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Information In Practice

Why general practitioners use computers and hospital doctors do not—Part 2: scalability

BMJ 2002; 325 doi: (Published 09 November 2002) Cite this as: BMJ 2002;325:1090

Clinical Terms Version 3: A pioneer terminology for use in primary and secondary care

Editor - Benson provides an interesting personal perspective of the
evolution of the
use of electronic records in general practice (1). He correctly outlines
the limitations of the original Read codes to support the terminology
of secondary care and cites the NHS Clinical Terms Projects as a major
towards addressing this issue. However he implies that the Public Accounts
criticised the technical aspects of one of these projects, Clinical Terms
Version 3 (CTV3), which is simply not true. They were concerned about
procedural irregularities.

Benson describes CTV3 as 'only having a primary hierarchy and
unnecessarily complex'. This again is incorrect as CTV3 is organised as a
directed acyclic graph and therefore provides multiple hierarchies. This
ability to classify concepts from several perspectives can only be
achieved at the expense of greater structural complexity (2). Indeed the
joint US-UK project SNOMED Clinical Terms structure is essentially
similar, having been based upon the original work on CTV3 and its US
counterpart SNOMED RT, so in no way 'can avoid these problems'. CTV3
remains internationally the only clinical terminology in regular use in
both primary and secondary care environments. It is anticipated that
SNOMED Clinical Terms having adopted many of the features of CTV3 will
provide similar functionality but this remains to be proven and its
content is currently undergoing evaluation.

1 Benson T. Why general practitioners use computers and hospital
doctors do
not - Part 2: scalability. BMJ 2002;325:1090-3.

2 Stuart-Buttle CDG, Brown PJB, Price C, O'Neil MJ, Read JD. (1997) The
Read Thesaurus - creation and beyond. (1997) In Pappas C et al (Eds).
Proceedings of the 14th Medical Informatics Europe '97 conference. Oxford:
IOS Press, 1997:416-20.

Phil Brown
Honorary lecturer in medical informatics

School of Information Systems,
University of East Anglia, Norwich

Mike ONeil

British Association of Clinical Terminology Specialists

Competing interests:  
Phil Brown and Mike ONeil were invloved in the development of Clinical Terms Version 3.

Competing interests: No competing interests

10 December 2002
Philip J B Brown
Honorary lecturer in medical informatics, School of Information Systems, University of East Anglia
Mike ONeil
C/O Hethersett Surgery, Great Melton Road, Hethersett, Norfolk NR9 3AB