FREQUENTLY ASKED QUESTIONS: SNOMED CT IMPLEMENTATION IN PRIMARY CARE

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The database provides responses to queries that have been received via our helpdesk.

You can  'Search' for particular words in the various areas of the responses if you have something specific in mind.

If you cant find the answer to your query please contact our helpdesk by emailing snomedprimarycare@nhs.net

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Key TermUIDDate added to databaseUpdatedQuery typeQuery detailsResolution
Drug Codes 126.01 27 Oct 2017 27 Oct 2017 Drugs
Can we take the same approach with drug codes as with the clinical codes?

The Data Quality guidance doesn't go into drug codes, are there any Data Quality errors that are specific to the drug codes?
Drug codes cannot be treated in the same way as clinical codes and the Data Quality guidance does not cover drugs for the following reasons.

All GP clinical systems will have been using NHS dictionary of medicines and devices (dm+d) for a number of years as required by the electronic prescription service (see fact sheet) . dm+d is the NHS terminology of choice for medicines and it uses SNOMED CT codes (more information can be found here). The last release of the Read Codes Drug and Appliance Dictionary (Read v2 Drugs) was on the 1st April 2016.

The Terminology and Classifications Development Service does not provide a map between Read based and SNOMED CT based drug terminologies. This means there is no map between Read drug codes and SNOMED CT codes in dm+d or the SNOMED CT UK Drug Extension. It is not possible to produce a map between Read and dm+d (or SNOMED CT) that will satisfy all possible use cases. The authoring styles and policies for Read and dm+d are divergent and make clinically safe mapping often impossible for drugs where a one to one map is required. There are also a significant number of Read codes that dm+d does not include (mainly they were removed from the market prior to the start of dm+d) and therefore cannot be mapped. This means a complete map from every Read code to dm+d is not possible.
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Editing and creating templates and searches 129.0 22 Jan 2018 Templates and Searches
Will practices still be able to edit/create Templates/Searches in Read2/CTV3 post SNOMED CT implementation?
No, when a template/search is opened to edit or a new one is created, this will need to be done in SNOMED CT. Best practice is to review and refresh (where needed) all templates and searches on a 2 year rolling timeframe (shorter for more critical artefacts) to ensure they are still fit for purpose.
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MIQUEST 117.02 06 Mar 2017 21 Jul 2017 MIQUEST
What’s happening with MIQUEST?
UPDATED
Miquest will not be supported after December 2018 as the GPSoC contract comes to a close.

There is no plan to replace MiQuest. Local searches that need to be ran in SNOMED CT will need to be created using clinical system reporting tools or other data extraction tools procured from the market place.
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Pathology messages 131.0 22 Jan 2018 Pathology
Can Pathology messages be received once SNOMED CT is implemented?
The way suppliers request pathology tests is not changing, and nor is the receipt of resultant EDI messages. The primary codes in these messages are Read and they will continue to receive Read codes. They will map them to SNOMED CT so that searches will be able to pick up the codes in Read and SNOMED CT.

Future development of Pathology messaging will be communicated by NHS Digital (not this project) at a later date.
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QOF 120.01 06 Mar 2017 19 Jan 2018 QOF
How will QOF be impacted?
QOF queries will be provided in SNOMED CT only for the year 2018/19
During 2017/18 QOF will run in Read but will be available to suppliers in SNOMED CT to enable testing
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QOF targets 130.0 22 Jan 2018 QOF
Will QOF targets be impacted by SNOMED codes becoming inactivated?
Inactive SNOMED codes will not be included in the 2018/19 QOF business rules.
Should any code become inactive within the year, NHS England, NHS Digital and the respective clinical teams will ensure that clinical care and payments to practices are not impacted.
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Requesting new SNOMED CT codes 127.01 27 Oct 2017 27 Oct 2017 SNOMED CT
How do I request a new SNOMED CT code?
Requests for new SNOMED CT codes are made in the same way that requests for Read2 and CTV3 codes were made through the Request Submission Portal https://isd.hscic.gov.uk/rsp-snomed/user/guest/home.jsf
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Running current templates and searches 128.0 22 Jan 2018 Templates and Searches
Will practices still be able to run current templates/searches post SNOMED CT implementation?
Yes, current templates/searches will continue to function after the system has transitioned to SNOMED CT for a period of time. The system will record data in both Read and SNOMED CT (‘dual coding’) using national mapping tables.
Where new SNOMED CT coded data has a Read code equivalent, the search will select such records. Where new SNOMED CT coded entries do not have a Read code equivalent, these will not be included in an existing Read defined search, therefore there is a risk that these will not then select all patients.
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SNOMED CT - NHS Digital Support 125.02 31 Jul 2017 27 Oct 2017 SNOMED CT
How will NHS Digital Support the move to SNOMED CT?
UPDATED 125.02
NHS Digital is facilitating and coordinating the managed migration to SNOMED CT in Primary Care.

NHS Digital is working with all of the GP Principal Clinical System (PCS) suppliers EMIS, TPP, Vision (formally known as INPS) and Microtest, to deliver training and support to users, and are also working with and supporting the suppliers with the migration of their solutions, the aim is to do this with minimal disruption to day-to-day work, and without affecting critical system components, such as long-term condition care, QOF, reporting, and the scheduling of regular care.

NHS Digital is providing knowledge and advice for CCGs, Primary care data users and the NHS digital National Programmes (e.g. GPES, GP2GP etc.).

NHS Digital are also providing general awareness training on SNOMED CT and providing guidance and updates to ensure the primary care estate is aware of the introduction of SNOMED CT and the impacts it will have on them.

NHS Digital has been working with the UK Terminology Centre (UKTC) to provide high quality mapping tables that will safeguard the period of dual coding. These mapping tables are being assured by a group of leading clinicians.
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SNOMED CT code releases 101 06 Mar 2017 SNOMED CT
Will SNOMED Codes be updated twice a year (in October and April) like Read codes?
Yes, new releases are provided for 1st April and 1st October each year. Suppliers implement these into their systems as soon as possible.
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SNOMED CT codes 114 06 Mar 2017 General Practice
Are practices expected to carry out some kind of batch transfer to change current read codes to Snomed ones?
No, there will not be a requirement to undertake a batch transfer; in effect systems will create equivalent SNOMED CT codes for the existing Read codes in patient records.  The current Read codes in records will remain in the record. This is being undertaken by your principal supplier.
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SNOMED CT coding misuse and mapping 122 13 Jun 2017 13 Jun 2017 Subsets & Mapping
Codes in Read v2 are sometimes misused. for example 13JR 'Left military service', 13JR is Left military service, however 13JR-1 is Discharged from services, practices were recording 13JR-1 by mistake relating to community service. Does this persist in SNOMED?
Discharge from services does persist in SNOMED CT as a synonym of Left military service. The Delen lookup table allows you to see how things have been mapped from Read to SNOMED CT: https://hscic.kahootz.com/connect.ti/t_c_home/view?objectId=368196&exp=e1 SNOMED CT is undergoing a continual process of retiring legacy codes. We can request the description is retired with details as to why. The way to request that is via: https://isd.hscic.gov.uk/rsp/user/guest/home.jsf . Anyone can request a change as well as new content via this site. This would result in historical data still being recorded using this code, but it would be highlighted as inactive, people would see the text. It wouldn’t be available to be recorded in future entries as we have a requirement that inactive content isn’t available for data entry.
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SNOMED CT data quality 105.02 06 Mar 2017 16 Jan 2018 Data Quality
What data quality measures are in place to ensure that translation from READ codes to SNOMED CT will not produce artefactual coding errors?
The mapping tables have undergone scrutiny from an expert reference group of GPs nominated by the Joint GP IT Committee in addition to the use of semantic tools to further quality assure the existing maps from Read to SNOMED CT. The current maps have been in use for many years as part of GP2GP; the current work will also address many of the maps that result in text degrades in GP2GP. The maps will continue to be updated as SNOMED CT is updated and we would ask users to notify the terminology service of any issues they identify through the Terminology request portal.
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SNOMED CT dates 115.02 06 Mar 2017 16 Jan 2018 SNOMED CT
When is primary care to start using SNOMED CT?
SNOMED CT will go live in general practice care in a phased approach from April 2018. The deployment rollout will commence with pilot sites for the four principal clinical system suppliers, EMIS, TPP, Vision and Microtest. This will commence from April 2018 with a phased roll-out approach ensuring year-end processes can be completed prior to implementation.
Secondary Care, Acute Care, Mental Health, Community systems and other systems used in the direct management of care of an individual must use SNOMED CT before 1 April 2020, although a number already do use SNOMED CT.
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SNOMED CT dates 121 06 Mar 2017 SNOMED CT
The national target for secondary care is 2020 - should Trusts be actively engaging with suppliers on this now or is NHS Digital managing this?
There are a number of systems available to trusts for an Electronic Patient Record (EPR) that utilises SNOMED CT. As part of the requirement for Paperless 2020 trusts are expected to implement an EPR; they should ensure that when they contract for such a system that it uses SNOMED CT. There is currently not an equivalent programme for secondary care as the requirement for SNOMED CT has been in place for many years and should be part of their EPR implementation; all systems deployed under the national programme incorporated SNOMED CT. The programme in primary care is to manage the transition from the Read codes.
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SNOMED CT dual coding 104.03 06 Mar 2017 27 Oct 2017 Subsets & Mapping
How will Dual Coding Support the Change?
UPDATED
Dual coding is where historical and new clinical data are available in both Read (either Read v2 or CTV3 depending on the system) and SNOMED CT.

Dual coding will give practices, CCGs and other consumers of data more time to transition; existing searches, templates and business rules/protocols will continue to work while dual coding is available. This will give users more time to update these as needed.

While historical data will always remain available in both Read and SNOMED CT, practices will soon be required to enter or to accept terms that cannot be dual coded. Such terms may be new or more detailed terms only found in SNOMED CT. As more non-dual coded data is added to records, searches, templates and business rules/protocols that need to use these terms will need to have been fully converted to SNOMED CT.

The exact duration of dual coding will be agreed with key stakeholders and communicated widely once confirmed.
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SNOMED CT hisotrical data 107 06 Mar 2017 Subsets & Mapping
Will Historical Data be coded in Read and SNOMED CT?
Yes, all historical coded data in Read will have a SNOMED CT equivalent; this will enable time series analysis.
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SNOMED CT implementation dates 102.02 06 Mar 2017 16 Jan 2018 Implementation
When is SNOMED CT being implemented?
SNOMED CT will go live in general practice care in a phased approach from April 2018. The deployment rollout will commence with pilot sites for the four principal clinical system suppliers, EMIS, TPP, Vision and Microtest. This will commence from April 2018 with a phased roll-out approach ensuring year-end processes can be completed prior to implementation.
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SNOMED CT Implementation 123 13 Jun 2017 13 Jun 2017 SNOMED CT
How do I correctly identify the Fully Specified Name (FNS), Preferred term and synonyms for use within the UK? The description files seem to suggest some concepts have more than one FSN.
Although the description file includes the field typeId which identifies internationally the FSN and Synonyms, you also need to use the language files to identify the FSN, preferred term and synonyms within the UK. You will need to use both of the UK language files (clinical and pharmacy) even if you’re just using the clinical data. The link below takes you to a PDF document explaining a bit more about the language reference sets and also some sample MySQL code.

https://hscic.kahootz.com/gf2.ti/af/762498/118460/PDF/-/Technical_Report__UK_NHS_Realm_Description_Refsets.pdf there is also a pre-recorded presentation which explains which Release Format 2 files are needed for effective implementation. This can be viewed here: http://www.nwyhelearning.nhs.uk/elearning/nhsdigital/SCT_RF2/index.html
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SNOMED CT mapping 106.02 06 Mar 2017 27 Oct 2017 SNOMED CT
Why can't primary care continue to map to SNOMED CT?
UPDATED 106.02
Currently there are two versions of clinical codes (Read v2 and CTV3) in existence within general practice, so not all GP systems use the same coding system and they do not provide the sophisticated features now expected from a clinical terminology.

The NHS needs a single clinical terminology (SNOMED CT) in order for clinical data to be exchanged accurately and consistently across all care settings; this will enable better patient care and improve the analysis and reporting of clinical data.

Read codes are only available in the UK whereas SNOMED CT is an international terminology, and using this will enable the UK to participate more effectively in research and analysis of health information to support national and global health care improvements.

The Read codes have a number of design restrictions that are already causing issues:

*Read v2 was designed for general practice; it is not possible to extend this to cover the requirements of all of healthcare due to its fixed 5 character codes. SNOMED CT provides content for all health and care.
–* In Read there is no mechanism to safely 'delete' out of date or erroneous codes. There are requirements to retire some of the codes in Read v2 and SNOMED CT enables these requirements to be met.
* Some areas of Read v2 are full and terms cannot be added where they logically need to sit. Therefore codes have been allocated into a 'vacant space'. Writing accurate reports then becomes problematic; in Read there are reports that are incorrect and have missed codes that are located in wrong areas of the terminology. SNOMED CT does not have these limitations and will address this issue.
* Where data is communicated electronically between GP practices, mechanisms have evolved to facilitate the two sets of Read codes (v2 and CTV3), however, because of the depth of detail that we know exists in SNOMED CT in secondary care, it is not possible to go from SNOMED CT back to Read.
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