Just to introduce myself: I'm Rob Hampton, GP working at the NHS CCC charged
with the task of evaluating needs and co-ordinating work that would lead to
the Read V3 being adopted as a standard coded terminology in Primary and
Secondary care. Lucky me!
I joined GP-UK today and so will dive in now and pick up any threads on coding
as they arrive.
	
A few responses to Jeremy Rogers points will follow. I hope that this forum will
allow Read and GALEN to communicate more constructively. I know that those of us
at the 'lower'  levels of both organisations agree.

>I would have thought that, after committing so much money to such a high
profile,
>publically funded project as the READ codes, there would have been in existence
from
>the start a more detailed and formal evaluation methodology. This is a bit like
saying
>'it works when it works'. How will we know if, in fact, READ can *never* fulfil
the above
>requirements?

Formal evaluation has taken place but perhaps not in the way you, as an
academic, would like. The evaluation that has taken place is by the
Computer-based Patient Record Institute in the USA  regarding the coverage,
clarity, redundancy and cross mapping to administrative classifications. I
gather this will be published soon - ?for AMIA conference in October.

Is a clinical coding scheme a 'product' , a process, (and now for the jargon), a
semantic framework, interlingua etc.. I would contend that Read is actually a
'Product' and that it's evaluation should take place in the market. Many people
have problems with Read but the good news is that people are using it. Feedback
mechanisms exist.

'We must have a formal evaluation methodolgy for Read' sounds great but is akin
to stating 'We must define criteria to assess the usefulness of singing' before
writing a song. At the base level it is common sense that if computers are
useful to Healthcare (still contentious to many) and structured data entry,
analysis of activity or decision support a good use of computers, then coding
clinical concepts is a natural step and essential for the next few years.

If that is agreed, then the issues of enumerative schemes vs compositional(with
or without constraining mechanisms) are of immense interest to those with an
Informatics leaning and probably not at all to everyone else. Read V3 is based
on models described in the international literature and is designed to be far
more expressive than previous versions.  Experience tells us that the more
expressive the terminology, the more complicated is it's implementation. This
applies to GALEN and Read V3. It is this complexity that the CCC is currently
looking into removing for future GP systems.

The GRAIL engine and Pen&Pad was an impressive display of removing complexity
from the user where it worked. Clinical concepts based on site, pathology and
manifestation lend themselves to the pure compositional approach. The trouble
with compositional schemes is the need to record common but difficult to define
or complex concepts e.g. - Anxiety, Menopause, Stress. Here the enumerative
approach works well. Maybe things have moved on since HC96 but I'm still to be
convinced that it is even worth the effort to build these into the compositional
framework that is theoretically possible.  Non medical analogy: 'A good time'  -
I can't define it but I know what it is when I see it

Rob Hampton
NHS CCC



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