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Since GPs never provide sufficient clinical information to differentiate the purpose for the test, I would we will continue to use the general code and GPs can recode in their systems if they wish [and no doubt QoF will provide them with sufficient financial incentive to make them do that]... ************************************************************************ ************** Prof. Tim Reynolds Consultant Chemical Pathologist / Divisional Medical Director (CH&CSS) / R&D Lead, Burton Hospitals NHS Foundation Trust work tel: 01283 511511 ext 4035 work fax: 01283 593064 work email: [log in to unmask] work URL: www.burtonhospitals.nhs.uk This e-mail, and any files transmitted with it, are confidential and intended solely for the use of the individual to whom it is addressed. If you are not the intended recipient please destroy this message, delete any copies held on your systems, and notify the sender immediately. You should not retain copy or use this e-mail for any purpose, nor disclose all or any part of its content to any other person. If you have received this e-mail in error, please notify me on 01283 511511 Ext 4035 [Picture of tree not available] Please consider the environment before printing this e-mail ________________________________ From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of GIFFORD BATSTONE Sent: 01 April 2015 8:02 PM To: [log in to unmask] Subject: Re: New A1c read codes Dear Colleagues The addition of two new HbA1c entries into PBCL in Oct 2014 was in response to problems encountered by GPs in differentiating test results for diagnosis from those for monitoring of known diabetics. The concern was that the ranges being used for monitoring led to new diabetics being missed. So codes were created for both diagnosis and for monitoring in order that this clinical risk could be mitigated. The 'old' code has not been deleted as there is obviously a need for local arrangements between LIMS and GP systems to agree how or even if to use the new codes. My guess is that the new code for diagnosis will and probably should be implemented in order that new diagnoses of diabetes can be made often as part of the new health and vascular checks. However this may require changes to electronic requesting systems and hence there is no time frame for deleting the current code. There may also be implications for data collection for QUOF purposes. I hope this sets out the situation and indicates there is no compulsion for early adoption but that where HbA1c is widely used for the diagnosis of diabetes results can be reported with reference ranges to meet this clinical need Regards Gifford Chair Pathology Catalogues Executive Team Royal College of Pathologists Gifford Dr Gifford Batstone MBBS, BSc, FRCPath, MSc Tel 01962 860761 Mob 0791 285 9344 From: "Mascall, Gary (WRH Biochemistry Medical Staff)" <[log in to unmask]> To: [log in to unmask] Sent: Wednesday, 1 April 2015, 11:35 Subject: Re: New A1c read codes Hi Stuart, I raised this some time ago with the people looking at Read coding, because I envisaged the same scenario at some time in the future we saw with the recent deletion of Read codes. The one which created mayhem was PSA, where the "old" code was replaced, so all of a sudden, EMIS users were getting back PSA to the "new" Read code, with no link to up to 9 years worth of previous data. So, we currently allow users to request either HbA1c - diagnostic, or HbA1c - monitoring, which they are after 2 years since we made this change, getting pretty good at getting right. BUT, both these requesting entities use the same actual Test Code, so we only send back to the present Read code of 42W5. If this code at some time in the future gets deleted too, then we will need to change to having separate lab test codes to point to the different Read codes, and the same confusion will arise again, but this time for more patients. Plus, what happens when you have 2 diagnostic tests, are diagnosed and started on treatment, then follow-up tests become the monitoring ones, and you will not see the previous 2 results. I have asked whether EMIS have now sorted this, to allow them to link together the old Read codes, but as they have been deleted from the list, then they may appear as un-coded now, I'm not sure. Kind regards, Gary Mascall Gary Mascall Consultant in Clinical Biochemistry Worcestershire Acute Hospitals NHS Trust www.worcsacute.nhs.uk <http://www.worcsacute.nhs.uk/> Tel: 01905 760760 extn 30214 From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of JONES Stuart (Pathology) (RF4) BHR Hospitals Sent: 01 April 2015 10:32 To: [log in to unmask] Subject: New A1c read codes No joy on the ACB-IT mailbase with this one. Has anybody looked at this yet? (apologies to non-UK users): Has anybody worked out how they are going to report HbA1c with the newly released read codes? We have two new codes to differentiate A1c for diagnosis / monitoring so we could potentially be reporting A1c results with three different read codes i.e. Diagnosis, monitoring or level (where detail not specified)?? This could become quite cumbersome in our LIMS! How are GP systems going to handle multiple codes for the same test simultaneously? Stuart V2_READ_CODE V2_TERM COMMENTS REPORT REQUEST BATTERY LEVEL TEST RATIO BOOLEAN TEXT STATUS RELEASE_DATE 42W.. Hb. A1C - diabetic control Deleted: use 44TB. (Haemoglobin A1c level) T T T F F F F F D 1997-03-01 42W4. HbA1c level (DCCT aligned) For deletion Oct15. Transition to IFCC standard completed. T T F T T F F F C 1999-09-01 44TL. Total glycosylated Hb level Apr15: For deletion Oct15. Use HbA1c entries. T T F T T F T T C 2004-01-01 44TB. Haemoglobin A1c level T T T T T F F F C 1999-09-01 44TC. Haemoglobin A1 level T T F T T F F F C 1999-09-01 42W5. HbA1c levl - IFCC standardised T T F T T F F F C 2009-04-01 44TB0 HbA1c (diagnostic refrn range) T T T T T F F F C 2014-10-01 44TB1 HbA1c (monitoring ranges) T T T T T F F F C 2014-10-01 Barking, Havering & Redbridge University Hospitals NHS Trust: Working to make our hospitals better. 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