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Switching IT systems – codes a-go-go

Last week was data validation week – and what a long week it was. Regular readers will know my practice is changing from EMIS LV to SystemOne and as part of the change over process all the patient data from a recent backup is transferred over to SystemOne so the validity of the data transfer process can be checked.

This isn’t the first time we’ve changed computer systems.  Back in the 1980s we were one of the first practices to take up a system from VAMP, and though record keeping was very limited, it transformed how we worked and made repeat prescribing much easier.  Prior to this we employed a clerk to handwrite prescriptions…

VAMP used the Oxmis coding system and when we moved over to EMIS LV there were many old OXMIS codes that were transferred over as they did not match with a READ code.  The plan was to remove these old codes and replace them opportunistically , if clinically relevant, soon after changing systems.

I’m sure my partners and I started doing this with good intention in 1997 when we changed over but as time went by, and the old OXMIS codes drifted to the bottom of both Significant Active and Significant Past problems they gradually got ignored.

Now in 2013 they have reared their heads again as the data transfer and validation process has flagged them up – all 4,000 of them.

Not all of them are OXMIS codes, there are also local surgery codes that were created in the past for administrative purposes.  These ‘local codes’ are not just from my surgery either.  When patients have transferred in from other EMIS LV practices and their records have been transmitted via GP2GP, we’ve inherited these other practices’ ‘local codes’ as well. The question is does it matter that these old OXMIS and local codes are unmatched in SystemOne? 

In fact, we discovered it does, for some of the time. The old unmatched codes aren’t lost forever: they actually become plain text entries in the clinical record, or ‘Patient Journal’ as SystemOne calls it.  So their presence is recorded but as they are plain text they cannot be searched on.

After going through the 4,000 unmatched codes it soon became obvious that it didn’t really matter that in 1990 a flu vaccination letter was sent (a local code). But it was important that in 1996 a patient had a bowel resection for cancer (note, this was still recorded as an old OXMIS code).  

The clinical entry was there on the Active Problem list for all to see on our current system, but once transferred to SystemOne it would be buried in the Patient Journal unless an appropriate SystemOne READ code replaced it. We decided to be pragmatic about this and ignore the unmatched administrative codes, or find a SystemOne READ code for relevant clinical entries.

Hence it was a busy week, as we felt this code-matching (and decision to ignore or match codes) could not be delegated to a non-clinician. So yours truly had to knuckle down and do it.

Truth be told, it was all going quite well – until a key member of staff found even more data that hadn’t been transferred across.  But that’s another story for another week…

Dr Hadrian Moss is a GP in Kettering, Northamptonshire. You can tweet him at @DrHMoss.