Clinical Classifications Subject Guide
Authors: D. Dawes (Digital Health and Care Wales - National Training Programme Lead), and R Burdon (Digital Health and Care Wales Classifications Standard Manager)
First Created: 23/07/2020
Last Updated: 08/08/2023
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Clinical Classifications sit at the interface between medicine and data. The NHS in Wales holds rich and varied resources of clinical data, but in order to access and make full use of them, you will need to understand both the clinical information, and the format and structure of the data. This subject guide is designed to introduce you to, and provide further resources for, the latter.
A wide range of demographic and administrative data are available either directly from NHS Wales or by linking data sets. The heart of the clinical data held by NHS Wales, however, are classifications codes. Clinical classifications are standardised groupings of information that translate the clinical terminology describing a patient's condition and treatment recorded in individual patient records into codes that can be easily tabulated, aggregated, and sorted for statistical analysis in an efficient and meaningful manner. There are two major classifications currently in use in the NHS in Wales.
Both ICD-10 and OPCS-4 are systems of categories to which entities are assigned according to established criteria. Their purpose is to translate diagnostic and operative information into alphanumeric code, which permits easy storage, retrieval and analysis of the data. They are designed to aggregate complex medical concepts into a form suitable for population-level statistical analysis. Other classifications in use in the NHS include Healthcare Resource Groups (HRGs) which aggregate patient admissions to hospital for costing. Further classifications are in use in other organisations, including the Logical Observation Identifiers Names and Codes (LOINC), or the WHO International Classifications of Health Interventions (ICHI) and Functioning, Disability and Health (ICF).
Other ways of managing clinical information also exist, like describing individual drugs (including dm+d), messaging between systems (including HL7 FHIR), and patient-level and bedside care terminologies (like SNOMED-CT). These differ from clinical classifications in that they model the information differently, making them less suited to population level health information management. This guide is focused on population level data, although some of the information and resources will apply across domains.
We would like to thank Local Health Board and Trust Clinical Coding Departments and the NHS Wales e-Library Champions Group for their support with putting this guide together. If you find that any resources are missing or would like to recommend a resource please contact us.
The resources listed below provide access to the clinical classifications (and their applicable standards) used in NHS Wales. It should be noted that other countries, and each nation within the UK, use modified versions of these resources, particularly standards and guidance.
Introductory Information
A brief introduction to how Clinical Classifications are used in practice.
The department that sets out the core standards on technology and data for IT systems and digital services in NHS England.
An introduction to clinical coding from a Welsh perspective.
A report by the Auditor General for Wales that highlights the current challenges and opportunities for clinical coding
Classification Codes and Standards
A browser-based version of both the OPCS-4.10 and ICD-10 classifications. This contains the full classification of procedures and interventions, and the localised version of the international classification of diseases in use in the NHS, including validation tools developed by NHS England for use in the United Kingdom.
Use this when you want to find out the meaning of a procedure or diagnosis code or group of codes.
The following resources are only available to users on the NHS Wales network – either directly or via a virtual private network.
A repository of the current information standards in use in NHS Wales to ensure the consistency, integrity, and accuracy of Clinical Classifications data. These standards are maintained by Digital Health and Care Wales.
Use this when you want to identify the validation rules for a specific diagnosis or procedure, and whether this differs in Wales or has changed over time.
A repository of the current valid data items in use in NHS Wales, including the valid codes from each of the above clinical classifications. This database is maintained by Digital Health and Care Wales.
Use this when you want to check whether a code is in use in Wales or download the relevant data files for use elsewhere.
Primary Data Sources
An annually updated record of admissions to Welsh Hospital Providers, including diagnoses and procedures.
A selection of pre-calculated reports on a range of health problems and interventions, with links to the underlying data.
A selection of dashboards designed to answer specific questions regarding a range of health problems and interventions.
The following links will take you to live searches on that topic on NHS Wales LibrarySearch. You will find a range of resources from full text articles, e-Journals, Journals, e-Books, Books, dissertations and more.
The field of health informatics or health information management is supported by a range of journals, although none of them focus on population level health data alone. The following e-Journals contain robust and up to date information on the wider field:
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Journal of the American Medical Informatics Association : JAMIA ISSN: 1527-974X |
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International Journal of Medical Informatics ISSN: 1872-8243 |
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Journal of Biomedical Semantics ISSN: 2041-1480
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Methods of Information in Medicine ISSN: 0026-1270
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The NHS Wales Library and Knowledge Service provides access to physical books that can be loaned by NHS Wales employees and contract holders (except Public Health Wales) as well as some e-Books available to those users in the Health Board or Trust that have purchased/subscribed to them. The following books have been identified relevant to this guide but please note that these are only available to the above-mentioned users. If you are not an NHS Wales employed or contracted person and would like electronic access to any of these titles, please email elibrary@wales.nhs.uk and we can consider for purchase.
If you are an NHS Wales employee or contract holder, to loan and reserve the following books, you will need to be an NHS Wales Library Service member. For this, you can self-register online.
Other online Learning and Training opportunities
Digital Health and Care Wales (DHCW) collects and maintains the clinical classifications data for Wales, including data quality assurance through audit and training programmes for Clinical Coders in Wales. The national Clinical Classifications team can also put you in contact with local health board clinical coding departments.
NHS England is responsible for data quality standards in England, and maintains OPCS-4, and the UK editions of ICD-10 and SNOMED-CT.
IHRIM is the professional body for Clinical Classifications staff. It is responsible for the biannual National Clinical Coding Qualification exam, which allows the professional to use the post-nominal designation ACC (Accredited Clinical Coder).
HEIW have a leading role in the education, training, development and shaping of the healthcare workforce in Wales. Ensuring we have the right staff, with the right skills, to deliver world-class healthcare to the people of Wales both now and in the future.
The NHS Wales Library Service promotes evidence-based practice and provides quality health information to support patient care, education, professional development, training and research.
Libraries are in each of the major hospitals in Wales and offer a friendly and helpful service.
The Public Health Wales Observatory transform data and evidence into public health intelligence
The Welsh Government Library Service facilitates access to information within the Government. It provides a service to Ministers and Welsh Government officials only. Contact details for the Welsh Government as a whole are provided here
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