Transcript Indexing EBM guidelines with ICPC-2 and linking guidelines to medical records

Indexing EBM guidelines with
ICPC-2 and linking guidelines
to medical records
Ilkka Kunnamo, MD
The Finnish Medical Society Duodecim
Finland
[email protected]
Marc Verbeke, MD
University of Gent, Belgium
WONCA Europe Kos 6.9.2005
Problems with accessing
guidelines during encounters
• Time needed to explore websites and guidelines
• Different search terms or search systems
• Physicians’ ability in defining the question
• Correct spelling in other language
• No standardized way of assessing keywords
• Patients are watching what the doctor is doing
Aim: creating tools to
• Improve the accessibility of selected
guidelines on-line
• Make it work during patient encounters
• Search with a language independent system
• Search with own terminology in own
language
• Create short-lists of quality controlled sites
• Find only guidelines linked to your problem
Components of the system
• EPR system that makes the link from ICPC
code used by EPR in assessment of the
patient’s problem
• 946 topics in “EBM guidelines” indexed by
ICPC: to which question is this guideline an
answer?
- ICPC codes 1-29 and 70-99 at assessment /
diagnostic level
- ICPC code used at intervention level (process
codes *30-*69)
- Guidelines accessible by ICPC instead of
search terms
Indexing result
Number of guidelines in
search result
Number of ICPC-2
codes used as main
indexing terms
1
2
3
4-6
7-10
More than 10
188
83
40
35
12
14
Indexing result
• 372 ICPC codes used as main indexing terms
• 20 guidelines with a process code as main
indexing term
• 50% of ICPC codes retrieve only one
guideline
• 93% of the ICPC codes retrieve not more
than 6 guidelines
Search results with ICPC-2 codes
• L77
– Sprain of the ankle
– Joint and ligament injuries in children
• P20
– Evaluation of a neurological patient
– Memory disorders and dementia
– Examination of patients with memory disorders and
dementia
– Treatable causes of dementia and memory
disorders
– Neuropsychological problems
Search results with ICPC-2 codes
• R78
–
–
–
–
–
Acute brochitis
Acute bronchitis (instructions for patients)
Mycoplasma pneumoniae infections
Wheezing in children
Treatment of obstructive bronchitis and acute
asthma in children
• S70
–
–
–
–
Herpes zoster
Herpesvirus skin infections
Fever and rash in a child
Meningitis in children
• *31
– Diagnostic tests in dermatology
ICPC is not always specific enough
• ICPC
– D99 Other diseases of the digestive system
• ICD-10
–
–
–
–
K56.6
E73.9
K85
K90.0
Bowel obstruction
Lactose intolerance
Acute pancreatitis
Coeliac disease
ICPC code found by using
Dutch thesaurus
Guidelines searched
automatically using the
ICPC code as search term
Pilot use by 10 Belgian GPs
• Opened articles
• Search
• Browse
1287
168
85
Comments from test users 4/2005
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Very useful during doctor-patient encounter
Real improvement and very good tool!
10-20 % new search needed
Very user-friendly and high speed search: very
quick results and accurate information
• Evaluation scores of 8-9/10
Problems with search terms
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•
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•
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Atrial fibrilation
Basal cell epithelioma
Erythema infectiosa
Fiever
Fistulisation
Hydradenitis
Intertigo
Neuronitis
Paulbunnel
Prostate malignancy
Comments from test users 8/2005
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Very user friendly
Easy and adequate access
Useful information
Daily use
Can be used in cooperation with patient
Better search results compared with using
EBMG by entering search terms
Seldom second search needed
Level (ICPC code) needed during encounter
No better search system known
Good cost/benefit balance
Critical comments
• Not always congruent with Belgian or Dutch
Guidelines (e.g. sometimes too much use of
antibiotics)
• Too Anglo-Saxon
• Sometimes too general guidelines - nothing
more than needed during encounter
• No automatic login (first use of the day)
• Problem with ICPC rag-bag (D99, T99):
specific diagnostic label links to other
guidelines
• Create use of ICPC/ICD link (-99 codes)
• Process codes less commonly used
Conclusions
• Indexing guidelines by ICPC codes and
linking directly to the EPR
– enables quick use during patient
encounters
– avoids spelling mistakes when searching
– improves search results
Wishful thinking?
• All primary care journals and expert
systems indexing with ICPC in addition
to keywords
• Guidelines created in ICPC structure
• Uniformity in the use of ICPC codes
• Developing links even more patientoriented (sex/age/history/risk profile)
Future developments?
• Indexing other general or “regional-specific” sites
– Prodigy
– Trip Database
– Dermis
– Clinical Evidence
• Indexing sites in other languages (each in his own country)
– e.g. Diagnostisch Kompas
– NHG standards
• Imaging and investigation sites as guidelines
– (e.g. “consilium radiologicum”)
• Indexing drug information sites with ICPC drug codes or
ATC
• Generating pick up lists with all the quality controlled sites
giving an answer to the physician’s question