Developing a standard dataset for the NHS

Read codes' primary use is clinical

EDITOR,--N Smith and colleagues identify imperfections in the Read codes.1 They do not, however, give due consideration to the fact that the codes were developed primarily as a means of entering clinical data into a computer in general practice, facilitating the development of an electronic record of certain aspects of patients' care. The codes were not developed as a tool for delivering health care information to central, academic, public health, or managerial bodies.

The codes have been used successfully in general practice for some years and have helped the foundation of clinical computing in primary care. This success was illustrated by a survey of computing in general practice in 1993, which showed that nearly two thirds of practices actively used the computer to some extent during the consultation and that use of the computer as a clinical record was increasing.2 Indeed, this has been recognised to be of such value that a recent report on reducing bureaucracy in general practice called for a speedy legitimisation of computerised records.3 While I have every sympathy for the researchers in finding that the codes did not fit with their definitions, thus requiring them to redefine aspects of their study, they should appreciate that the windfall benefit of access to clinical data through computerisation is not at the core of clinical computing in general practice. Nor is this access likely to become universal without considerable investment in training clinicians to use the codes and in upgrading all systems in general practice to accept them.

Furthermore, some caution is justified. The success of the codes has been partly due to their relative simplicity and ease of use. Subsequent versions of the Read codes will address many of the issues raised by the authors.4 A huge thesaurus of clinical terms and qualifiers would almost certainly have overheads in terms of slowing terminals considerably or requiring upgrades to hardware. Slow, unusable systems will be detrimental to the development of clinical computing.

In conclusion, it must be borne in mind that the Read codes were developed to support the maintenance of a computerised clinical record and adopted as such by the joint computing group of the Royal College of General Practitioners and General Medical Services Committee. Any other research, audit, information, or managerial project support is a secondary bonus. The emphasis must remain on clinical use, with any other use being supported as a byproduct.