Informatics in Primary Care (BCS, The Chartered Institute for IT)
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A Method of Assessment of Reliability of Coding Clinical terms to ICD-10 and ICPC Using ENCODE-FMΩ, a Primary Care Controlled Clinical Terminology
No full textBackground: Data entry into electronic medical records remains a barrier to their use in primary care. One of the difficulties in data recording has been the use of terminologies unsuited to clinical data entry by physicians. Canada has chosen ICD-10 as its standard of classification of medical diagnoses and the World Organization of Family Doctors created and uses ICPC-2. In this study, we tested a clinical terminology for reliability of classification. ICD-10 is not intended to be used by clinicians as care is given, and ICPC is too small to be useful to follow patients in a clinical record. ENCODE-FMΩ is a clinical terminology specifically designed to overcome these limitations and provide both clinical specificity of health problems for patient care, and data aggregation for statistics and research. This study was intended both to test the reliability of data entry using ENCODE-FMΩ and to serve as a model methodology for testing vocabularies in general.
Method: Terms for "reason for encounter" taken from a random selection of encounter forms in family practice were coded by five different physician coders using a computerised search engine for ENCODE-FMΩ. Intraclass correlations were calculated to see how well clinical data grouped to ICD-10 and ICPC.
Results: Use of the ENCODE-FMΩ clinical terminology resulted in highly reliable data aggregation to the standard international classifications ICD-10 and ICPC. Intraclass correlations were .87 (p<.001) and .85 (p<.001).
Interpretation: The study shows that the method of assessment is both simple and acceptable. ENCODE-FMΩ can be used reliably for data entry into an electronic medical record, and analysis of coding errors suggests that direct data entry by care providers would be more reliable than third party coding. Physician coders prefer simple partial word searches
Expert Systems in Medicine: Academic Illusion or Real Power?
No full textFrom the very earliest moments in the modern history of the computer, scientists have dreamed of creating advanced systems that would simulate human thinking and reasoning. Of all the modern technological quests, research to create artificially intelligent computer systems has been one of the most ambitious and fascinating. Although attempts were made more than thirty years ago to develop and apply such systems to the medical sciences, the field languished for decades. In this context, this paper aims to share thoughts about and assessments of the important role of expert systems in medicine and address their future as well as the trends that are foreseen in this area
Computerised Genetic Risk Assessment and Decision Support in Primary Care
No full textPublic awareness of the availability of genetic testing threatens to put severe strain upon genetics clinics in the near future. General practitioners (GPs) could help avert this problem by making an initial genetic risk assessment and acting as gatekeepers to specialist services. However, studies in the United Kingdom suggest that few GPs feel they have the requisite skills for taking family history details and making an appropriate referral decision. They are also poorly served by computer-based pedigree programs, which do not cater to the specific needs of a general practice consultation.
To address these issues, a new computer application called RAGs (Risk Assessment in Genetics) has been designed. The system allows a doctor to create family trees and assess genetic risk of breast cancer. RAGs possesses two features that distinguish it from similar software: (a) a user-centred design, which takes into account the requirements of the doctor-patient encounter; (b) risk reporting using qualitative evidence for or against an increased risk, which the authors believe to be more useful and accessible than numerical probabilities are. In that the system allows for any genetic risk guideline to be implemented, it can be used with all diseases for which evaluation guidelines exist. The software may be easily modified to cater for the amount of detail required by different specialists
Measuring health and social functioning in primary care: adapting the Health of the Nation Outcome Scales (HoNOS) for the primary care setting
No full textSupporting a set of Read coded terms for use in pathology messaging
No full textA limited list of (Read coded) pathology investigations, the so-called 'bounded list', has been used since 1996 in Electronic Data Interchange (EDI) messages sent from laboratories to GP surgeries. It was developed as part of the General Practice Provider Links (GPPL) project, and this trial work, together with use of the list outside these projects suggested a need to expand the list. This work has been carried out as part of the Pathology Messaging Enabler Project and involved a collaboration between the NHS Information Authority (Data Interchange Standards Programme and Coding and Classification) along with representatives from the Royal College of General Practitioners and the Royal College of Pathologists. In this paper we explain the contribution of the bounded list to quality in pathology messaging, and we describe the processes used to identify and select the terms required and the incorporation of these terms into an appropriate structure
A Researcher's Experiences of MIQUEST
No full textMIQUEST (Morbidity Information QUery and Export SynTax) is an approach to the collection of computerised data from general practice databases. It is being used increasingly in local and national data collection schemes because it offers the opportunity to access anonymised data in a common format from different general practice computer systems. For individual research projects, however, MIQUEST has yet to find widespread use. This paper describes the experiences from a MIQUEST-based study in five general practices that form part of the Trent Focus Collaborative Research Network
The Clinical Content of the Computerised British General Practice Record
No full textEvidence of a computerised record was found in about half of the 100 general practitioner record folders received from the Health Authority for newly-registered patients. Half of the computer records had some clinical data but no diagnostic entries, and of those with diagnostic entries only half contained free text notes. There was inconsistent data entry of important information
Implications of WWW technologies for exchanging medical records
No full textThis article addresses some of the implications for medical record exchange of very recent developments in technology and tools that support the World Wide Web. It argues that XML (Extensible Mark-up Language) is a very good enabling technology for medical record exchange. XML provides a much cheaper way of executing the exchange of medical information that circumvents the need for proprietary software. Use of XML can also simplify solutions to the problems associated with coping with the evolution of medical systems in time. However XML on its own does not resolve all the semantic heterogeneities
The Impact of Single Versus Dual Data Entry on Accuracy of Relational Database Information
No full textObjective: To evaluate the differences in entry errors associated with entry of prospective cohort data using a single versus a dual data entry system.
Design: Cross-over trial
Measurements: The database for the Canadian Intercollegiate Sport Injury Registry (CISIR) has, to date, used a dual data entry system. To test the differences in entry error, one season of injury and exposure (participation) data were entered for one sport from two participating institutions. A total of 5 data entry clerks were involved. Discrepancies between the final entries from both systems were flagged and checked against the original paper record. The number of instances where the dual entry system was correct but the single entry system was incorrect, and vice versa, were determined.
Results: A total of 17,988 database fields were evaluated (15,509 text and 2,479 fixed response fields). There was a statistically significant difference in error where the dual entry system was correct but the single entry system was incorrect for 2 out of the 4 data entry modules. The percent accuracy using the single entry system was lower (99.35%) than that using the dual entry system (99.83%).
Conclusions: Although the single entry system was statistically different from the dual entry system, the percent accuracy remained high and the errors did not cluster in one specific field. Given the doubling of entry costs with a dual entry system, it is recommended that a single entry system be used for the CISIR