NHS IT: Government's £5bn IT programme runs into trouble as key
medical coding scheme comes under fire and doctors complain they
have not been consulted
Clinicians have strongly criticised a medical coding system that
will underpin electronic patient records and lies at the core of a
£5bn government plan to radically reform the NHS by improving IT
systems.
An internal NHS report dated 27 January, leaked to Computer Weekly,
says that senior clinicians in some key areas of hospital work have
rejected a database system, "Snomed" (Systemised Nomenclature of
Medicine), as being unsuitable for use in the NHS, only two months
before it is due to go live.
The project, and its UK predecessors, have been 10 years in
development and have consumed £37.4m of taxpayers' money.
Implementing Snomed will cost a further £100m.
Problems with the system raise fresh questions about the ability of
the NHS and the Department of Health to manage nationwide technical
projects of large size and complexity.
Developed under a deal signed between the UK's health secretary and
the College of American Pathologists, Snomed is pivotal to the
government's plans to put the medical records of patients into
electronic form so that GPs and hospitals can exchange files
quickly, and healthcare professionals can access them at any time
of the day or night.
If work on Snomed were delayed or abandoned, it could jeopardise
plans to give every person an electronic health record by 2005.
Electronic medical records are central to the government's plans to
improve the care of patients by spending an extra £5bn on health
service IT over the next five years.
Clinicians, and particularly GPs, strongly support the concept of
Snomed, which would allow diagnoses, treatments and medical
problems, to be given short electronic codes that could be keyed
into patient records.
The leaked "interim status report" disclosed the results of tests
by a small sample of about 40 clinicians, who identified 836 flaws
in the medical terminology.
Some of the report's comments reflected fundamental concerns over
the system's design. Clinicians also said that the Snomed's codes
and medical terms contained "inaccuracies," were "missing", or
"duplicated".
As the NHS made further announcements this week on its plans to
pump billions of pounds into health service IT systems, some
clinicians warned that although the Snomed scheme has run into
serious problems, it is still less complex than some national IT
projects planned by the Department of Health.
Snomed's predecessor, Read Codes version 3, a medical coding system
developed in part by the NHS, cost taxpayers about £32m. The
management of the project was strongly criticised by the House of
Commons Public Accounts Committee.
The combined Read Codes and Snomed system was originally due to be
completed by the end of 2001 but is now due to launch in
April.
In the leaked report, anaesthetists and clinicians in dermatology
and gastroenterology were among those who have rejected the system
as being unsuitable for use. Snomed's critics say the system may
take years to correct.
But a spokesman for the Department of Health said, "A lot of the
reviews on Snomed relate to the first release in 2002. There are
substantial refinements in a release due out shortly."
The problems with Snomed would be resolved and would not cause the
programme for introducing electronic records to falter, he
added.
What is Snomed?
The Systemised Nomenclature of Medicine (Snomed - pronounced
"snow-med") is a critical building block of the government's plans
to give all patients an electronic medical record by 2005.
Computerised patient records would allow files to be exchanged
quickly between hospitals, GPs, and other parts of the NHS.
Snomed would provide an agreed standard of coded medical terms,
allowing doctors to enter patient data in the form of an electronic
shorthand that summarises diagnoses and treatments
consistently.
At present hospital clinicians may describe medical conditions
in a variety of ways. A medical problem such as "unawareness during
general anaesthetic" would be given an electronic shortform.
However, critics of Snomed say it is mired in complexity.