Use of Read codes in diabetes management in a south London primary care group: implications for establishing disease registers

Dear Sir,

Re:
BMJ 2003;326:1130 (24 May)

Information in practice
Use of Read codes in diabetes management in a south London primary care
group: implications for establishing disease registers

Jeremy Gray, director1, Douglas Orr, researcher1, Azeem Majeed, professor
of primary care2

We take issue with the conclusion of the authors that ' The use of
Read codes for diabetes needs to be standardised and coding levels
improved if valid diabetic registers are to be constructed and the quality
of care is to be monitored effectively.'

In fact, we have shown that standard read codes for recording disease
already exist and are widely used in primary care .Many software systems
used by GP practices to record clinical information already use standard
data entry screens to help clinicians to manage patients with chronic
diseases such as diabetes, asthma and coronary heart disease. Templates
provide clinicians with reminders to check details such as blood pressure,
cholesterol, HbA1c etc, and automatically record information using
standard read codes, meaning that clinicians never need to see or have to
choose a read code. Over 94% of GPs in Scotland now use a computer system
to record clinical information, and 36% use it to record their management
of chronic disease (1). In addition, clinical criteria for template
screens have been developed by the Clinical Effectiveness programme of the
RCGP in Scotland, (SPICE –pc) and are thus national standards. (2) A
group representing users of all the clinical systems used in primary care
in Scotland has been formed to agree on standard codes and templates for
use in practices, called SCIMP (Scottish Clinical Information Management
in primary care). A minimum set of codes for use in primary care was
agreed in 1999 and are now in widespread use across Scotland, providing a
national standard for the recording of diagnostic codes. (3)

The SCIMP
group recently carried out a study to investigate whether practices will
be ready for the data reporting requirements for the new contract using
CHD as an example, looking at electronic GP records of all CHD patients in
five Scottish Practices validated by manual searches in 50 randomly
selected patients in each practice. The study measured the recording of
family history, smoking status, BP, diabetes testing, aspirin therapy and
cholesterol measurement. The results showed that it is extremely easy for
practices with completely electronic patient records to extract a disease
register. Extraction of a complete data set takes several days if it
involves checking through paper records, whereas setting up and running a
search from electronic records is possible in less than two hours. If
practices use the same clinical system and identical data entry templates,
the data can be directly compared. We have shown that in Scotland, there
is a high level of testing and recording of all the important information
regarding patients with recorded CHD, irrespective of whether practices
have fully electronic, paper based records, or a mixture of the two. If
practices have fully electronic patient records, the information can be
extracted easily, but unless there is a standard template, the information
can only be viewed in isolation and is of little value for comparative
purposes.

When information is entered onto clinical records using standard
templates, it can be extracted and amalgamated electronically. In
Scotland, the information from SPICE-pc templates is collected and
reported by PCCIU (Primary Care Clinical Informatics Unit) at Aberdeen
University. (3)

In Spring 2003, information was collected from 173 practices, with
data from 1,052,770 patients. Of these,
39,771 were shown to have CHD (4.4%),
23,485 had diabetes (2.6%),
46,679 had active asthma (5.2%) and
73,357 were hypertensive and aged >35. (14.5%)
This information was sent by the practices by email or disc, taking on
average 10 mins by email, or 30 mins by disc.

A similar function is provided by the PRIMIS unit in England, which
gives advice on data recording and standard queries or searches, and
extracts reports and amalgamates results across practices. (4)

References:

[1] Morris L. Dumville J, Campbell L M, Sullivan F A survey of
computer use in primary care: general practitioners are no longer
technophobic but other primary care staff need better access. Informatics
in Primary Care (2003) 11: 5-11

[2] SPICE-pc: www.ceppc.org/spice/index.shtml

[3] SCIMP:www.ceppc.org/scimp/index.shtml

[4] PRIMIS:www.primis.nhs.uk

Yours sincerely,

Dr Libby Morris MBChB, Chairman of SCIMP

Dr Robert M Milne MBChB, FRCGP, Senior lecturer, University of Aberdeen,
Director of PCCIU

Dr L. Malcolm Campbell, Senior lecturer, University of Glasgow Director
of Quality Standards, RCGP Scotland

Address for correspondence

Dr. Libby Morris,
RCGP (Scotland),
25 Queen Street,
Edinburgh,
Scotland

Competing interests:  
None declared