= i2b2 - GEM data load for GENVASC

== Patient Request

UHLDWH.DWBRICCS.dbo.UVW_GENVASC_PATIENTS_GEM => UHLDBSQLCORP02.LLR_CSS.dbo.BRICCS_GENVASC_PATIENTS

== Data Response


UHLDBSQLCORP02.LLR_CSS.dbo.Genvasc_Clinical_ReadCode => UHLDWH.DWBRICCS.dbo.Genvasc_Clinical_ReadCode

UHLDBSQLCORP02.LLR_CSS.dbo.Genvasc_Ethnic_ReadCode => UHLDWH.DWBRICCS.dbo.Genvasc_Ethnic_ReadCode

== Health Check Read Codes

||= Field Name =||= Read Code v3 =||= Concept Code =||
|| Cardiovascular disease risk assessment declined || XaN8t || HCK:0000486 ||
|| Cardiovascular disease risk assessment offered || XaPl0 || HCK:0000490 ||
|| Informed consent given || XaLQR || HCK:0000485 ||
|| Patient informed about research study || 9Q... || HCK:0000466 ||
|| Cigarette consumption || Ub1tI || HCK:0000470 ||
|| Smoking cessation advice || Ua1Nz || HCK:0000468 ||
|| Health education - smoking || 6791. || HCK:0000463 ||
|| Referral to smoking cessation advisor || XaItC || HCK:0000482 ||
|| Not interested in stopping smoking || XaIkY || HCK:0000480 ||
|| Cigar consumption || Ub1tJ || HCK:0000471 ||
|| Loose tobacco consumption || Y01e6 || HCK:0000999 ||
|| Smoker || 137R. || HCK:0000449 ||
|| Ex-smoker || Ub1na || HCK:0000469 ||
|| Never smoked tobacco || XE0oh || HCK:0000492 ||
|| Current non-smoker || 137L. || HCK:0000448 ||
|| Ethnic groups (census) || 9S... || HCK:0000467 ||
|| - White - ethnic group || 9S1.. || HCK:0000088 ||
|| - Other ethnic non-mixed (NMO) || 9SA.. || HCK:0000104 ||
|| - Ethnic groups (census) NOS || 9SZ.. || HCK:0000123 ||
|| - Mixed ethnic census group || XaFwG || HCK:0000262 ||
|| - Black - ethnic group || XaFwH || HCK:0000263 ||
|| - Asian - ethnic group || XaFwz || HCK:0000265 ||
|| - Other ethnic group || XaFx1 || HCK:0000267 ||
|| Ethnic category - 2001 census || XaJQu || HCK:0000483 ||
|| - British or mixed British - ethnic category 2001 census || XaJQv || HCK:0000278 ||
|| - Irish - ethnic category 2001 census || XaJQw || HCK:0000279 ||
|| - Other White background - ethnic category 2001 census || XaJQx || HCK:0000280 ||
|| - White and Black Caribbean - ethnic category 2001 census || XaJQy || HCK:0000281 ||
|| - White and Black African - ethnic category 2001 census || XaJQz || HCK:0000282 ||
|| - White and Asian - ethnic category 2001 census || XaJR0 || HCK:0000283 ||
|| - Other Mixed background - ethnic category 2001 census || XaJR1 || HCK:0000284 ||
|| - Indian or British Indian - ethnic category 2001 census || XaJR2 || HCK:0000285 ||
|| - Pakistani or British Pakistani - ethnic category 2001 census || XaJR3 || HCK:0000286 ||
|| - Bangladeshi or British Bangladeshi - ethn categ 2001 census || XaJR4 || HCK:0000287 ||
|| - Other Asian background - ethnic category 2001 census || XaJR5 || HCK:0000288 ||
|| - Caribbean - ethnic category 2001 census || XaJR6 || HCK:0000289 ||
|| - African - ethnic category 2001 census || XaJR7 || HCK:0000290 ||
|| - Other Black background - ethnic category 2001 census || XaJR8 || HCK:0000291 ||
|| - Chinese - ethnic category 2001 census || XaJR9 || HCK:0000292 ||
|| - Other - ethnic category 2001 census || XaJRA || HCK:0000293 ||
|| - Ethnic category not stated - 2001 census || XaJRB || HCK:0000295 ||
|| FH: Cardiovascular disease 1st degree female reltve < 65 yrs || XaP9M || HCK:0000488 ||
|| FH: Cardiovascular disease 1st degree male relative < 55 yrs || XaP9K || HCK:0000487 ||
|| Alcohol intake || 136.. || HCK:0000447 ||
|| Advice on alcohol consumption || Xa1dA || HCK:0000476 ||
|| Enjoys light exercise || 1383. || HCK:0000450 ||
|| Enjoys moderate exercise || 1384. || HCK:0000451 ||
|| Enjoys heavy exercise || 1385. || HCK:0000452 ||
|| Body mass index - observation || 22K.. || HCK:0000455 ||
|| O/E - height || 229.. || HCK:0000453 ||
|| O/E - weight || 22A.. || HCK:0000454 ||
|| Waist circumference || Xa041 || HCK:0000475 ||
|| Ideal body weight || 66CB. || HCK:0000462 ||
|| Advice about weight || XaADJ || HCK:0000477 ||
|| Dietary advice || 8CA4. || HCK:0000464 ||
|| Refer to weight management programme || XaJSu || HCK:0000484 ||
|| Referral to dietitian || XaBSz || HCK:0000478 ||
|| Pulse rate || X773s || HCK:0000473 ||
|| Pulse regular || XM02J || HCK:0000495 ||
|| Pulse irregular || X76JE || HCK:0000472 ||
|| O/E - Systolic BP reading || 2469. || HCK:0000456 ||
|| O/E - Diastolic BP reading || 246A. || HCK:0000457 ||
|| Fasting || X78x9 || HCK:0000474 ||
|| Serum cholesterol level || XE2eD || HCK:0000493 ||
|| Serum HDL cholesterol level || 44P5. || HCK:0000459 ||
|| Serum triglyceride levels || XE2q9 || HCK:0000494 ||
|| Serum LDL cholesterol level || 44P6. || HCK:0000460 ||
|| Serum glucose level || 44f.. || HCK:0000458 ||
|| Total cholesterol:HDL ratio || 44PF. || HCK:0000461 ||
|| HbA1c level (DCCT aligned) || XaERp || HCK:0000479 ||
|| Cardiovascular event risk || XaIpv || HCK:0000481 ||
|| Cardiovascular disease risk assessment done || XaPkZ || HCK:0000489 ||
|| Follow-up arranged || 8H8.. || HCK:0000465 ||
|| High risk of diabetes mellitus || XaZLG || HCK:0000491 ||

== Recreating the Health Check Discussion

Below are some questions with responses by Sarah-Jane Gray (in italics) about the Read Codes used to generate a QRisk Score:

- What (Read code or otherwise) do the CCG use to identify that a health check has occurred for payment purposes?
    ''XaPkZ - Cardiovascular disease risk assessment done''

- For questions where the answer is a tick box (yes/no) is there a way to differentiate for all cases between an answer of ‘no’ / unticked and the question not being answered?
    ''No – one of the drawbacks of the system in terms of data gathering is that the read codes are for a positive response and rarely a negative. Tickbox indicates a ‘yes’ response to that question but absence of a tick could be either ‘no’ or ‘not applicable / not asked’''

- Similarly, for questions where the answer is a number, is there a way to differentiate for all cases between an answer of zero and the question not being answered?
    ''Generally with numeric, because a negative (0) can be recorded, question not being answered is not the same as a negative response.''

- What audit data is available for the data completeness for health checks?
    ''Might need more explanation on what you mean for this one J''

- For calculations such as QRisk or BMI, is it possible for the health check form to be filled in such a way that they are not calculated?
    ''Yes. These should be recorded as part of a health check but there is the possibility (particularly with QRISK being a tool external to the template which ‘pops up’) but it is possible to complete the template without calculating these.''

- For calculations such as QRisk or BMI, is it possible for the calculation to be based on historic data?  Is there a limit to how old that data can be?
    ''Yes. This is generally the most recent reading in the last 5yrs except ‘treated for hypertension’ in QRISK which needs to be hypertension diagnosis (any time) but hyp meds prescribed within last 6 months of the calculation. For BMI/BP, if nothing is recorded then a default value considering the patient’s age, sex and ethnicity is calculated.''

- Is there a way to correctly identify all the values associated with a health check or QRisk calculation? 
    ''Not easily. We can produce a template specification for the NHS Health Check template which lists all the codes used (this is what you attached to the original email) but not for the QRISK calculation.''
 

- In addition, we want to make sure that we have all the information that was used to calculate the QRisk score.  From what I can gather, the following fields are required for this calculation:
 - Ethnicity
 - Age > ''directly taken from patient demographic information''
 - Sex > ''directly taken from patient demographic information''
 - Smoking Status 
 - Systolic blood pressure 
 - Total cholesterol:HDL ratio 
 - BMI 
 - Family History of CHD in 1st degree relative under 60 > ''both codes used in the template will mark this as positive. On S1 is just ‘Family history of CVD’ ?''
 - Townsend deprivation score > ''directly taken from patient demographic information (if postcode recognised)''
 - Treated hypertension > ''Any codes in the HYP cluster (I can provide these) with hypertension medication in <6m''
 - Rhematoid arthritis > ''Any codes in the RARTH cluster''
 - Chronic renal disease > ''Any codes in the CKD cluster''
 - Type 2 diabetes > ''Codes and children of X40J5 (“Type II diabetes mellitus’)''
 - Atrial fibrillation > ''Any codes in the AFIB cluster''
 - ''+ also ‘personal history of CVD’''

- Do you know what algorithm for calculating QRisk is used in SystemOne, as this may resolve the ambiguities?
    ''Afraid not, and I can’t see any way of obtaining this from S1 – will see if it’s available elsewhere.''


== Health Check Information

Information about the Health Check can be found on the [[http://www.hscic.gov.uk/nhshealthcheck|HSCIC Health Check]] page.  This includes a [[http://www.hscic.gov.uk/media/9445/NHS-Health-Check---Read-Code-Mapping-Guidance-XLS-396kb/xls/NHS_Health_Check_-_Read_Code_Mapping_Guidance.xls|list of mappings]] for the