Distinguish between remote and face to face consultations

[StevenMaude]

From https://github.com/opensafely/documentation/issues/430:

@v1kki213 wrote:

Is it possible, or will it be possible to distinguish if a consultation is remote (i.e. over the phone) or face to face in either TPP or EMIS or both systems? Being able to define this would give more detailed information about how COIVD has impacted on care pathways for different conditions, and indeed variability in outcomes for these conditions based on consultation mode.

Guessing this is Consultation_Medium_Used in the TPP database? https://datadictionary.nhs.uk/attributes/consultation_medium_used.html

[sebbacon]

There are multiple caveat emptor warnings around the use of this kind of information in analytic work. General consensus is that it's very hard to draw any conclusions from it at all. If we chose to implement this, we should be sure to document them all thoroughly. @brianmackenna is a person who has a good handle on this.

[madwort]

Consultation_Medium_Used was implemented for outpatient appointments in https://github.com/opensafely-core/cohort-extractor/pull/644 , following discussion in https://github.com/opensafely-core/cohort-extractor/issues/492

[brianmackenna]

@v1kki213 This has come up frequently in our work with collaborators. Although seemingly straightforward its very complex once we get into it! Briefly there are two main issues

• Although incredibly powerful and complex the first purpose of GP clinical systems is to record clinical interactions with a patient in a coded manner. How practices and individual staff use this to record non-clinical information varies substantially!
• Secondly "online" consultations are carried out over third party systems which increasingly automate collection of data that is fed back to GP records. There are no standards for this work and as there has been an explosion in activity in this area the data's quality and character remains unknown.

There is a substantial amount of work required in this area and we are keen to collaborate with teams with the skills/experience on it. As an immediate first step @mbfons at NHSX has completed a descriptive project on the use of online consultation codes. This work is going through approvals and @mbfons will share soon!