Long covid: coding is caringBMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1262 (Published 19 May 2021) Cite this as: BMJ 2021;373:n1262
- Nikhil Mayor, academic foundation doctor1 2,
- Ruby Tsang, researcher clinical informatics2,
- Mark Joy, senior researcher2,
- FD Richard Hobbs, Nuffield professor of primary health care sciences2,
- Simon de Lusignan, professor of primary care and clinical informatics2
- 1Royal Surrey NHS Foundation Trust, Guildford, UK
- 2Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Research, 24 April
Sivan and colleagues1 and Ayoubkhani and colleagues2 describe the scale of adverse health outcomes for people admitted to hospital with covid-19. We agree that key questions of this complex, heterogeneous patient group are yet to be answered—such as whether particular symptom clusters exist, the impact on disparities, and whether young, fit people are disproportionately affected.3
For our health system to rise to the challenge of long covid we need systematically to record cases in primary care computerised medical record (CMR) systems. People with long covid are largely invisible to searches. There is the possibility that those who present and are prospectively flagged in record systems will be the more articulate and less deprived, further widening disparities.
In England, we have been slow to provide clinical terms that enable those with long covid to be recorded in CMR systems. We now have, however, a schema for doing this, provided by the National Institute for Health and Care Excellence and included in the Systematized Nomenclature of Medicine Clinical Terms (SMOMED) clinical terms:
• Acute covid-19: signs and symptoms of covid-19: ≤4 weeks
• Ongoing symptomatic covid-19: signs and symptoms of covid-19: 4-12 weeks
• Post-covid-19 syndrome: signs and symptoms that develop during or after covid-19, lasting >12 weeks and not explained by another diagnosis4
Coding is caring—we need a means to flag those with long covid. We recommend people with long covid have this coded as a “problem” (diagnosis) in their CMR. In England, we recommend that GPs use the “post-covid-19 syndrome” SNOMED clinical term and record the start date as three months after that person’s positive test date.
Please code correctly and caringly so we can collect the necessary real world evidence to manage covid-19 and its complicated sequelae.
Competing interests: SdeL is director of the Oxford-RCGP RSC and involved in covid-19 research, including an AstraZeneca funded project (not related to long covid).
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