Facilitator Handbook 2005 - PRIMIS

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PRIMIS Facilitator Handbook Clinical Coding Example of the hierarchical nature of Read codes Level Term Read 4-byte Read Version 2 1 Circulatory system disease G… G.... 2 Ischaemic heart disease G4.. G3... 3 Acute myocardial infarction G41. G30.. 4 Anterior myocardial infarction G301. 5 Acute anteroseptal infarction G3011 The NHS Executive and the College of American Pathologists (CAP) have developed a new collaborative work, SNOMED Clinical Terms. This coding system combines CAP’s SNOMED RT with the Clinical Terms Version 3 (Read Codes) and is called SNOMED CT. This single unified terminology will underpin the development of the integrated electronic patient record and is a pivotal part of the National Programme for Information Technology National Care Record Service. PRIMIS is currently developing a training module on SNOMED CT. The Training The training takes place over a half day and is run on an individual scheme basis. It covers the advantages and disadvantages of coding, the different coding schemes in use across health care and a detailed overview of Read codes, including the structure, the hierarchy and the Read code chapters. The training also provides practical techniques and exercises for searching for Read codes within a browser. Further information on the background and subject matter included in this training is available in the form of a workbook. This is provided to facilitators during the training. Learning Objectives The training will provide information facilitators with: • an understanding of the history, principles and structure of the Read codes in the various versions • skills in finding and selecting appropriate codes for specified conditions/ investigations/procedures, etc., using a variety of Read Code browsers (including GP systems, CLUE and NHS Connecting for Health) • an understanding of the limitations of Read codes when grouped for analysis • skills to enable them to teach practice team members how to find and select the appropriate Read code using the Read code browser available to them 30 PRIMIS
Clinical Coding PRIMIS Facilitator Handbook Further Reading PRIMIS Guidelines www.primis.nhs.uk/pages/download_template.asp?r=Guidelines_Sept01.pdf NHS Connecting for Health www.connectingforhealth.nhs.uk Training Plan - Links to other PRIMIS training Facilitators attending the Clinical Coding training module would also find the following training modules of interest: • The MIQUEST Process • Data Analysis, Interpretation and Feedback • CHART • Data Quality and Patient Safety • Primary Care Data Uses and Abuses PRIMIS 31
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Page 3: Contents Introduction 1 The PRIMIS
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Facilitator Handbook 2005 - PRIMIS

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