Gutteridge: SNOMED at bed is too hard

Clinicians are struggling to use SNOMED coding to capture information about patients because it is technically too hard to do it, particularly at the bedside, EHI Live 2012 was told.

Charles Gutteridge, who combines a role as national director for clinical informatics at NHS Connecting for Health with clinical practice as a consultant haematologist at the Royal London Hospital, described how he and colleagues are using SNOMED in Cerner Millennium in outpatient clinics and to build research databases.

For example, Dr Gutteridge said he spends 30 minutes before each outpatient clinic coding data from GP letters and uses this as a basis for history taking.

He uses SNOMED coding at multidisciplinary handover meetings, with codes added to patient’s notes as the team discusses each case.

With colleagues in the emergency department and informaticians at CfH he has identified a sub group of sickle cell patients with very high use of emergency services.

Nurses are now coding for VTE assessments while doctors in multiple sclerosis have started to build a research database linking risk factors and place of birth. But the use of coding at the bedside remained a problem, he admitted.

“This is about the ways that different clinicians work,” he said. “I do it in my outpatient clinics but I really think that it is a challenge when you are walking from bed to bed. The portability question is very challenging.”

Where there had been success in persuading clinicians to adopt SNOMED it was either because they are researchers “who totally get” the opportunity coding offers to or because he had made a personal intervention.

“That’s not scalable,” said Dr Gutteridge. He called for developers to continue to explore ways to make coding portable by developing new user interfaces.