Prometheus: the implementation of clinical coding schemes in French routine general practice

Laurent Letrilliart, B_n_dicte Gelas-Dore, Bernard Ortolan, Cyrille Colin

Abstract


Background Clinical data are most useful, both at the individual level and collectively, if they are coded according to a standard classification system. However, clinicians often have little motivation to routinely code their consultation data. The main classification systems available in French primary care are the International Classification of Primary Care (ICPC)and the Dictionary of Consultation Results (DCR).
Objective To assess the feasibility of using the ICPC-2 and the DCR for coding health problems managed in routine general practice in France.
Methods Between December 2001 and June 2003, 61 volunteer general practitioners (GPs)from the Paris area prospectively recorded the health problems they managed at consultations, using either the ICPC (36 GPs)or the DCR (25 GPs), for a period of six months. They were equipped with one of three proprietary medical software applications specifically adapted for the study, or one open source utility, interfacing with five other, non-adapted, proprietary software programs. They had a two-day training session, were financially compensated, and were provided with electronic feedback.
Results The mean reported coding time per consultation was 2.5 minutes, but 28 physicians (46%) judged the coding time excessive and reported a maximum acceptable time of 1.2 minutes. Coding consultation data was considered more useful at the collective level (by 95% of physicians)than at the individual practice level (by 69%). Only 34 physicians (56%)expressed willingness to carry on routine coding after the end of the study. Some results differed depending on the classification system used, especially due to confounding factors, as some physicians could have previously used the given system.
Conclusions Coding health problems on a routine basis proved to be feasible. However, this process can be used on a more widespread basis and linked to other management data only if physicians are specially trained and rewarded, and the software incorporates large terminologies mapped with classifications.

Keywords


classification; coding; health problems

Full Text:

PDF


DOI: http://dx.doi.org/10.14236/jhi.v14i3.626

Refbacks

  • There are currently no refbacks.


This is an open access journal, which means that all content is freely available without charge to the user or their institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal starting from Volume 21 without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open accessFor permission regarding papers published in previous volumes, please contact us.

Privacy statement: The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.

Online ISSN 2058-4563 - Print ISSN 2058-4555. Published by BCS, The Chartered Institute for IT