1. QIPP Digital Technology and ITK Care Co-Ordination: Interoperability WebEx 3. 1 st Nov 2012

2. WebEx  Quick overview of approach being taken to coding data items  Example of a code-list  Proposed approach to coding for each data item  There will then be time for questions and comments at the end.  During the WebEx all participants will be muted to avoid background noise  Discussion on this WebEx – either:  Use the “raise hand” and I will un-mute you so you can speak, or  Use the “chat” box to ask a question or make a comment  Please ensure you send it to “all” and not just the host!  The WebEx is being recorded, and a recording will be made available on the ITK NHS networks site after the session. http://www.networks.nhs.uk/nhs-networks/interoperability-toolkit-itk

3. Clinical Codes in the End of Life Document  Background:  Many fields in the ISB 1580 EoL dataset are coded, variously: Snomed CT, Read 2, CTV3 and Data Dictionary codes  Most of these fields have small sets of pre-specified codes  Three of the fields do not have pre- specified codes: diagnoses (two) and allergies and adverse reactions

4. Clinical Codes in the End of Life Document  EPaCCS Document Interoperability Requirements:  Requirement 103: “Some fields will have a published SNOMED CT code list associated with them in the message specification. These fields MUST be populated using a SNOMED CT term within that published list. The list of allowed values will be maintained separately from the message definition itself” (Workshop Output)  Requirement 100: “Any mapping from a locally held code to the published SNOMED CT or Data Dictionary codes (or any other published codes) for any field MUST be clinically validated” (Best Practice)  ISB 1580 End of Life care Coordination, Section 3.5:  “The Information Standards Board has approved the SNOMED CT fundamental standard for use in the NHS. Suppliers implementing the End of Life Care Co- ordination core content standard MUST refer to ISB 0034. Organisations contracting for new EPaCCS must specify that suppliers use SNOMED CT for all coded information within systems that are developed, but there may also be a need to support other coding systems where required for interoperability”

5. Clinical Codes in the End of Life Document  What we Propose:  Where there are manageable sets of codes we propose to use Snomed CT or, in some cases, Data Dictionary  Where this is not possible, allow one of Snomed CT, Read 2 or CTV3  Use Data Dictionary codes where PDS can supply them

6. Coded Fields for Iteration 1 (Dec 2012 / Jan 2013) Item Brief description 09Gender 10Need for Interpreter 11Language spoken 17 Main Informal carer aware of prognosis 28 Anticipatory medicines box issued 34 DNACPR 41 Authority of Lasting Power of Attorney

7. Snomed CT CodePreferred Term 751961000000104Relative aware of prognosis (situation) 760101000000101Relative unaware of prognosis (situation) 751941000000100Carer aware of prognosis (situation) 711951000000105Carer unaware of prognosis (situation) ISB 1580 Item17: Is Main Informal Carer Aware of Person’s Prognosis? Example

8. Coding System to Use EOL ISB 1580 Dataset Coded in Iteration 1PDSData Dict.Snomed CTRead 2CTV3 9. Person Gender Probably√ISB Code set 10. Need for an Interpreter√√ISB Code set 11. Preferred Spoken Language Probably√ISB Code set 12. Disability DD Code SetNo code set 17. Is Main Informal Carer Aware of Person’s Prognosis?√ ISB Code set 23. Formal Carers Involved in Care: Professional Group ISB Code set 25. Primary End of Life Care Diagnosis Loc. code setNo code set 26. Other Relevant End of Life Care Diagnoses and Clinical Problems Loc. code setNo code set 27. Allergies/Adverse Drug Reactions No code set 28. Anticipatory Medicines/Just in Case Box Issued√ ISB Code set 30. EoLC tool in Use? (e.g. GSF, LCP (or other ICP), PPC, other) ISB Code set 31. Advance Statement Requests and Preferences ISB Code set 32. Preferred Place of Death 1st Choice ISB Code set 33. Preferred Place of Death 2 nd Choice ISB Code set 34. DNACPR Decision Made √ ISB Code set 38. Person has made an Advance Decision to Refuse Treatment ISB Code set 38a ADRT discussed with clinical professional ISB Code set 41. Authority of LPA√ ISB Code set KEY ISB Code Set - use set defined by ISB 1580 No code set - use any code that is suitable for that field Loc. Code Set - ISB 1580 specifies locally determined set DD Code Set - Code set as specified in the Data Dictionary How it looks in Practice

9. Further Information  End of Life Care Coordination requirements:  http://www.networks.nhs.uk/nhs-networks/interoperability-toolkit-itk/care- co-ordination-interoperability http://www.networks.nhs.uk/nhs-networks/interoperability-toolkit-itk/care- co-ordination-interoperability  ISB 1580 End of Life Care Coordination  http://www.isb.nhs.uk/documents/isb-1580/amd-11- 2011/1580112011spec.pdf http://www.isb.nhs.uk/documents/isb-1580/amd-11- 2011/1580112011spec.pdf