Known system code issues (EMIS)
This article details known problems with codes and reference sets which can impact on QOF and other reporting mechanisms.
LD_COD codes removed
(25/07/2024)
A customer contacted EMIS querying why a patient was no longer on the Learning Disability register despite a history of reviews. They then reached out to PCIT for assistance - in the two examples it was found the code "Moderate learning disability" [984671000000103] was the code that was missing. The Practice was on MKB212, while PCIT was able to compare with MKB211 - both of which did not include the yellow QOF icon.
All PCIT resources are affected as they use LD_COD in concepts, or refset 999002611000230109 in searches.
As of 25/07/2024:
- PCD Refset (date 31/05/2024) shows code included
- MKB211 and MKB212 both exclude code
PCIT investigation found that several codes were removed in TRUD release 52.0.0 (published 07/05/2024), but reinstated in release 53.0.0 (11/07/2024).
Codes affected are:
SNOMED | Term | Removal | Reinstatement |
984661000000105 | Mild learning disability | Removed TRUD 52.0.0 - 01/05/2024 | Restored TRUD 53.0.0 - 31/05/2024 |
984671000000103 | Moderate learning disability | Removed TRUD 52.0.0 - 01/05/2024 | Restored TRUD 53.0.0 - 31/05/2024 |
931001000000105 | Significant learning disability | Removed TRUD 52.0.0 - 01/05/2024 | Restored TRUD 53.0.0 - 31/05/2024 |
984681000000101 | Profound learning disability | Removed TRUD 52.0.0 - 01/05/2024 | Restored TRUD 53.0.0 - 31/05/2024 |
508171000000105 | Severe learning disability | Removed TRUD 52.0.0 - 01/05/2024 | Restored TRUD 53.0.0 - 31/05/2024 |
403767009 | Acrocephalopolysyndactyly type II (Carpenter syndrome) | Removed TRUD 52.0.0 - 01/05/2024 | n/a |
5619004 | Bardet-Biedl syndrome | Removed TRUD 52.0.0 - 01/05/2024 | n/a |
PCIT has not raised a case with EMIS, on the expectation a future MKB will restore the code.
LD_COD concept code list
(09/01/2024)
A customer highlighted an incorrectly showing alert which we investigated and found that a code not visibly included in the code list was causing concepts relating to Learning Disabilities to pass.
The code is Cortical dysplasia with focal epilepsy syndrome [771142009]
The patient record displayed EMIS' own alerts suggesting the patient was on the Learning Disability register; had not had a learning disability review; was suitable for a dementia assessment. Primary Care IT authored alerts relating to Learning Disabilities such as one for IIF Outstanding were also shown.
PCIT has raised this case with EMIS under CS1295844.
Resolution achieved March 2024
Drugs missing from reference sets - MKB205
(11/12/2023)
The following reference sets appear to have drugs missing following the MKB205 update which are affecting QOF indicators and other searches which use the reference sets.
| Cluster ID | Refset ID | Used in | Missing drugs |
12464001000001103 | STAT_COD | CHOL001, DM022, DM023 | Simvastatin 10mg / 20mg / 40mg tablets Pravastatin 10mg / 20mg / 40mg tablets Rosuvastatin 5mg tablets Cerivastatin 100mcg / 200mcg / 300mcg / 400mcg / 800mcg tablets |
| 12464201000001109 | ACE_COD | DM006, HF003 | Captopril 12.5mg / 25mg / 50mg tablets Enalapril 2.5mg / 5mg / 10mg tablets Imidapril 5mg / 10mg / 20mg tablets Lisinopril 2.5mg / 5mg / 10mg / 20mg tablets Moexipril 7.5mg / 15mg tablets Perindopril erbumine 2mg / 4mg / 8mg tablets Quinapril 5mg / 10mg / 20mg / 40mg tablets Ramipril 1.25mg / 2.5mg / 5mg / 10mg tablets Ramipril 1.25mg / 2.5mg / 5mg / 10mg capsules Trandolapril 1mg / 2mg / 4mg capsules |
| 12464301000001100 | AII_COD | DM006, HF003 | Candesartan 2mg / 4mg / 8mg / 16mg / 32mg tablets Eprosartan 300mg / 400mg / 600mg tablets Irbesartan 75mg / 150mg / 300mg tablets Losartan 25mg / 50mg. / 100mg tablets Olmesartan 10mg / 20mg / 40mg tablets Telmisartan 20mg / 40mg / 80mg tablets Valsartan 40mg / 80mg / 160mg / 320mg tablets Valsartan 40mg / 80mg / 160mg capsules |
| 12465501000001108 | LBB_COD | HF006 | Bisoprolol 1.25mg / 2.5mg / 3.75mg / 5mg / 7.5mg / 10mg tablets Carvedilol 3.125mg / 6.25mg / 12.5mg / 25mg tablets |
12465401000001109 | ULBB_COD | HF006 | Angilol 10mg / 40mg tablets Atenolol 25mg / 50mg / 100mg tablets Betaloc-SA 200mg tablets Betim 10mg tablets Celiprolol 200mg / 400mg tablets Co-tenidone 50mg+12.5mg / 100mg+25mg tablets Esmolol 2.5mg powder for infusion Esmolol 2.5mg/10ml solution for infusion Esmolol 100mg/10ml solution for injection Labetalol 100mg / 200mg / 400mg tablets Metoprolol 50mg / 100mg tablets Nadolol 40mg / 80mg tablets Oxprenolol 20mg / 40mg / 80mg tablets Pindolol 5mg tablets Propranolol 10mg / 40mg / 80mg / 160mg tablets Sotalol 40mg / 80mg / 160mg tablets |
The absence of drugs in the first 4 refsets (STAT_COD, ACE_COD, AII_COD, LBB_COD) have the effect of reducing the numerator and the percentage achievement. ULBB_COD is part of an exclusion rule for HF006 as it lists unlicensed beta blocker agents; the absence of these drugs actually increases the size of the denominator, meaning HF006 has a double whammy of larger denominator with smaller numerator and an even lower percentage achievement.
Interim fix by EMIS achieved in QOF V48 Release 1.5. Drug refsets replaced by lists of individual drugs.
COPD014 achievement has dropped
(11/12/2023)
Following MKB205 update, Practices identified a significant drop in their percentage acheivement for QOF indicator COPD014 (offer of pulmonary rehabilitation where MRC is ≥3).
The cause is not EMIS, but due to a change in the TRUD at national level. The update was released on 12/10/2023, but system suppliers usually take some time to reflect the changes in their own code dictionaries.
The code Pulmonary rehabilitation offered [913981000000106] has been removed from the PULRHBOFF_COD [999010451000230106] refset.
This creates a fundamental change to the indicator, requiring patients to be referred to pulmonary rehabilitation.
Users may recall that the pulmonary rehabilitation indicator was changed from COPD008 to COPD014 in April 2023. This change saw the removal of the ability to code Pulmonary rehabilitation declined, leaving just an offer and a referral as the two options. By removing one of the remaining options, which would have been used extensively in lieu of declined in the first 9 months of the contract year, Practices face seeing their work being ignored with no option but to code that a referral has been made.
Primary Care IT has been feeding back at national level to JGPITC and NHS England.
On 11th January 2024, we learned from NHSE that a fix will be applied for the remainder of the contract year. Pulmonary rehabilitation declined will be added to an existing refset relating to pulmonary rehab being unsuitable. This can be found in rule 5 of the denominator [COPD014].
Interim fix by EMIS achieved in QOF V48 Release 1.5.
Learning Disability register size has increased
(11/12/2023)
Following MKB205 update, the Learning Disability register size increased unexpectedly, including patients who did not have a learning disability.
The cause is not EMIS, but due to a change in the TRUD at national level. TRUD defines which codes are active and what codes are included in primary care reference sets (eg: LD_COD). The update was released on 12/10/2023, but system suppliers usually take some time to reflect the changes in their own code dictionaries.
Primary Care IT was aware of this change prior to the release of MKB205, but was unable to demonstrate the extent of the problem until sites began to receive MKB205.
Primary Care IT has been feeding back at national level to JGPITC and NHS England.
NHS England has subsequently acknowledged that there were a number of codes which should not have been included in the final release.
The following codes should not have been included: Retinitis pigmentosa [28835009]; Neurofibromatosis type 1 [92824003]; Narcolepsy type 1 [735676003]; Xeroderma pigmentosum [44600005]; Maple syrup urine disease [27718001]; Alexander disease [81854007]; Benign myoclonic epilepsy in infancy [192990004]; Craniodiaphyseal dysplasia [205506004]; IRIDA syndrome [722005000]; Marden Walker syndrome [449824004]; Schwartz-Jampel syndrome [29145002]; Thanatophoric dysplasia [29352008]; Usher syndrome type 1 [232057003]; Wilson disease [88518009]; X-linked adrenoleukodystrophy [65389002]
Primary Care IT highlighted other codes to NHSE (such as Classical phenylketonuria) which we felt were capturing patients who did not have a learning disability. In early January NHSE acknowledged that a further 13 codes would be removed from the LD refset as soon as possible.
9p partial trisomy syndrome [77527000]; Adenylosuccinate lyase deficiency [15285008]; Classical phenylketonuria [7573000]; Coffin-Lowry syndrome [15182000]; Cutis laxa, x-linked [59399004]; Dubowitz's syndrome [2593002]; Fetal alcohol syndrome [205788004]; Fragile X syndrome [613003]; Lesch-Nyhan syndrome [10406007]; Macroencephaly [9740002]; Multiple sulfatase deficiency [54898003]; Peters plus syndrome [449817000]; Weaver syndrome [63119004].
Resolved in MKB206
Drugs missing from reference sets - MKB203
(24/10/2023)
The following reference sets appear to have drugs missing following the MKB203 update which are affecting QOF indicators and other searches which use the reference sets.
| Cluster ID | Refset ID | Used in | Missing drugs |
92161000001100 | DIRECTORANTICOAGDRUG_COD | AF008 | Apixaban 2.5mg / 5mg tablets |
93141000001109 | VITKANTAGDRUG_COD | AF008 | Warfarin 1mg / 3mg / 5mg / 500 microgram tablets Acenocoumarol 1mg tablets Phenindione 10mg / 25mg / 50mg tablets |
12463501000001109 | ORANTICOAGDRUG_COD | CHD005, STIA007 | Apixaban 2.5mg / 5mg tablets Warfarin 1mg / 3mg / 5mg / 500 microgram tablets Acenocoumarol 1mg tablets Phenindione 10mg / 25mg / 50mg tablets |
12463701000001103 | SAL_COD | CHD005, STIA007 | Aspirin 75mg / 75mg dispersible / 75mg gastro-resistant / 300mg / 300mg gastro-resistant tablets Aspirin 300mg suppositories |
12463901000001101 | DIPY_COD | STIA007 | Dipyridamole 25mg / 100mg tablets |
12464001000001103 | STAT_COD | CHOL001, DM022, DM023 | Rosuvastatin 10mg / 20mg / 40mg tablets Simvastatin 80mg tablets Simvastatin 80mg/ezetimibe 10mg tablets |
115131000001105 | EZETIMIBE_COD | CHOL001 | Ezetimibe 10mg tablets Simvastatin 80mg/ezetimibe 10mg tablets |
Resolved in MKB205
Codes missing from Flu invite reference set
In October 2023, Practices have begun to notice that their achievement for IIF flu indicators VI-02 and VI-03 is not as high as they were expecting. Furthermore, patients who have already been invited twice (at least 7 days apart) are still included in the denominator population. For the purposes of IIF, patients who decline or are non responders are supposed to be removed from the denominator population.
The problem centres around code terms for Influenza vaccination invitation SMS text message sent.
Practices were selecting active SMS invitation codes (also pre-selected in AccuRx) in order to record that invitations had been sent. These were codes 1484821000000104, 1484831000000102, 1484841000000106, 1484851000000109.
An investigation focusing on the TRUD release has found that these codes were not added to the refset FLUINVITE_COD until the July publication. It appears that the TRUD managers had identified that there was a gap and attempted to rectify if before the start of the flu campaign. Unfortunately system suppliers usually take a couple of months to process the changes in their own code dictionaries before releasing across the sites. This has not happened prior to 1st September when flu invitations can be coded.
A further complication to this refset history is the three previous codes (711301000000108, 777791000000102, 777831000000109) had been made inactive in MKB197.
Primary Care IT had already been in contact with EMIS in mid-September (CS1230949) who confirmed that the 148 codes were going to be added to the refset in MKB202, but were unable to provide an approximate indication of when deployment would start. For Practices who have already used the 148 codes, no action needs to be taken as the denominator will correct itself. Continue to invite patients for vaccination.
Resolved in MKB202
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