Making sure that FIT tests are matched to the correct SNOMED code for CAN02
The information in this article is still relevant even since CAN02 evolved into CAN04
Why does this matter
The Network Contract DES for PCNs has the following indicator:
CAN-02 Percentage of lower gastrointestinal two week wait (fast track)
cancer referrals accompanied by a faecal immunochemical test result, with
the result recorded in the twenty-one days leading up to the referral.
In order to achieve this indicator, practices need to ensure that FIT tests coming into the practices are coded properly.
Primary Care IT has written some searches to help you monitor performance on this activity and identify patients who are not hitting this target. These are found in folder 025A IIF 2023-24. You can make sure you have the latest version of these searches by copying them from the Primary Care IT folder in EMIS Population Reporting or from your local Enterprise Search & Report area. The folder you want for CAN-02 is:
and within here you will see two reports that will help you to calculate your percentage performance:
How can I check which code is being allocated to incoming FIT results?
If a code has been linked by somebody at the site, it can be changed in Workflow Config. All users should be able to see the button but only those with the appropriate RBAC code B1700 will be able to manage the Organisation Options.
On the left hand side click on Inbound Code Matches. Do not worry that a lot of entries in this list do not have a code attached to them.
Housekeeping tip: review this list periodically to check what tests have been linked to a code.
You can use the Edit and Delete buttons at the top of the page to make any amendments but remember that this will only affect future incoming reports.
Linking an inappropriate code to the report means that every subsequent incoming lab report for any patient will have the same code. If you select the wrong code any future incoming lab results will be allocated to this code. Correcting such a mistake might be possible when a few patients are affected, but left untouched a site would need to request assistance from EMIS at a cost.
Ideally all codes relating to test results should come in from the lab, so it is definitely worth approaching the lab to ask them to change the code on their messaging. This will save all other Practices having to do the process themselves. It may be necessary to have your ICS/CCG act as an intermediary to negotiate such updates. You can see our separate support article on Managing codes on lab reports
Aside from the faecal immunochemical test in the example above, diagnostic HbA1c and the CKD-epi calculation are two other types of test we are aware of which required code matching before the local lab made some changes. There are undoubtedly more examples.
What codes count for CAN-02?
The codes that are included are in the CAN-02 refset are as follows:
What can I do about previous uncoded reports?
Aside from missing the trendline functionality, it probably doesn't matter much from a clinician's perspective that some results are not coded as it is still possible to search for text within a record. Some QOF, Local Enhanced Services, and the National Contract DES (IIF) contain rules which look for coded results. It is therefore important for these that certain types of test result are correctly coded.
Having identified and matched a code going forward, there isn't a lot you can do automatically code reports retrospectively - unfortunately the only way to correct is a manual process. To do this you need to view the lab reports archive in Workflow Manager - you do not have to be a global viewer to see everything.
Press the Report column to sort by report name. EMIS may hang for a few moments as it thinks, then use the page navigator in the bottom left hand corner to locate the type of report you want. Each page has 50 reports so start off by making some big jumps of hundreds of pages, then refining by tens of pages until you find the range you want. Aside from being sorted alphabetically by report name they should also be sorted chronologically within each range of reports.
Once the range has been identified it is possible to work through the reports and add a code - if you have already mapped a line with UC for a recent result, you can actually use the UC button on each archived report to link a code - JUST MAKE SURE THE SAME CODE IS USED EVERY TIME!
The alternative approach is to print a list of all the patients you wish to add a code to, then manually add it on the same date as the report. Your Practice can make a decision over how far back to update, but consider that only the current NHS year is likely to be of benefit to achievement metrics. Whilst this second approach will look less tidy in the record, any mistakes made during the coding exercise can be more easily rolled back.
It is worth noting that the exercise described here may result in a lot more reports being 'fixed' than are required for the IIF indicator. Consider taking a list of names from the Population Excluded list of [IIF-CAN02a] (found in [IIF subsets] folder) to assist in cherry picking patients just for IIF.
Batch adding is not advisable since timing of reports can be critical to achieving some QOF/ES/IIF indicators.
Updated 2nd January 2024
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