnerships For Progress March 2004 Exception from entire domains The 9h… series of codes –9h01.Excepted from CHD quality indicators: Patient unsuitable –9h02.Excepted from CHD quality indicators: Informed dissent –Required annually (15 monthly) Newly diagnosed / newly registered Ignored if an individual indicator is achieved Subject to scrutiny at review visits

7 PRIMIS Partnerships For Progress March 2004 Exception from single indicators Allergies / Adverse drug reactions –Lifelong Contraindications, refusals, intolerances –Required annually (15 monthly) Ignored if an individual indicator is achieved Subject to scrutiny at review visits

8 PRIMIS Partnerships For Progress March 2004 Mental Illness Register The only register not based on diagnosis codes –Unable to compile a cluster –……severe long-term mental health problems who require and have agreed to regular follow-up Addition to register –9H6 - On national service framework mental health register –9H8 - On severe mental illness register –Prescribed lithium in last 6/12 Removal from register –9H7 - Removed from severe mental illness register

9 PRIMIS Partnerships For Progress March 2004 Questions

10 SNOMED – The Reality Dr Colin Price PRIMIS CONFERENCE 2 nd March 2004

11 Systematized Nomenclature of Human and Veterinary Medicine

12 Outline Some history Where are we now? What happens next? Questions.

13 Where have we come from? How did we get here?

14 Since 1992, the NHS has had a strategic commitment to using a single comprehensive terminology to support patient care.

15 Standard architecture Input Output Standards for clinical descriptions Standard queries & messages Agreed Datasets Confidentiality standards

16 Input Output Standards for clinical descriptions Standard queries & messages Standard architecture Agreed Datasets Confidentiality standards

17 Clinical Terms V3 development April 1992 April 1996 April 1993 April 1994 Term collection – 55 SWGs Read V3 file structure Start-up April 1995 Release 1 April 1994 Medical April Nursing Allied Health Withybush NAO etc Jan 1997 IMIA WG 6 Florida Clinical enthusiasm

18 SNOMED CT development April 1999 April 2003 April 2000 April 2001 Agreement signed with College of American Pathologists Read/SNOMED merger SNOMED CT design Formative Evaluation. Start-up April 2002 Release 1 January 2002 Alpha test April 2004 Implementation Foundation. Evaluation & Testing Core Refinement. Draft Standard Clinical engagement

19 What lessons did we learn from Read 3? User requirements need to be clearly understood The product needs to be fit-for-purpose Clinical users need to buy into it Evaluation and testing needs to be focussed Implementation needs to be planned The soft change management challenges need to be addressed.

20 Where are we now?

21 600 x 800 = pixels SNOMED CT 420,000 READ 2 4 BYTE ICD10 OPCS4

22 Distinguishes concepts from terms Semantic definition of concepts Tonsillitis: Finding site = tonsil structure Associated morphology = inflammation Uses description logic Formal basis for definitions Auto-classification Maintains hierarchical relationships between codes Based on semantic definitions. Technical Aspects

23 Concepts ConceptID CTV3ID SNOMEDID FullySpecifiedName Status Relationships RelationshipID Concept ID1 RelationshipType ConceptID2 Characteristic Type Refinability Descriptions ConceptID DescriptionID Term DescriptionType DescriptionStatus LanguageCode InitialCapitalStatus SNOMED ® Clinical Terms Core Structure © 2000 College of American Pathologists

24 SNOMED CT Identifier (SCTID) ConceptId, DescriptionId, RelationshipId Numeric (not alphanumeric) E.g. CT of spine concept identifiers SNOMED RT P Read V3X70nv SNOMED CT

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26 Other tables Cross references ICD10, OPCS4, ICD9, CPT4 Change management To track changes between 6-monthly re-issues Subsets E.g. primary care, ophthalmology Extensions E.g. NHS administration terms Keywords E.g. renal ~ kidney ~ nephric.

27 Kaiser-Permanente Cerner Hospital EMR Ardais Tissue banking project TheraDoc Decision support in antibiotic prescribing Cedars-Sinai Medical Center Computerised physician order entry Hope Hospital, Salford. Who is using SNOMED CT?

28 Implementation What happens next? What might go wrong?

29 What is SNOMED Clinical Terms? SNOMED CT is a terminological resource that can be implemented in software applications to represent clinically relevant information reliably and reproducibly.

30 What is SNOMED Clinical Terms? SNOMED CT is a terminological resource that can be implemented in software applications to represent clinically relevant information reliably and reproducibly.

31 Functional requirements Documentation in electronic records Decision support Clinical audit Reporting Summaries Administrative & management information Epidemiology Billing & reimbursement Resource management. Direct Indirect

32 Typology of terminologies SNOMED CT OPCS 4 ICD 10 Read 4 byte ICPCFocussed Comprehensive Content Direct care Indirect care Function CTV3 LOINC Datasets

33 Brown field = General Practice IT maturity Use Read Codes at point of care Generalist, summary records Green field = Most others IT immaturity Little use of terminology Specialist, detailed records. Two constituencies

34 Will a clinical terminology add value by meeting requirements and delivering benefits? Primary care Others ? Is SNOMED CT a suitable terminology to deploy? More comprehensive content than Read Flexible structure Growing support internationally (e.g. USA). Two questions

35 Live testing in green field settings Agreed with the NHS Information Standards Boards To confirm benefits in a wider range of clinical uses Working with NPfIT around NCRS Primary Care Migration Project Exploring the brown field legacy problem GP systems and their data. Evaluation & Testing programme

36 Implementations Time Implementation failure patterns Replication failure Sustainability failure Adapted from Heeks et al 1999

37 History Many years NHS terminology development A lot of lessons learned Where are we now? SNOMED CT is available What happens next? We need to get on and use it Refining as necessary through evaluation and testing Building on our experience to ensure that implementation delivers real benefits. Summary

38 SNOMED – The Reality Dr Colin Price PRIMIS CONFERENCE 2 nd March 2004


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