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Practices could receive incorrect QOF payments following IT update

Exclusive GP practices using EMIS Web may receive incorrect QOF payments at the end of the year, as a result of NHS Digital's push to replace Read codes.

Experts have warned that patients are being erroneously added to disease registers and, as a result, practices are facing greater workload to determine which patients genuinely need treatment. 

They added that, unless the problem is ironed out by the end of the year, practices' payments may be affected.

The errors included patients with ‘post concussive disorder’ being placed on the QOF dementia register, while patients coded as being ‘tired all the time’ were automatically added to the depression register.

NHS Digital said it is aware of the issue and is carrying out a review to determine whether changes are required.

The problems have arisen after NHS Digital updated the QOF business rules to align with the new 'SNOMED' CT clinical vocabulary earlier this year.

But the translation method used by EMIS, implemented earlier this month, has led to the errors, according to QOF expert Dr Gavin Jamie.

Dr Jamie said: 'If you go into Google translate and translate things into another language and back, it doesn’t quite come out the same, and we’re getting the same sort of effect here.'

According to Dr Jamie, GP practices using SystmOne have not been affected by the issue.

Dr Jamie, who is also a GP in Swindon, warned that unless the problem is ironed out before the end of the year, practices stand to receive incorrect payments for QOF.

He said: 'We've got a 25-year-old on the dementia register who doesn't have dementia but technically the rules are now saying we have to do a dementia review on this guy, which we won’t do because it’s silly. That can affect payment at the end of the year, if these things are still going on.'

He also warned that the problem was causing added workload for GPs, who had to review which patients were genuinely in need of certain reviews and treatments.

Dr Jamie told Pulse: 'It's all about identifying which patients need a review or need a blood test or a flu jab, disrupting that certainly generates more work.'

SNOMED is a 'structured clinical vocabulary', which allows GPs add a code to patients' electronic health record that corresponds with diagnoses, procedures, symptoms, family history, allergies, assessment tools, observations and healthcare devices. 

NHS Digital is aiming for all GP practices to transition to using SNOMED by the end of this calendar year.

It has said the reason for this is because parts of the Read code vocabulary database 'are full and new codes have been allocated to unrelated areas', making it difficult to analyse how the codes are used. 

Also, SNOMED is already used widely in hospitals and NHS Digital has said it is looking to create a 'single clinical terminology, for clinical data to be exchanged accurately and consistently across all care settings'.

To date, 20 practices have been piloting the clinical coding system since April this year.

NHS Digital's head of primary care information Dave Roberts said: 'We are aware of a query around the business rules for post-concussion syndrome and our clinical advisors are currently carrying out a review to determine whether changes are required, as is our approach to any potential issue with business rules.'

NHS Digital added that further changes to the QOF specifications are planned following the October SNOMED CT code release and testing will begin in December 2018, with any changes to specifications identified prior to this testing to be included in the updated QOF specification.

EMIS declined to comment.

Readers' comments (5)

  • I’d be happy to have a qof payment for reviewing all the tired all the time coded patients , we must see these for review at least as often as our depression patients, even those who don’t have unacknowledged depression as well.if we get paid for doing enough coded ‘interim reviews ‘of those I’m not giving the money back!

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  • Jones the Tie

    mmm 'Dave Roberts '..and our clinical advisors are currently carrying out a review to determine whether changes are required'.. here we go Dave this will save you some time ' yes changes are required as this is clearly a cock up as is the tired-all the time code being classed as depression' job done . cash saved ..ooh no hang on that would mean a pile of gravy-train folk won't get a cushy day eating buns and drinking tea whilst discussing this 'contentious clinical issue' rather than seeing patients etc

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  • Wholesale change of codes, halfway through year, patients vanishing off registers, or spuriously added. All adds up to a QOF clawback across all practices. Seen it before in a different guise: inflating average list size to dilute everyone’s relative list size. Winter is coming...

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  • We have no choice to accept that IT is the present, future and here to stay until Armageddon. I would be interested to know of the incidence of errors before everything related to IT controlled our lives! Someone somewhere may like to do some research on this since the DOH thinks we have so much time on our hands and are down at the golf course all the time too!

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  • If the problems started with a change in the Business Rules (Change? In September?That's *half way through the year*!!), why does it only apply to EMIS practices & not S1 practices? (What about Vision?)

    Has anyone checked whether this is a mapping problem? In the 4 to 5 byte conversion in 1994, my favourite mis-map was "Whole blood transfusion" converted to "lateral rhinostomy"..

    In the "Tired all the time" patients being listed as "depression", is this a Business Rule/extraction problem (easily correctable) or a Code Conversion problem (TATT actually mapped to "Depression")? If the later, this - in addition to corrupting the EPR - could have serious, long-term repercussions for the patients including job applications and insurance.

    I really hope the problem lies with the authors of the Business Rules!

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