021 Data Quality: Coding
This folder is part of 021 Data Quality
Overview
Outlier height/weight/BMI
This group of searches are closely related. Outlier heights and weights have been defined as values which fall outside a normal range. Not every adult patient appearing in these searches has an incorrect value as it is possible for certain individuals to be exceptionally tall or short, or overweight or underweight. The main reason these exist is to pick out where the latest value isn't quite right, which may be due to staff error or due to how data is transferred between SystmOne and EMIS.
- Staff may have transposed height and weight so instead of a patient being 160cm tall and 70kg, they were recorded as 70cm tall and 160kg.
- A patient may have recently registered, coming from a SystmOne Practice, and the GP2GP record saved the height in metres instead of centimetres. EMIS interprets the patient as 1.6cm tall.
Both of these examples have profound impacts on the BMI, which is where the calculation is reported for a BMI in the hundred range, or in the 10s of thousands range!
The reports show the dates of the affected values, many of which should be possible fix without checking the patient (based on previous data points).
There may be some patients who always appear in the height and weight searches, which could potentially act as a proxy for a register.
History of drug allergy
Patients with a generic code of 'h/o drug allergy' or similar will cause EMIS to trigger an additional safety popup every time medication is added or issued. This is because EMIS is unable to recognise these as an allergy to a specific medication, so generates additional warnings that users must click through. By removing and replacing these codes with a valid SNOMED code describing an allergy to a specific medication, the warnings will disappear.
Degraded codes
Transfer degraded allergy codes arise because of how other clinical systems (Vision and SystmOne) manage allergies. When a patient registers with an EMIS site and the record is transferred via GP2GP, all allergy codes (plus codes of Urticaria) are marked as degraded. A safety feature of EMIS means that all of these degraded entries must be removed and replaced with a valid allergy code before any medication can be issued. This is because EMIS does not recognise the code for what humans can read it as, so it cannot check that a drug being added is not related to the allergy described by the degraded code.
The degraded entry can usually be replaced with a code using very similar words.
Ordinarily staff filing GP2GP tasks should take notice of degraded allergies as soon as possible. This search, run on a weekly basis, should help mop up any missed tasks to ensure that clinicians are not delayed in issuing drugs to new patients.
Transfer degraded codes are similar to allergies in that the codes are not recognised by EMIS. In the first instance a workflow task will tell a user that degraded codes exist. When run regularly the report may assist in identifying degraded codes which must be converted to a proper code, such as vaccinations. Consider exporting the report to Excel to filter codes.
Not all degraded codes have to be fixed, but it is recommended that major problems, operations, and vaccinations are all recorded to ensure that registers and alerts function correctly.
Diabetics who are T1DM and T2DM
This search is designed to find patients with both T1DM and T2DM codes. With Read v2 coding, some terms were ambiguous and Type 2 patients on insulin may have been coded with Insulin dependent diabetes mellitus. This was really a code for Type 1 diabetes.
The impact of having both groups of codes is varied and dependent on local schemes.
- Incorrectly coded diagnoses recorded as problems introduce uncertainty on Summary Care Records or referrals where problem lists are automatically included.
- Depending on how they have been built, a LES for intended Type 2 diabetics may inadvertently exclude patients with Type 1 codes, or include Type 1 patients with Type 2 codes.
Type 2 patients with Type 1 codes is a more likely scenario than Type 1 patients with Type 2 codes.
Multiple significant problems, Admin/immunisation codes recorded as problems
The brief for identifying a large number of significant problems came about partly as an exercise in tidying up problem lists, and partly as a means of creating a list of the most complex patients - in a time before frailty and risk stratification became the norm. Very large lists of problems mean that other users may not be able to immediately pick out the important information they need, so it's important to maintain a concise list.
The initial approach to these reports - start with 60+ first - should be for a clinician to review each problem list and to tidy up where possible. Once all patients have been reviewed, all patients left are likely become part of that complex patient list.
Admin codes recorded as problems are the most likely of these 3 searches to return a large number. There are many 'administration' codes, some being quite simple such as Patient reviewed and others being something that may make sense to the staff adding them.
Chronic disease monitoring in particular can be a large group of codes. Nurses may have added a code of Diabetic monitoring during their diabetes reviews rather than adding the existing Diabetes diagnosis as a (Review) problem. If this has been done repeatedly, a fix requires a user to work backwards (most recent first) to relink consultation problems to the diagnosis. In addition to replacing the problem heading it would be necessary to manually add the original problem code under a comment heading to preserve the integrity of the record.
Immunisation codes recorded as problems should be downgraded. They have their own way of being listed collectively, and do not need to be added to a list that may already be large.
Multiple blood types
Whilst not impossible, multiple coded blood types are unlikely especially if the patient has not had a stem cell transplant. This report extracts the relevant coded blood types which would have to be validated to determine the correct coding. In women of childbearing age it may be helpful to ensure that the blood type is correctly recorded. In most cases, the usual reason for blood type being recorded will be antenatal clinics.
Chronic Disease multiple problems
An exercise in tidying up problem lists. Problem lists clogged up with the same diagnoses demonstrates poor data management, and adds a layer of confusion if the record is ever reviewed by an external organisation. The reports provided show where patients have more than 1 problem recorded for the condition. This may be because somebody has coded Asthma (First), but later Asthma (New), and possible Asthma (New) again. Carefully review each patient to determine the correct approach. Editing a consultation to change (New) to (Review) should resolve the problem, although this exercise can become complicated if there are many (Reviews) based off the later (New) entry.
Reports in this folder only check codes found in the register reference set. Disease monitoring codes such as Hypertension monitoring may also exist, but would be exposed in other reports such as Admin codes recorded as problems.
Grouping, Evolving, and Combining problems is a cosmetic procedure which looks good to the user in EMIS, but doesn't change how the codes exist in the record, or how they may be viewed in eRS referral data or summary printouts. Codes which have already been tidied in this way will still appear in the reports, but will initially be harder to locate in the Problem list.
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