SCIMP Conference November 2006

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SCIMP ConferenceNovember 2006
OSCAR

• CODING/ OSCAR PROJECT Workshop

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Introduction
OSCAR

• Read codes
• Issues in practices
• OSCAR Project
• The National Picture/ Snomed

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OSCAR
Background/ history of Read codes

• Devised by Dr James Read as a means of coding
  patients history, problems, care and treatment
• Purchased by UK Government in 1990 for use in NHS
• Is used in all General Practice systems
• There are now gt80 000 read codes available

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OSCAR
Benefits of coding

• Recording data consistently
• Retrieving data more easily
• Analysing data more thoroughly
• Also, competent computer systems can search for
  anything that has been typed except for
• Typing mistakes
• Different words for the same thing
• Human foibles

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OSCAR
Read code structure

• Hierarchical/ tree-like structure with 5 levels
• Alphanumeric coding from 1-5 characters
• The more letters/ numbers the more detailed the
  code
• .z indicates the lowest level of coding
• Each code has preferred wording (some with
  synonym choice)
• The first digit indicates which chapter the code
  is from

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OSCAR
Read code thesaurus
0. Occupations 1. History/ Symptoms 2. Examinat
ions/ Signs 3. Diagnostic Procedures 4. Laborato
ry Procedures 5. Radiology/ Physics in
Medicine 6. Preventive Procedures 7.
Operations, Procedures, Sites 8. Other
therapeutic procedures 9. Administration A. Infe
ctions/ Parasitic diseases B. Neoplasms C. Endoc
/ Nut/ Met/ Immune diseases D. Blood/ blood
organ disease E. Mental disorders
F. Nervous System/ Sensory organ disease G.
Circulatory system disease H. Respiratory
System disease J. Digestive system
disease K. Genitourinary system disease L.
Pregnancy/ Childbirth/ Puerperium M. Skin/
Subcutaneous tissue disease N.
Musculoskeletal/ Connective tissue disease P.
Congenital Abnormalities Q. Perinatal
Conditions R. (D) Symptom, Signs, Ill defined
condition S. Injury and Poisoning T.
Causes of Injury/ Poisoning U. (X) Ext. cause
Morbidity/ Mortality Z. Unspecified Conditions
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OSCAR
Read code structure
Example G. Circulatory system disease
G3 Ischaemic Heart Disease G30.. Acute
myocardial infarction G301. Anterior
myocardial infarction G3011 Acute anteroseptal
infarction
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OSCAR
Symbols used in Read Thesaurus
P Preferred terminology S Synonym for
preferred code NOS Not otherwise specified
NEC Not elsewhere classified D Diagnosis
(symptom as a diagnosis) SO Site of (e.g. an
operation) M Morphology of neoplasms
X Uses ICD 10 coding V Supplementary
influencing health services or contact other
than for illness
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OSCAR
Unusual codes

• U1284 Bit/ hit by crocodile/ alligator on
  highway
• U126. contact with a marine animal
• T550. Spacecraft launching pad accident

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The Issues in Practice
OSCAR
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OSCAR
The Process In General Practice
The Consultation
Record Keeping - The Computer - Notes
Letters Labs
Interpretation
Reports
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Issues in Practices
OSCAR

• System requires
• Good IT
• - Hardware/ software
• Good information management
• - Reliable data entry complete consistent
• - Audit/ search tools
• - Communication/ feedback/ prompts

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Reliable Data Entry
OSCAR

• Who collect the data?
• - GPs, nurses, admin staff, data clerks
• - Automated (lab results)
• What data is collected?
• - Sources letters/ consultations
• Why is it collected?
• - Audit/ clinical support/ clinical
  communication
• How is it collected?
• - Systems within practices

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OSCAR
Which would you chose?
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Which would you chose?
OSCAR
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Coding Systems
OSCAR

• Why use a standard Coding Summary (formulary)?
• Within practice
• - Simplifies data entry
• - Retrieval of information
• - Standard search systems ( payment purposes)
• Outwith Practice
• - Transfer of specific information (SCI-DC, ECS)
• - Transfer of electronic notes (between
  practices and systems)
• - Aggregation of information National Disease
  Prevalence,
• Public Health Initiatives

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SCIMP LIST
OSCAR

• First produced in 2001 (pre-contract)
• - A recommended list of 800 (with limited 300
  list)
• - Common conditions for patient summaries
• - Not intended to be exhaustive
• Updated list September 2006
• - To align with new developments in IT,
  Contract, NCDDP, other
• coding formularies (inc. OSCAR)
• - Available for use in formularies/ other
  developments
• - Also separate list for Contract with
  recommended codes
• - Found on SCIMP website - http//www.scimp.scot.
  nhs.uk/

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OSCAR
THE OSCAR PROJECT Optimal Summarising, Coding
Accurate Records

• HAZEL DODDS - Project Manager

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OSCAR
Major problems identified in summarising clinical
records in primary care

• Inconsistency of diagnostic coding due to wide
  selection of codes available in full read code
  thesaurus
• Difficulties in extracting accurate/ auditing
  information from practice systems
• Widely varying completeness across practices
• Practices moving to paperlite/ paperless status
• All members of practice team need to be involved
  in data entry
• Data entry needs to be consistent and accurate

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OSCAR
Reasons for the project

• Standardise summarising/ coding across WL
• CDM in primary care
• Enable practices to identify, track and treat
  these patients more effectively
• Good practice to have patient summaries
• Enable collection of data from all practices
• Research tool
• Demonstrate more accurate/ actual morbidity
  figures in primary care
• Improved capture of primary care data - influence
  resource allocation

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OSCAR
Reasons for the project

• Electronic transfer of patient information
• Consistent coding required for cross population
  between software packages/ databases, e.g.
  SCI-DC, ECS etc.
• Electronic transfer of whole patient record
• Paperlite practices
• nGMS contract
• Quality payments - depend on extracting accurate
  data from practice systems
• Practice required to have up to date summaries in
  records

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OSCAR
Objectives

• To support all practices to develop and maintain
  a standardised summarising/ coding system
• All practices would be supported regardless of
  system used
• All practices would receive an element of funding
• To produce a comprehensive coding formulary and
  protocol
• To regularly update and further develop coding
  formulary and protocol
• To train practice personnel in accurate/
  appropriate data entry methods

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OSCAR
Progress to date

• Summarised approx. 60 of patient records
• Annual audit review demonstrates a clear
  improvement in quality of summarising
• Training provided (on request) for all staff
• Extremely positive feedback from practices and
  management teams
• Assisted practices with information for QOF
  visits and QPA/ practice accreditation
• Practices able to show OSCAR documentation and
  project information

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OSCAR
Progress to date

• Roll out of project across Lothian
• Training workshops across Lothian
• Funded by IMT department
• Training in individual practices across Lothian
• Funded by individual practices
• Practices in Tayside and Fife utilising OSCAR
• Funded by individual practices
• Forth Valley Gpass Users Group interested
• Working with SCIMP to review current coding list
• Comparing with SCIMP 300/ 800, Midlothian list,
  GMS preferred codes and ISD National Dataset
  codes
• Coding list now complete and on SCIMP website

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OSCAR
Office Tel [phone] Mobile Tel 07734
540504 Email hazel.dodds_at_wlt.scot.nhs.uk Addres
s Primary Care Office Strathbrock Partnership
Centre 189a West Main Street Broxburn EH52 5LH
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OSCAR
The National Picture
The Health Service - Hospitals - Primary
Care - Community - Patients
Record Keeping - Paper - Computer - Web based
Interpretation
Reports/ audits
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The (Inter) National Picture - Communication
OSCAR

• Aided by
• A common language
• Consistent and uniform use of the language
• IT infrastructure

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SNOMED CT a common language Systematised
Nomenclature of Medicine
OSCAR

• A comprehensive clinical terminology that is
  used to code, retrieve and analyse clinical data
  (includes dentistry, vetinary, pharmacy,
  laboratory etc.)
• Over 350,000 concepts (codes) - Read has approx.
  80,000 codes
• Concepts arranged in 18 hierarchies each with
  sub-hierarchies (Read 1)

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SNOMED CT a common language
OSCAR

• Each concept has one fixed identifier and a set
  of relationships (the logical definition) and a
  set of names (preferred terms and synonyms)
• Examples Diabetes Resolved - Read
  212H.
• - Snomed 315051004
• Max. BP treatment -
  Read 8BL0.
• - Snomed 407567007
• Concepts can be individual (pre-coordinated
  term) or multiple (post-coordinated term)
• E.g. Spiral fracture R tibia (1
  term)
• Spiral fracture tibia
  Right side (2 terms)
• Can develop Subsets e.g. for GMS Contract

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Snomed CT
OSCAR

• Main Heirachies-
• 1. Clinical finding
• 2. Procedure
• 3. Observable entity
• 4. Body structure
• 5. Organism (bacteria, virus, plants etc)
• 6. Substance
• 7. Pharmaceutical/ biological product
• 8. Specimen
• 9. Physical object
• 10. Physical force

11. Events (adverse events, accidents) 12.
Environments and geographical
locations (sites of care) 13. Social contexts
(family, religion, ethnicity) 14.
Context-dependent categories 15. Staging and
scales 16. Attribute 17. Qualifier value 18.
Special concept
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Snomed CT
OSCAR

• Currently run by College of American
  Pathologists
• An international system (approx 35 countries
  with licences)
• Mapping of Read 2 to Snomed
• Snomed GP systems in early development stage
  (e.g. INPS Vision 4, EMIS Web)
• Partially used in localised sites (AE dept. in
  London)
• Plans for use in England 2007 GP summary
  record, export of prescriptions/ allergy
  information to OOH
• Initially small number of practices will be in
  Snomed CT
• Challenges for software providers/ end users
• Education, support etc.

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National Clinical Dataset Development Board
OSCAR
Standardised and Consistent use of coding

• Development of standardised datasets/ data
  definitions for Scotland
• To ensure data has the same meaning at time of
  entry and subsequent use
• Will be Snomed CT coded
• Current datasets include Cancer, CHD, Diabetes
  others
• Published via NCDDP website
• http//www.clinical datasets.scot.nhs.uk/Links.htm
  l