James Read remembered in lecture

Tim Benson gave the first James Read Memorial Lecture last month in memory of James Read, the clinical coding pioneer, who died this summer.

The founder of Abies, who worked with Dr Read and others on some of the first GP systems in the 1980s, talked about how he came to start a coding system for diagnoses in computerised records.

He also talked about how the task grew as Dr Read realised that it would need to cover all aspects of a patient’s medical history.

“A back of envelope calculation suggested that if we wrote 30 codes an hour, it would take 200 hours to create 6,000 codes," Benson told the IHTSDO SNOMED Showcase Conference, Sydney, last month.

"James Read undertook to edit the codes, and estimated that the task would take about three months. We did not account for James’ obsessiveness.”

Benson also told his audience that Dr Read didn’t use a computer himself. “James’ method of working was to write the codes, rubrics and synonyms (for lookup) on a large sheet of paper using a fountain pen, and post these to Sue Uphill, our secretary in London, who entered them into the computer.

"I do not remember James ever using a computer himself for this or any other task,” he said.

Benson went on explain in detail how the codes were constructed. He argued that the first generation of Read Codes were successful because they had a single author, were written for GPs by a GP, were comprehensive and yet easy to implement, and that they were well understood by users.

On the other hand, he admitted, there were problems with them. It was easy to make mistakes when entering data using the codes, which impacted on data quality, and they were inflexible. Hospital doctors also found the codes impractical.

The NHS Clinical Terms project was started in 1992 to try and address these issues. The resulting scheme, known as Clinical Terms Version 3, was merged into the College of American Pathologist’s SNOMED RT during 1999-2002 to create SNOMED CT.

The Information Standards Board for Health and Social Care officially approved this terminology as a ‘fundamental standard’ for the NHS in August.

Some national projects, such as Choose and Book and the Summary Care Record already use SNOMED CT, but it has yet to be widely adopted by either GP systems – which continue to use the older Read Codes – or hospital systems.

Benson acknowledged that Dr Read was not always easy to work with. The National Audit Office criticised the NHS’ purchase of the Read Codes, which left Read as the director of the new Centre for Coding and Classification and allowed a company that he owned to market the codes.

But he said that without Dr Read the computerisation of general practice would not have been possible, and nor would SNOMED CT. “He changed the way that medicine is practiced now and in the future,” Benson concluded.

The edited text of the first James Read Memorial Lecture can be found here.