Read code

Read codes are the standard clinical terminology system used in General Practice in the United Kingdom. It supports detailed clinical encoding of multiple patient phenomena including: occupation; social circumstances; ethnicity and religion; clinical signs, symptoms and observations; laboratory tests and results; diagnoses; diagnostic, therapeutic or surgical procedures performed; and a variety of administrative items (e.g. whether a screening recall has been sent and by what communication modality, or whether an item of service fee has been claimed). It therefore includes but goes significantly beyond the expressivity of a diagnosis coding system.

History

Since its origins in the 1980s,[1] the system has evolved through three major technical design changes and significantly expanded its content.

READ version 1 (4-byte READ)

The first version was developed in the early 1980s by Dr James Read, a Loughborough general medical practitioner.[2] The scheme was structured similarly to ICD-9:

Because of its four character code structure, READ Codes version 1 was more commonly known as 4-Byte READ. The first release was in April 1986; the final official release of 4-Byte READ occurred in April 2009.

READ version 2 (5-byte READ)

4-Byte READ could only encode a monoaxial hierarchy with a maximum of 4 hierarchical levels. The operational NHS requirement to provide a direct crossmap to both ICD-9-CM and OPCS-4 implied an additional hierarchical level was required. Accordingly, a new scheme was devised with exactly the same technical properties as 4-Byte READ except that the code structure was extended to 5-Bytes. This became known as READ2, or 5-Byte READ. The first release of 5-Byte READ occurred sometime prior to January 1991. The October 2010 release contained 82,967 discrete 5-byte codes (although the actual number of discrete clinical concepts that may be represented is estimated to be slightly lower - 82,593 - because of duplicate entries).

A later extension of READ version 2 product family was the co-publication of a drug and appliance dictionary. This follows the same technical structure (5-character alphanumeric codes with first character lower case alpha organised in a monohierarchy). Released every four weeks, the October 2010 release contained 52,316 codes.

A popular misconception is that all 4-Byte codes are also present in 5-Byte, where they will also carry the same meaning. Whilst in the majority of cases any 4-Byte code of the general form 'wxyz' will be equivalent to a 5-Byte code of the form 'wxyz.', there are notable exceptions. The 4-Byte code [E333 Fear of flying], for example, corresponds to 5-Byte [E202A Fear of flying]; no [E333.] code exists in 5-Byte READ at all.

NHS mandation

In 1988 a joint conference of the Royal College of General Practitioners and the British Medical Association recommended standardisation of the system in general practice Electronic Medical Record (EMR) systems and the National Health Service mandated this in April 1999.[3] The intellectual property of the codes themselves was purchased outright by the UK government, and they have therefore been published under Crown Copyright ever since.

READ version 3 (Clinical Terms Version 3 or 'CTV3')

A third and more radically progressive version was devised through the 1990s in an attempt to address some of the more serious technical limitations of the earlier designs, including:

  e.g. 70266|Repair of acoustic nerve|:X9019|Site|=7N031|Vestibulocochlear nerve|
       or
       73143|Myringostapediopexy|:
             X9019|Site|=Xa18W|Tympanic membrane structure|,
             X9019|Site|=Xa8RI|Stapes structure|

The first release of Clinical Terms Version 3 occurred in the late 1990s. The October 2010 release contained 298,102 discrete concept codes of which 55,829 were marked as inactive, and 58,130 were pharmaceutical products or devices.

Production and license

Both actively maintained versions of the READ codes are now maintained by the UK Terminology Centre, a division within NHS Data Standards and Products (currently in turn a division of NHS Connecting for Health).

Both versions are released biannually, in October and April, under the Open Government Licence.

License application, and distribution, are now electronic only via the UKTC Terminology Reference data Update Distribution service.

READ and SNOMED

SNOMED CT was created in 2001 out of a technical, editorial and content merger of CTV3 and SNOMED RT, an American system. A significant part of the International Core content of SNOMED CT derives directly from CTV3; most of this content is identifiable as those SNOMED ConceptIDs where the CTV3ID column in the sct_concept table cites a code NOT beginning with the characters 'XU'.

Although CTV3 continues to be released biannually by the NHS independently of SNOMED CT, maintenance of both occurs in parallel; most concepts required to be added to CTV3 are as a matter of course simultaneously dual-authored into both CTV3 and the UK extension of SNOMED CT.

The NHS in England has committed to a strategic move to SNOMED CT, and systems using SNOMED are now being deployed within the NHS primary and secondary care estates. At the end of 2010, however, READ versions 2 and 3 remained the core clinical terminology used in UK primary care, with roughly 90% of the primary care estate still using version 2.

Deprecation and withdrawal

In preparation for the whole health system moving to SNOMED CT by April 2020, primary care systems are to have adopted the new nomenclature by December 2016.[4]

The former Information Standards Board for Health and Social Care (ISB) set December 2010 as the deprecation date for Read version 2, but did not set a date for its withdrawal at the time.[5] In August 2014 the ISB's successor, the Standardisation Committee for Care Information (SCCI), formalised the withdrawal time frame of Read version 2: A final updated release for Read version 2 is to be made available on 1 April 2016, and will be withdrawn completely on 1 April 2020.[6]

The deprecation and withdrawal time frame for Read version 3 was also agreed by the SCCI in August 2014. The deprecation date was set at 1 September 2014,[7] with a final updated release for 1 April 2018, and complete withdrawal on 1 April 2020.[6]

Although not actively maintained since 2006, a withdrawal date for Read drugs has yet to be set.

See also

References

  1. ↑ Benson, Tim. "The history of the Read codes: the inaugural James Read Memorial Lecture 2011." Informatics in primary care 19.3 (2011): 173-182. http://www.ingentaconnect.com/content/bcs/ipc/2011/00000019/00000003/art00008
  2. ↑ Bentley T, Price C, Brown P (13–15 September 1996). "Structural and lexical features of successive versions of the Read Codes". The Proceedings of the 1996 Annual Conference of The Primary Health Care Specialist Group of the British Computer Society. Retrieved 2010-04-17.
  3. ↑ "Frequently Asked Questions about Clinical Terms (The Read Codes)". NHS Connecting for Health. Retrieved 2010-04-17.
  4. ↑ "Personalised Health and Care 2020" (PDF). National Information Board. Retrieved 15 May 2015.
  5. ↑ "Information Standards Notice – Deprecation" (PDF). Standardisation Committee for Care Information. Retrieved 15 May 2015.
  6. 1 2 "Deprecation of Read Version 2 and Clinical Terms Version 3". Health & Social Care Information Centre. Retrieved 15 May 2015.
  7. ↑ "Information Standards Notice – Deprecation" (PDF). Standardisation Committee for Care Information (SCCI). Retrieved 15 May 2015.
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