NHS director urges doctors to adopt new health codes

Howard Schmidt, the former Microsoft director appointed by US president George W Bush to create a national strategy to protect...

Anthony Nowlan, a director of the NHS Information Authority, this week urged IT suppliers and clinicians to use the Snomed clinical coding language, which he said could improve the care and treatment of patients.

In an exclusive interview with Computer Weekly, Nowlan said the product did not have to be perfect in every respect before IT suppliers incorporated it into their designs and clinicians began to use it.

The adoption of Snomed should be looked at as "analogous to a clinical drugs trial," said Nowlan. "You get to a point where you find the issues when people start to look at it and start to use it.

"We are not talking about a world in which everyone has to wait three years until everything is right before anyone can use it. That may be the model of a large computer system project but that is not the situation here."

The culmination of more than 10 years' work in the NHS, Snomed uses clinical codes - a form of electronic shorthand - as a critical component in computer-based records on the care of patients. It allows doctors and nurses to record the problems of patients, how they were treated, and the outcome. The system ensures that data goes into patient records in a uniform way so that it can be retrieved quickly.

Using Snomed, a GP would be able to see immediately the medicines a patient was taking, their major operations and current problems, said Nowlan. Snomed would also allow doctors to study batches of patient records and judge treatments' efficacy for specific medical conditions.

Nowlan strongly defended Snomed, after some doctors rejected it as unsuitable for use in the NHS following trials of the first version. Some doctors said in their review of Snomed that some important aspects of the codes were missing, duplicated or inaccurate.

But Nowlan said a lot of the comments made in the review of Snomed were issues of "fine detail". And he emphasised that designers of healthcare software can incorporate Snomed into their systems now, before all the flaws in the terminology are resolved. "It is not a major big-bang computer project," he said.

If changes need to be made to the structure of Snomed this would be a "soft database issue" and would not require system or hardware changes.

According to Nowlan, the principal limiting factor in the take up of Snomed by the NHS was the development of systems. However, some suppliers have indicated that they will be reluctant to include Snomed in their systems until it is shown to be a robust product.

Why does the NHS need a coding system?   

Steve Ponting, an IT manager in the private sector, described as a "shambles" the patient files held on paper in the NHS. 

When Ponting's mother was seriously ill in hospital recently, and was moved between wards, staff had little knowledge of what had gone before and were unable, for example, to tell whether she had had an ultrasound scan. His mother died. 

"Let me make it clear that I do not blame the staff who were doing their best, but the records they had were not able to support their needs," said Ponting. 

Like Ponting, clinicians, IT suppliers, and computer specialists want the NHS to convert files held on paper to comprehensive electronic records that can be exchanged securely and reliably between GPs and hospitals. 

But for computer records to work well, hospital doctors and GPs need to agree a standard way of describing diagnoses, conditions and treatments. It sounds simple, but the NHS has spent more than 10 years trying to develop what it calls "a common language of health". Complexity has been the enemy. 

In the 1990s, a clinical coding system called Read Codes set out to become a world standard. But Read Codes version 3 became bogged down in complexity. In its attempt to include every possible medical problem, it included such terms as "forced landing on take-off - occupant of spacecraft injured". But at the time there was no specific code for hayfever.  

After telling Parliament that Read Codes version 3 would be mandated, the Department of Health decided instead to merge the terminology with a US system called Snomed. The NHS said the two products were successfully blended in 2001, but Snomed has yet to be adopted.  

An interim status report on Snomed dated 27 January 2003 revealed many of the reviewers rejected Snomed as a standard for the NHS. The Department of Health said the review of Snomed is unfinished and the version tested has since been upgraded to remove its flaws.

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