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Coded fairy tales at Medical Informatics Europe conference

16 May

Sleeping Beauty_cropped

Niels Peek and Richard Williams from the NIHR Greater Manchester PSTRC’s Safety Informatics theme recently attended Medical Informatics Europe (MIE) in Gothenburg, Sweden. MIE is the leading European health informatics conference and saw delegates attending from all corners of the world. While there, Richard beat off stiff competition to win the prestigious Science Slam – a competition held at MIE where contestants have up to 8 minutes to present their work in a humorous and entertaining way.

Richard talked about clinical codes, which clinicians use as a short cut to describe medical concepts e.g. hypertension is represented by the code G2 and Type 2 diabetes by the code C10F. Richard highlighted the absurdity of some clinical codes such as “U102700 – Fall involving ice-skates, skis, roller-skates or skateboards, occurrence on farm”, the dreaded “TE63100 – Moray eel bite”, and that there are no fewer than 11 codes for falling off a cliff including “U10F200 – Fall from cliff, occurrence at school”.

Richard then translated fairy tales into clinical codes – care to guess the following?

1. Female baby (634..12), black magic (13y8.00), wiccan (13yD.00), puberty (ZV21100), accident caused by spinning machine (TG3y500), excessive sleep (1BX1.00), contact with plant thorns and spines and sharp leaves occurrence at other specified place (U12Ay00), concussion with more than 24 hours loss of consciousness and (S603.00)… manual resuscitation (8731.00) …return to pre-existing conscious level (S603.00 cont.), married (1332.00).

2. Newly wed (1332.12), infertility problem (1AZ2.11), specific food craving (E275800), unborn child subject to child protection plan (13Iv000), female baby (634..12), imprisonment (ZV62511), abnormalities of the hair (M242.00), fall from turret (TC25.00), accident caused by plant thorn (TG4y600), foreign body entering into or through eye or natural orifice occurrence at other specified place (U11Qy00), acquired blindness both eyes (F490900), length of time homeless (13D8.00), tearing eyes (1B87.14), patient cured (2129.00).

3. Female baby (634..12), pale colour (1674.00), mother dead (12K3.00), father remarried (13HJ.00), has stepmother (133D100), hunter’s syndrome (C375.12), ran away (13HW.00), mining engineers (058..12), dwarfism (C1z4.00), found dead (R213100), manual resuscitation (8731.00), found dead (R213100), manual resuscitation (8731.00), found dead (R213100), suspected food poisoning (1J8..00), manual resuscitation (8731.00), married (1332.00).

Answers on a postcard.

On a more serious note, the talk also highlighted that the current coding system used in UK general practice (Read Codes) is in the process of changing to SNOMED (an internationally recognised coding system). This is a major project with potential implications for the continuity of patient care if managed poorly, but also with large implications for researchers in the UK who have much experience of working with databases of Read Codes but little experience of working with SNOMED.

What does the future hold? “God only knows (R2yz.11)”.

ISQua 34th annual conference

1 Feb

ISQua 1_CROPPED_Becci Morris

In October 2017, Sudeh Cheraghi-Sohi chaired a workshop at The International Society for Quality in Health Care (ISQua) 34th annual conference. The workshop was entitled “Developing and improving a systems approach to diagnostic safety in primary care” and was developed with collaborators Hardeep Singh from the Veterans Affairs organisation based in Houston, Texas and Ian Litchfield from the Institute of Applied Health Research, Birmingham University.

The workshop covered three major areas in diagnostic error and safety.  Firstly, Sudeh introduced the concept and various definitions of diagnostic error, along with the various causes of such errors and how to measure them. This was followed by Ian Litchfield presenting some work on a specific cause of diagnostic errors: poor or non-existent test results follow-up. Ian Litchfield described where these issues commonly occur e.g. clinicians being unaware that ordered tests had not come back from the lab. Finally, Hardeep Singh summarised the future research agenda in this area and highlighted how Information Technology will play an increasing role in diagnostic safety.

Many in the audience expressed surprise as to how little focus there had been on this area given its importance and expressed support of our current work and the future research agenda. Diagnostic error is still a niche area, but is gaining prominence due to America’s Institute of Medicine’s 2015 Improving Diagnosis report and The World Health Organization’s Technical Series on Safer Primary Care, which both prioritised errors in diagnosis as a global priority for patient safety.

Diagnostic Error in Medicine: key topics

2 Nov

by Sudeh Cheraghi-Sohi, Research Fellow in Safety in Marginalised Groups: Patients and Carers theme

DEM 10th conference_cropped

I recently attended the 10th International Conference on Diagnostic Error in Medicine (DEM) held in Boston and organised by the Society to Improve Diagnosis in Medicine (SIDM).  I was invited to attend the research summit as well as to display some of my work from the 2012-2017 NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre (PSTRC).

The research summit was an excellent forum for discussing the key areas of interest in the field of DEM research.   This year’s topics of interest were around uncertainty and the role of the team and teamwork. For the first topic, I was really interested to participate in discussions as I have already done some work in the area of uncertainty in terms of a review[1] around the various aspects of uncertainty and the PSTRC has also developed a training package[2] to help peoples’ awareness of the issues and in managing their uncertainty.  The discussions were very lively and a keynote speech at the conference given by Dr Arabella Simpkin also resonated with the conference delegates.

The second topic is an area that the Institute of Medicine, in their 2015 report on Improving Diagnosis, placed a focus on. The role of team in making a diagnosis may not be obvious to many people, particularly in the context of UK general practice where patients probably think about the one-to-one consultation with their general practitioner, but even in general practice, there are often multiple people involved in making a diagnosis. For example, the phlebotomist and the practice nurse/nurse practitioner may have already seen a patient prior to the GP consultation and performed certain tasks and provided prior information for the GP to work with. Also, when GPs make referrals, they are seeking the expertise of others and then utilising all the gathered information to inform their diagnostic thinking and hopefully coming up with an accurate diagnosis. This is certainly an area that I would like to explore more.

Finally, the main conference itself was fascinating. There was a superb talk given by Don Berwick, one the world’s leading patient safety experts, as well as many interesting workshops to attend. I am also happy to say people were very interested in the Greater Manchester PSTRC’s work around Missed Diagnostic Opportunities[3] and I will write another blog when we are able to share more of our findings from this project.