Doctors attack health IT codes

NHS IT: Government's £5bn IT programme runs into trouble as key medical coding scheme comes under fire

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.

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