Dear Editor,

We read with interest the paper by Edge and colleagues[1] on paediatric diabetes services in the UK which reports on data received from 169/216 (78%) of hospitals identified as delivering care to children with diabetes. It reported that 95% of these clinics had registers of their diabetic children (an improvement on previous years) and 75% of those clinics held the data electronically. In a survey (September 2005) of the 16 units within Yorkshire who contribute data to the population based Yorkshire Register of Children and Young People with Diabetes[2] we found that 8/16 (50%) of these units rely on paper based records for clinical management. However, they are safe in the knowledge that basic diagnostic and demographic data are available electronically for their patients from the Register. The apparent improvement in ‘computerisation’ of patient data in diabetes clinics may therefore be an overestimate.

The National Diabetes Audit (NDA) of diabetes in England was recently established under the direction of the Health and Social Care Information Centre[3] and replaced the audit of children and adolescents with diabetes in the United Kingdom previously undertaken by Diabetes UK (DUK). It provides a key means to give healthcare workers information about the quality of diabetes services and helps them monitor progress towards meeting the Diabetes National Service Framework requirements.[4] For their first report the NDA received data from 28 paediatric units. Both the paper by Edge et al.[1] and our Yorkshire survey show that a surprisingly large number of paediatric units have yet to implement electronic systems. It seems that this failure to implement electronic systems is caused by a combination of constraints arising from hospital IM&T strategies requiring new systems to be compatible and share key information with existing systems, lack of resource to implement new systems and the low priority afforded for paediatric as opposed to adult systems

When the National Audit was undertaken by DUK, data could be submitted using not only electronic systems but in virtually any other format (e.g. paper records) and resulted in submission of more than four times the amount of data submitted to the NDA. However, not only does this often entail double entry of data into these records (thus increasing the likelihood of errors), but these methods are now inappropriate for confidentiality reasons. The fact that the NDA relies on electronic submission of data via NHSnet, coupled with the inability of many units to collect or submit in this medium, may explain the relatively low proportion of paediatric units participating so far. It is essential that as many data as possible are submitted in order to draw meaningful conclusions. The NDA are fully aware of these difficulties and are working towards further guidance and assistance with the collection of audit data, which is crucial for clinical governance, in units without electronic systems.

Fiona M Campbell
Jeremy Allgrove
Jo Dalton
Patricia A McKinney
On behalf of the National Diabetes Audit Paediatric User Group

References

1. Edge JA, Swift PGF, Anderson W, Turner B on behalf of the Youth and Family Advisory Committee of Diabetes UK. Diabetes services in the UK: fourth national survey; are we meeting NSF standards and NICE guidelines? Arch Dis Childhood 2005;90:1005-1009.

2. Feltbower RF, McKinney PA, Parslow RC, Stephenson CR, Bodansky HJ. Type I diabetes in Yorkshire, UK: time trends in 0-14 and 15-29 year olds, age at onset and age-period-cohort modelling. Diab Med 2003; 20:437 -441.

3. http://www.icservices.nhs.uk/ncasp/pages/audit_topics/diabetes Accessed 11th October 2005.

4. http://www.nhs.uk/England/AboutTheNHS/Nsf/Diabetes.cmsx Accessed 11th October 2005.