Coding and Data Quality in Primary Care

1. Coding and Data Quality in Primary Care

2. Value of primary care databases • Current State of Primary Care Coding and data quality in Lothian/Scotland • Barriers to coding • Improving Coding

3. The Importance of Primary Care Databases • Only 5% of clinical research happens in Primary care • 90% of all clinical interactions happen there • Dearth of knowledge on so-called minor conditions and GP based major conditions

4. Uses of Primary Care Databases • Prevalence and incidence of conditions nationally and locally. • Information on how conditions are managed • Applied to both high and low profile conditions. • Look for associations between illnesses, lifestyles and the impacts of treatment.

5. Examples of Research Using Databases • Effect of combinations of drugs on all cause mortality in patients with ischaemic heart disease • Associations between, inhaled steroid and low impact fractures • Impact of BP control on stroke • Association between antidepressants and IHD

6. Recruitment and Data Entry • Identifying patients • Ease of contacting • Future • Remote collection of GP entered data • Minimises disturbance to practices • Enhances practices’ own record keeping

7. Primary Care Use of Computers • 99% of practices are computerised • Three main computer systems + GPASS • Vary in how they are used • Repeat prescribing • Acute prescribing • Call and recall • Recording of ‘contract’ conditions • Recording of ‘significant’ conditions • Recording of blood pressure some test results • Paper-light

8. Computerisation of Lothian Practices

9. Pre and Post nGMS

10. Other Major Pathologies

11. Other Information

12. New GMS Data

13. New GMS Data 2

14. New GMS Data 3

15. Why not code for everything? • Some computer systems make coding difficult • They allow free-text entry discouraging coding • Large array of available codes • Some variation in dialects • There is no tradition of coding • Can see no point to it

16. Hope for the Future • New GMS contract • Beacon Practices CMR/PTI • Financial assistance LHCCs • Agreement on codes • Improved software • Easy data entry • Common coding formulary • Downloads from labs OPDs discharges • NPfIT

17. Willingness to share data

18. Challenges • Change the culture of coding • Improve computer software. Greater integration between providers (NPfIT) • Links to hospital data • Move to patient level nGMS data • Reassure colleagues • Resources to pay for coding data quality checks • Data protection act/patient agreement