Read to SNOMED register attention needed
The folder IOM Read to SNOMED register attention needed has been built by Primary Care IT to facilitate the identification of patients who have been added or removed from registers as a result of the code migration from Read v2 to SNOMED CT.
Why is this folder necessary?
When EMIS migrated from Read v2 to SNOMED terminology, the number of codes available to use increased significantly. The two terminologies differ in their approach, so a mapping exercise was employed to convert code terms in Read to an appropriate SNOMED concept. Some Read terms within a section of the hierarchy were mapped to different concepts than their sibling codes which either changed the meaning or the context of the code.
Furthermore, the lists of codes used in EMIS' Read registers was quite small and may not have been updated since EMIS began to utilise SNOMED in England.
The folder has been built with two aspects in mind:
- Identifying patients who were on a chronic disease register when Read v2 was in use, but have now dropped off the register using SNOMED codes
- Identifying patients who were not previously on a chronic disease register, but have been added due to a SNOMED code on the record
What does it look like?
The top level folder contains the reports that users may review to check codes that have removed or added a patient.
The reports for "Added to..." and "Record for inclusion on..." are identical.
Some reports contain more than just Read and SNOMED codes - depending on the register there are extra tables which will help to understand whether a patient should have something done to fix their inclusion on a SNOMED register.
- Active medication relevant to the condition (in asthma and epilepsy)
- Monitoring codes suggesting that the patient has been reviewed for the condition (such as hypertension monitoring)
- Values which may help prioritise which patients to check first. Blood pressure, eGFR, and weight all appear.
What should I look out for?
The migration to SNOMED has previously thrown up several unusual coding activities which users should be aware of.
Asthma
The codes 'Wheezy bronchitis' and 'Recurrent wheezy bronchitis' are found within the asthma SNOMED code cluster, but were not used in the Read register. There are likely to be a mix of patients who are being treated as asthmatics but have never had a code for 'Asthma' on their record, as well as those for whom 'Wheezy bronchitis' was added as a symptom rather than a diagnosis. All 'Wheezy bronchitis' codes must be replaced with another code such as 'Acute bronchitis co-occurrent with wheeze' [785745000].
Do not use 'Chronic bronchitis co-occurrent with wheeze' [785736001] as this code is used in the COPD register code cluster.
A separate report for Wheezy bronchitis appears at the bottom of the folder. We recommend working through that report before re-running the folder to deal with any other patients.
COPD
Similar to asthma, 'Recurrent wheezy bronchitis' pulls patients into the COPD register via its synonym Chronic asthmatic bronchitis. All 'Recurrent wheezy bronchitis' codes must be replaced with another code such as 'Acute bronchitis co-occurrent with wheeze' [785745000].
Heart Failure
The Read register for heart failure included patients with a code for Heart failure as well as others for LVSD. In SNOMED, these are treated as separate (sub) registers. HF1 is a register that looks for "Heart failure" codes, while HF2 is effectively a subsidiary that requires both "Heart failure" and "Left ventricular systolic dysfunction".
Hypertension
'Raised blood pressure' has historically been an acceptable code in the Read register, but it is not part of SNOMED. The report Recode for inclusion on hypertension register is likely to have some of the biggest numbers for each Practice to review. The most recent blood pressure has been included on the report to help stratify the review process - some values may be low and several years old which might suggest that the patient does not have hypertension. It is worth checking each patient's medication screen to see if there is any active medication used to manage blood pressure.
Learning Disabilities
Codes have been added to the SNOMED learning disability code cluster which cause patients to appear on the register despite the patient not having any history of intellectual impairment. This is because of how the Read codes looked in EMIS, and what they were subsequently mapped to for SNOMED.
- Dysequilibrium syndrome
It is likely that patients with this code had it added during a consultation where the code selected was for the symptom of dysequilibrium (a feeling of unsteadiness). Having been mapped to a syndrome, these patients are now added to the LD register. The only way to remove patients is to replace the codes with a different code, even if the consultation was many years ago. - Sjogren-Larsson syndrome
This is a rare syndrome and it is likely that anybody found with this code was supposed to have a code of Sjogren's syndrome - an entirely different condition named after an unrelated Swedish individual who happened to be alive at the same time. If the patient definitely does not have Sjogren-Larsson syndrome, delete the code and add a more appropriate code.
Rheumatoid Arthritis
Unlike many of the above examples, the number of patients highlighted for review are actually due to a behaviour of EMIS rather than of coding. Following the migration from Read to SNOMED, searches using Read continue to work but they only look at a specific concept ID/description ID combination. Primary Care IT had to rebuild the Read search terms in SNOMED as EMIS prevents Read authored resources from being copied or imported. There are some code terms which share a concept ID of a term used in the old Read register, but EMIS will not pick them up as the description ID is different.
Description ID can be considered a synonym of another code which it shares a concept ID.
'Rheumatoid arthritis', 'Rheumatoid arthritis NOS', and 'Rheumatoid disease' look different on the screen but all share a concept ID.
'Rheumatoid arthritis', 'Rheumatoid arthritis NOS', and 'Rheumatoid disease' look different on the screen but all share a concept ID.
Two codes have been confirmed to appear in the Primary Care IT 'Read' version of RA001:
- Ankylosing spondylitis [9631008]
- Bursitis [84017003]
These codes are not part of the RARTH_COD cluster used for SNOMED, so they will not automatically appear on the SNOMED version of the RA register. You should carefully review the report Recode for inclusion on rheumatoid arthritis register as some patients may have been seen in a rheumatoid arthritis clinic before.
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