Record data more consistently
	Retrieve data with greater ease
	Analyse/audit data more thoroughly, aiding health needs assessment
	Communicate data to hospitals and other agencies by the use of a common clinical language.

Creating a Practice Formulary of Read Codes

If you wish to standardise the way you collect data in a coded manner, then you may wish to consider creating a practice formulary of Read Codes.

Emis allows you to do this quite neatly.

You can decide exactly which codes to include, and the level of detail required.

In effect, you are creating your own coding tree or hierarchy, which will allow you to fast track to those codes which your practice have decided are a priority.

You can follow the exercise below, to try this out, and I will give instructions at the end to remove it if you wish.

How do I get these codes into the patient’s record?

This is easy - once your coding selection are entered into the system you give them a name ( I will call it "Read Administration").

From the access screen, (the main screen you get to when you press:

A Add any data from Medical Record

P Problem title from Consultation Mode

A Additional from Consultation Mode)

you then choose "Read Administration", just as you might pick T for Templates, or L for Patients Problem list.

This will bring you into your own coding tree, from where you just "follow your nose" to an appropriate code! Once found, then highlight it, and pressing return will enter the code at the appropriate place in the patients medical record.

What exactly is the "access screen"?

The access screen is, if you like, a basic grouping mechanism for quick access to certain sets of codes. Go to it from one of the options above, and you will see that there is a path to templates, allergies, referrals, full classification of the Read Codes etc.

Each entry on the access screen is a pointer for a group of entries that lie on another screen "behind" the one you first see. By selecting an entry on the access screen, you will get to see another page of options. Behind each of these options there can be another page of choices, and so on........ There can be as many levels of pages as you wish.

What we are going to do is make a space on this screen (called "Read Administration") for you to get quick access to your own coding tree. The "chapters" and "subchapters" of your coding tree will appear as pages that will open up depending on how many "levels of detail" you build into your tree.

How do I set up the formulary?

Preparation:

I suggest that you look at one clinical area, (I’m going to use cardiovascular), and decide how you would like to break this down, and the codes you wish to include.

The easiest way of doing this is to go to the access screen, pick "G Full Classification" then "A Illness and disease" then "Circulatory system diseases".

The next page breaks down the main areas of cardiovascular disease. I am interested in the main areas of Hypertensive disease, G2..., Ischaemic Heart Disease G3..., and Cerebrovascular disease G6... There are a few other miscellaneous diseases I want to include, so I'm going to group them under cardiovascular disease NOS, Gz... Have a browse through the Read codes and choose which codes are of interest to you.

Under hypertensive disease, I have decided the only codes I want to record routinely are Benign Essential Hypertension, G201. and Secondary Hypertension G24... I have decided that for my purposes, I am not interested in the other codes.

Under ischaemic heart disease, I have decided I want Acute Myocardial Infarction G30.. and Angina pectoris G33.. only.

Under cerebrovascular disease, I want Transient cerebral ischaemia, G65.. Stroke and cerebrovascular accident unspecified G66.. and subarachnoid haemorrhage G60.. only.

My choices of codes will then be as follows

Circulatory System Disease(G.....)	Hypertensive Disease(G2)	Benign Essential Hypertension(G201)
		Secondary Hypertension(G24)
		Acute MI (G30)
	Ischaemic Heart Disease(G3)
		Angina Pectoris (G33)
		TIA (G65)
	Cerebrovascular Disease(G6)
		Stroke and CVA unspecified (G66)
		Subarachnoid Haem. (G60)

Level One Codes

Level Two Codes

Level Three Codes

You can decide exactly which groups of codes, and which specific codes you wish to use. It may be a good idea to browse the Read code system and draw up a similar tree to work on, with as many hierarchical levels as you need, but making the bottom level "codes"

You could then go on and do a similar thing for respiratory, GI, URTIs, Items of service codes, or whatever you like!

The technical bit - getting it on the system!

This may seem a bit complicated at first, but if you follow the instructions, it should be clear what to do. Setting up your own coding tree is not difficult, but it is repetitive. If you do not wish to do this yourself but would like to see what this is like set up, speak to me, and I will see if I can help.

Firstly we are going to create an entry in the access screen:

Go to the main menu:

Type DT for Dictionaries and Templates

Type C for Codes Templates and Protocols

Type E for Edit Access Screen/Forms/Templates

We are now at the "Editing access classification" screen. (Top, highlit bar)

(For your information...

All the following screens work on the same principle. To make a new entry, you first have to press "1". This allows you to choose an empty line, or to overwrite an existing entry on a line. You are then able to choose the name of your new entry. Once made, you highlight this entry to start creating new groups which are subsets of it.)

So, lets make a new entry which will hold the coding tree. Entries have to be existing Read Codes.

Press 1

The system asks you to "select the line label to add to or edit"

Choose an empty line, by typing in the letter to the left of it.

At "select entry in the usual manner", type in "Read Code" and press return.

You should get a couple of entries called "Read Code Administration" or similar.

Highlight one of these, and press return. You may be shown a second page, choose any code that has Read Code administration in it. (This is just the title of your coding tree)

You are now presented with a group of options. Pick

"H if this is entry is simply a pointer to a lower hierarchical level in the access screen."

You will see that you are now back at the access screen, but your "Read Code Administration" entry is in place, at the point you chose.

So, we have the title, let’s start entering some broad categories of your chosen codes.

Select your new code, "Read Code administration" This takes you to a new, empty access screen.

Press 1 (as we are going to make another new entry)

Choose "A"

Pick your read code which is going to be the pointer to the next level. In this case, it is Circulatory system diseases G..., so, either follow down the full classification until you get to this code, or type in "circ syst dis" and pick the option with the code G.... This brings up all the subsets of circulatory system diseases - all. I want the top level code itself, G.... Select this, and press return.

Press H at the next screen, as this is "simply a pointer to a lower hierarchical level".

Your new code is in place at A. We can now go in and repeat this procedure again, to get our next level of choices.

Choose A ( your new code)

We get another blank screen.

Press 1

Choose A

Type in G2 ( the code for hypertension)

Select Hypertensive disease - all G2

H this is a hierarchical pointer

Your new entry appears on the screen. The next level is going to contain the actual codes.

Choose A

Press 1

Choose A

Type G20 ( the code for essential hypertension)

Choose Benign Essential hypertension G201.

Choose C this is a CODE!

You will be back at the access screen, your new code in position at A.

Press 1

Choose B

Type G24 (the code for secondary hypertension)

Choose secondary hypertension - all G24 (I don’t want a specific code in this group- it will actually give you the choices you see under G24 in the patient's record)

Choose C

This section is finished now. Press escape, to go back a page, to get to hypertensive disease.

We are going to enter our next category, IHD at this level.

Press 1

Choose B

Type G3 ( ischaemic heart disease) and return

Choose G3 ischaemic heart disease all

Type H

Now back at the access screen again, choose B, to start to build up the codes in this section.

Press 1

Choose A

type G33

You can either choose Angina pectoris-all G33, (in which case you will be presented with the choices you see now when you are using your tree in the patients record), or G33z angina pectoris NOS, which is the bottom level code.

What ever you decide, choose C, this is a code.

I am going to leave it here, as I hope you now have the general idea about the setup of the coding system.

In summary, you can make as many levels of detail as you like, by pressing 1 you make new entries, by selecting your entries, you descend another level. Whatever you make as the bottom level access screen entry, should be a code, as this is what will be presented to you for recording in the patient's medical record. If you pick an ".....- all" code, then you will have a choice of the "child" codes of the "all" code. If you pick a "bottom level" code, then this is the code that will be inserted into the patient's record.

Using the tree from the patients record

Go into the patients record, MR, and choose A Add any data. (Alternatively go to consultation mode, and use problem title, or additional)

Press return for today

You will see your tree, "Read code administration" at the access screen.

Select it.

You only have one option so far, circulatory system diseases. (However, by building up the formulary, you could have a whole range of options, e.g. respiratory, GI, URTI, musculoskeletal .............)

Select it.

You have two options, hypertensive disease, and ischaemic heart disease.

Select hypertensive disease

You have only two options, benign essential, and secondary hypertension.

Select benign essential, and press return

You will need to press return a couple of times and choose whether active or inactive to get back to the MR, where you will see benign essential hypertension has been recorded, (or you will see that benign essential hypertension has been recorded in the record in CM.)

Removing this coding tree

DT

C

E

Press 1

Choose the line on which you have entered "Read code administration"

It will ask you if you wish to overwrite, say yes. The tree will be removed.

Pressing F1 exit a couple of times will return you to the main menu.

To transfer clinical data from one code to another

EXAMPLE:

The code DIABETES MONITORING ADMIN has been entered in patients’ records in error, the correct Read code should be DIABETES MELLITUS SCREENING.

1. set up a search for all patients with the Read code 9OL DIABETES MONITORING ADMINISTRATION.

2. at the main menu select BD Batch processing® Y to continue® C Batch data alteration® select Generated as result of search, select the relevant search name® select A Clinical record® at the prompt ‘Identify the entry you are going to alter’, enter the code 9OL ® at the prompt ‘Please replace the code to replace the above’ enter the new code 6872 ® type in Y to accept the alteration then Y again if absolutely sure.

3. all patients who had an entry of Diabetes Monitoring Admin., Read code 9OL in the medical record will now display as Read code 6872 Diabetes Mellitus screening