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Choose and Book 4.2 with SNOMED ready

Tags: Choose and Book Community GP Information iS PCT SNOMED US

17 Jun 2009

Choose and Book is launching a major upgrade to its service at the end of this month.

Release 4.2 will go live on Monday 29 June and will enable GPs to find and refer patients using SNOMED terms.

The e-booking system is used for between 53% and 55% of referrals for first outpatient appointments every week, and the introduction of SNOMED terms is designed to make it easier and quicker for GPs.

Dr Stephen Miller, medical director for Choose and Book, said the software upgrade had been more than 18 months in the making.

He added: “GPs told us that they wanted to search using clinical terms, similar to those already in use in many other clinical systems, because they thought it would help patients get referred more quickly and more effectively to the right place for treatment.”

Currently GPs are able to search using ‘speciality and clinic type’, ‘named clinician’ and by key word. Release 4.2 will still enable referrers to use the specialty, clinic type and named clinician functionality, but the key word searches will be replaced by SNOMED terms.

Dr Miller told EHI Primary Care: “It will save you time if you don’t know where a service is located.

"The key word search is purely text–based, so you are relying on providers having used the exact same key words.

"If you make a spelling mistake or use a synonym you might not be able to find the service you want, whereas the SNOMED browser will make suggestions if there is a spelling mistake or come up with a synonym.”

The SNOMED browser will also enable GPs to search for services by symptom and is designed to create a level playing field under 'free choice', as all providers will be using the same terms.

Dr Miller said there are 32,000 services on Choose and Book of which more than 80% have so far been loaded with SNOMED terms. He said many of the remaining services were not necessarily relevant to GPs or could easily be found by referrers using the speciality and clinic type search functions.

Dr Miller added: “The providers have done an amazing job and many of them have said to us that they now feel their Directory of Services is much more accurate and reliable and helpful to referrers as a result.”

The launch of release 4.2 has been supported by an extensive training programme. Dr Miller said that at the beginning of the year, the Choose and Book team ran online training sessions for “hundreds of people” across acute and foundation trusts, private providers and PCTs to train staff responsible for defining services in the use of the SNOMEFD functionality.

A 'train the trainers’ programme was then launched in PCTs to get staff ready to go out and train practices to use the new system, with virtually every PCT having at least one staff member trained.

However, Dr Miller said he had no information of whether the training had reached the GP practices it was designed to reach.

He told EHI Primary Care: “My greatest fear at the moment is that we don’t know how much of that training has got to the end user and that when GPs switch the system on June 29th they will wonder what has happened to Choose and Book."

NHS Connecting for Health has devised a short PowerPoint presentation to enable GPs who have not had training or want to refresh themselves on how the new system will work.

Use of Choose and Book has risen from 23,000 bookings each week day in May last year to around 30,000 bookings each week day in May 2009.

CfH said the system has also seen a 36% rise over the last 12 months in referrals to allied health professionals, diagnostics, assessment services and community based services. 100,000 referrals a month are currently made using the system.

Dr Miller said he hoped the introduction of SNOMED coding would encourage more GPs to initiate referrals on Choose and Book rather than delegating the task to administrative staff.

There is no data on where referrals are initiated, although figures show 10% of bookings are completed by GPs in the consulting room and a further 25% by administrative staff in practices.

He added: “I am hoping this will give the system another boost and those who haven’t used it before will give it a try. It takes only half a dozen clicks to shortlist services in the consulting room so patients can then ring the appointments line or book online. It takes me a minute or two at the most.”

Dr Miller said the current contract for Choose and Book runs until the end of 2011 and the team was currently working on a business case for re-procurement.

In the meantime, the team hopes for two further ‘5 series’ releases before the end of 2011. It has yet to be decided what would be included in each of those releases.

Link:

Choose and Book 4.2 training presentation

Fiona Barr

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Readers Comments

Welcome SNOMED

cunpr@globalnet.co.uk

17 Jun 09 14:59

Welcome to the NHS SNOMED. Although GP systems have been playing with SNOMED this large scale implementation of SNOMED is to be welcomed. It will cause troubles and disruption no doubt but these are hurdles that need to be dealt with. Other articles talk of the missing jigsaw peices the grand plan has, SNOMED is one and should have been prioritised long ago.

Who writes this stuff?

17 Jun 09 20:00

The PowerPoint demo is good for a laugh.

At first sight, it looks like the patient with a glue ear from Selby is offered an audiogram at a haematuria clinic in Lincoln!

Piloting

18 Jun 09 07:58

SNOMED CT is a bit of an unknown quantity in the NHS.

Do we know whether this has this been piloted anywhere?

Another Sacred Cow

18 Jun 09 09:59

Actually SNOMED has been prioritised since the mid 1990s. It has had tens of millions of pounds and clinician hours spent on it.

Originally billed as the Language of Health, it seems to have degenerated into a basic labelling system which no-one really wants but which is politically impossible to ditch. Suppliers pay lip service to it because it ticks a box.

Most clinicians using it are in fact using the early Read codes (prior to 3.1) which were developed by a handful of people for thrupence.

If it was any good then wouldn't people have been using it properly by now? And I don’t suppose the Americans would have sold it to the Danes for a paltry £3.6m 2 years ago, a tiny fraction of its development cost. Another sacred cow I am afraid.

Small step forwards

18 Jun 09 10:37

This is to my knowledge the widest and highest clinician visible deployment of SNOMED in the NHS to date.

To date the use of SNOMED within NPfIT have included mostly low profile or limited deployments e.g.

1. the Drugs and medicines dictionary (an optionally 'standalone' SNOMED extension) - used in ETP mainly for now

2. some SNOMED codes embedded invisibly in spine messages

3. some very tentative theatre system pilots in London

4. some visibility in Lorenzo pilots

This Choose and book SNOMED application appears fairly 'soft' (using SNOMED merely as a controlled vocabulary) in a greenfield site: Choose and book is a standalone application not deeply integrated with GP Systems which are effectively all still using Read codes.

We are still are far cry from the OBS edict

>>790.12 SNOMED CT
All new systems shall support the SNOMED CT standard. All existing systems should support
SNOMED CT.<< Integrated Care Records Service, PART III, Output Based Specification

That being said the slow roll out of SNOMED can be regarded as CfH's 'fault' only in as far as they insist upon it being used. SNOMED deployments are still rare anywhere in the World.

Indeed difficulties around implementing SNOMED may in part account for the slow progress of NPfIT! Sacred cows are not noted for their fleetness of foot ;-)

Re: Small step forwards

18 Jun 09 11:07

Can I venture to suggest that SNOMED deployments are rare worldwide because - despite SNOMED CT being in development for over 10 years - most of the world is still trying to work out what it's for? In particular, how it adds value over-and-above the simpler, cheaper and familiar schemes (e.g. early Read versions) that have stood the test of time in day-to-day clinical use for many years?

This added value issue becomes even more important as the "grand designs" of CfH are progressively eroded. My guess is that the C&B functionality reported here could just as easily have been provided by the GP 4 byte set of Read Codes from the 1980s.

Training

18 Jun 09 16:06

I am a GP and, far from receiving training, this is the first I have heard of the update.

Next week my practice manager will attend a meeting which includes Choose and Book on the agenda. I suspect that this is the 'training' that the PCT will be offering. Bad luck if you are the GP or admin staff who have to use the system and load it for the first time with a patient in front of you. We will face very different screens (and our first experience of SNOMED) with no training at all.

This is all very sad because the changes seem genuine improvements. Searching by clinical terms will reduce the number of patients inadvertently being sent to the wrong clinics as well as speeding the referral and booking process.

SNOMED still far too small to be useful

18 Jun 09 22:47

Snomed code of the day = 283766000 "Dog bite of groin"

But no classification for eg. cancelled operations.

Kind of says it all. The language of medicine but as spoken by a very talkative three year old.

And yes I know that "cancelled" is a Snomed qualifier, and there is a breakdown into 3 types w.r.t. appointment etc. But SNOMED needs to grow about 10 fold before it can usefully describe real-life medicine.

Read cost thruppence - pull the other one

18 Jun 09 23:50

Ah the onset of old age, or is it selective amnesia.

I'm sure there was a fuss about Sir James Read taking more than thruppence out of the kitty for developing the Read codes.

Most hospitals of course are still using ICD10, OPCS 4.3 and HRGs because that is how they get measured and paid.

One of the arguments for encoding is the ability to search and categorise. It is funny, but there's this thing called the Internet, better not tell CfH about it, but you can actually do some quite useful text searches on it.

If only they'd developed and adopted international XML standards for records instead of pouring money into proprietary, private and in some cases rather antiquated technologies.

There is some activity in that area, but CfH support has been far less mainstream than the SnomedCT work.

Re: Far too small

19 Jun 09 09:46

IMHO, SNOMED CT will always be far too small to describe real life clinical practice.

For that, you need the full richness of the English (or another) language + the techno-speak that goes with the clinical domain.

So whatever else SNOMED may or may not be for, detailed description of clinical care is probably off the list of functions.

Success

sue.l.sutherland@btinternet.com

20 Jun 09 12:09

I hope this is a success and that the SNOMED codes are used by GPs.

This whole project has resulted in an enormous amount of extra work for care providers. Each service they provide has had to be reviewed by a consultant to decide which SNOMED codes are appropriate. Once these have been reviewed each of them has to be individually checked on the Choose and Book system to ensure that a patient is not referred inappropriately.

There is no facility to copy terms, so even if 5 consultants decide they all want the same codes, the poor person setting them up has to wade through pages of codes for each service to include the correct ones. In my trust several services have over 100 pages of SMOMED codes to be checked. The whole system is badly conceived.

Trusts were not given the option as to whether to use the codes. It has been forced upon them. Statistics of percentage of services completed have been produced regularly to 'shame' some trusts into completing work. This may have just resulted in the work being completed quickly but shoddily.

Training 2

25 Jun 09 11:23

It appears that the extensive training provided to my PCT consisted of being given the same short powerpoint presentation that is suggested to be a way for GPs to refresh their knowledge post-training.

This has now been sent on to practices and forms the entire training process. There is no opportunity for hands-on experience before we start using the live system nest week.

Thank goodness the NHS does not run an airline. Otherwise pilots would be sent up in a new plane with the advice to 'get to know it as you go along'