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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 ilkka.kunnamo@duodecim.fi Marc Verbeke, MD University of Gent, Belgium WONCA Europe Kos 6.9.2005.

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

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  1. Indexing EBM guidelines with ICPC-2 and linking guidelines to medical records • Ilkka Kunnamo, MD • The Finnish Medical Society Duodecim • Finland • ilkka.kunnamo@duodecim.fi • Marc Verbeke, MD • University of Gent, Belgium • WONCA Europe Kos 6.9.2005

  2. 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

  3. 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

  4. 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

  5. Indexing result

  6. 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

  7. 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

  8. 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

  9. ICPC is not always specific enough • ICPC • D99 Other diseases of the digestive system • ICD-10 • K56.6 Bowel obstruction • E73.9 Lactose intolerance • K85 Acute pancreatitis • K90.0 Coeliac disease

  10. ICPC code found by using Dutch thesaurus

  11. Guidelines searched automatically using the ICPC code as search term

  12. Pilot use by 10 Belgian GPs • Opened articles 1287 • Search 168 • Browse 85

  13. Comments from test users 4/2005 • 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

  14. Problems with search terms • Atrial fibrilation • Basal cell epithelioma • Erythema infectiosa • Fiever • Fistulisation • Hydradenitis • Intertigo • Neuronitis • Paulbunnel • Prostate malignancy

  15. Comments from test users 8/2005 • 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

  16. 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

  17. 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

  18. 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 patient-oriented (sex/age/history/risk profile)

  19. 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

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