Breaking the first law of informatics: the Quality and Outcomes Framework (QOF) in the dock

Large complex terminologies: more coding choice, but harder to find data - reflections on introduction of SNOMED CT (Systematized Nomenclature of Medicine - Clinical Terms) as an NHS standard

“…The quality measures are based on a limited list of codes, defined in business rules for each indicator. Whilst it is accepted that a limited set of codes might distort data recording 8 practitioners must use this limited list if they want to be paid.…”

Implementing an integrated computerised information system about foot problems in diabetes is not enough to ensure adoption. Commentary on: General practitioners' and nurses' experiences of using computerised decision support in screening for diabetic foot disease: implementing Scottish Clinical Information - Diabetes Care in routine clinical practice

“…3,9 Incentives focussing on process rather than outcome are perverse Whilst financial incentives are an effective way to implement policy they can provide perverse incentives with prompts and reminders focussed on the process rather than the outcome measure. 10 GPs are neither obliged to act upon the findings of a foot screen nor train screeners (usually practice nurses) to perform a correct examination. Data quality issues, around 5% of diagnostic coding in diabetes may be problematic, further compounds problems.…”

Commentary on: Creating a diabetes foot reminder-based registry using the electronic medical record

“…3 The majority (c.80-90%) of patients with diabetes are screened as part of the P4P system. 4 However, there are limitations with this approach. Firstly, as Wrobel et al, report, it is important not only to identify pathology but to transcribe those findings in to a risk category.…”