ICPC use in the European Community
Prepared by Dr Marc Jamoulle for the WONCA International Classification
Committee at the 16th WONCA World Congress of Family Doctors, Durban, South
Africa,13th to the 17th May 2001.
Family Medicine and
Primary Care unit,
Public health school, Free University of Brussels, May 2001
Paper edited on http://www.ulb.ac.be/esp/wicc/icpc_2001.html
Links to
ICPC bibliography, to the
WICC Glossary
Introduction
ICPC use is rapidly growing in Europe and is
now implemented in many EMR's. It is also used at national level in Norway,
The Netherlands and Belgium. Listed below are the main initiatives and known
research projects and applications in Europe. Research using ICPC has been
well developed for many years in The Netherlands and is rapidly growing in
France and Romania. It's difficult to give a precise estimate of the use of
ICPC in day to day practice. ICPC is the de facto standard for Primary Care
and for emergency out patient clinics data retrieval. Underreporting of its
use is therefore expected. Please have a look at the ICPC bibliography (http://www.ulb.ac.be/esp/wicc/icpc_ref.html
) to obtain a deeper understanding of ICPC. Please feel free to contact the
author (marc.jamoulle@ulb.ac.be)
in order to modify the Internet published text or to add your contribution.
Be
Belgium /
Dk Denmark /
Fi Suomi/Finland /
Fr France /
Gr Greece /
Ma Malta /
Nl The Netherlands /
No Norway /
Ro Romania /
Sp Spain /
Ch
Switzerland
Belgium
ICPC / CISP has been chosen by the Belgian Federal Ministry of Health as a
criteria of first importance for the labelling process of Electronic Medical
Records (EMR) for general practice in Belgium. ICPC use will not be mandatory
but will become a deciding factor in obtaining the Federal quality label for
GP's EMR systems. The Federal ministry of health as also given a grant to two
university departments of general practice (RUG and ULB) for them to develop
and implement a bilingual (French and Dutch ) ICPC coded and ICD9 / ICD10
mapped electronic terminology. The Belgian state is considering the purchase
of a WONCA licence for ICPC
Contact ; Dr Marc Jamoulle, rue Frere Orban 94, B-6040 Jumet, Belgium
Mail :
marc.Jamoulle@ulb.ac.be
o
ICPC in Belgian
national health interview surveys (1997 and 2001)
The objectives of the
national health interview surveys
organised in 1997 and 2001 are identification of health problems, description
of the health status and health needs of the population, estimation of
prevalence and distribution of health indicators, analysis of social (in)equality
in health and access to the health services, study of health consumption and
its determinants, study of possible trends in the health status of the
population ICPC-1 has been in use in the 1997 study and ICPC-2 (French and
Dutch version) shall be in use in the 2001 survey performed by the
epidemiology section of the Belgian Scientific Institute Of Public Health
Contact ; Dr J. Tafforeau
Mail ;
jean.tafforeau@iph.fgov.be
-
Use of ICPC
in Flanders (Dutch speaking part of Belgium)
In 1989 Jan De Maeseneer published his Ph.D. thesis "General practice: an
exploration: an exploratory, descriptive study". In this thesis, for the first
time in Belgium, ICPC-1 has been used for description of the activities in
general practice. In 1992, Anselm Derese published his thesis on the work of
trainees in general practice, and used also ICPC-1 for description of the
encounters. At the level of the practice-registration, some EMD-software
packages are using ICPC-1.
In the year 2000, the Department of General Practice and Primary Health Care,
Ghent University, has contributed to the Dutch translation of ICPC-2,
published actually as a book (Anonymous.
ICPC-2-NL: Nederlandse versie - Utrecht, Nederlands Huisartsengenootschap,
2000).
In March 2001 an educational package has been developed together with the
scientific organisation of Flemish general practitioners (WVVH)
and the universities. The package follows the implementation-rules for
GP-software as they are actually discussed at the level of the federal
government. The aim is to train medical students, trainee general
practitioners and the GPs themselves in the use of the electronic medical
record, using episode based registration and ICPC-2 classification. There is
also a link to ICD-10.
In Flanders there is a consensus that in the future all registration in
general practice and all GP-software packages will be structured based on
ICPC-2, in the framework of episode-oriented registration. Actually the
Department of General Practice and Primary Health Care contributes the
development of a Flemish thesaurus for the ICPC-2
Contact ; Dr Jan De Maeseneer
Mail ;
jan.demaeseneer@rug.ac.be
o
ICPC in day to
day care in French speaking Belgium
ICPC is currently included in several EMRs.
Various health centres, participating to the Belgian French speaking
organisation "
Fédération des Maisons Médicales"
are using ICPC as a quality assurance and research tool in day to day practice
Contact ; Dr Michel Roland, Fédération des
Maisons médicales, Bld du Midi 25, B-1000 Brussels Belgium
Mail :
Michel.Roland@ulb.ac.be
o
The CISP-2
(French ICPC-2) book is published in Belgium
The non profit association "Care Editions, asbl", based in Waterloo, Belgium,
has recently (Jan. 2001) published the CISP-2 book (M.Jamoulle, M.Roland,
J.Humbert, JF.Brűlet. (Eds)).
Traitement
de l'information médicale par la Classification Internationale des Soins
Primaires 2čme version (CISP-2), assorti d'un glossaire de médecine générale,
préparé par le Comité International de Classification de la WONCA.
Care Edition, Bruxelles, 2000
Contact : This book is available through the website;
http://docpatient.net/care
o
The CISP-Club,
the club of the ICPC fans
The French speaking association of the users of CISP (French ICPC) is located
in France but its president, Dr. Marc Jamoulle, works in Belgium. The CISP
Club is a meeting point for researchers in data gathering and coding in
Primary Care in the French speaking world. The CISP Club has members in
France, Belgium, Tunisia, Rumania and Switzerland. The CISP club is very
active though its mailing list, its website and its annual workshop. Please
refer to
www.ulb.ac.be/esp/cisp
for more information.
o
Extended Danish
ICPC (ICPC-E).
A small part of ICD-10, that is relevant to general practise, has been
accommodated within ICPC .This is a useful tool for diagnosis registration and
quality development using the Extended Danish International Classification of
Primary Care (a pilot study).
o
Continuous
morbidity registration
Aim: To describe the disease patterns in general practice using ICPC coding
and at the same time make it possible for individual general practitioners
(GP) to compare practice pattern with each other and compare their management
as exemplified by diabetic patients. Method: In a 3 month period in 1999, 14
GPs from 6 practices coded all their patient encounters with diagnosis, using
ICPC. Feedback was given to each GP about disease- and contact pattern of
their patients and selected parameters as for instance HbA1c, serum
cholesterol and blood pressure. A list of identified patients with sub-optimal
management was send to the GP as well.
o
Perspectives.
When using ICPC-2-E every diagnoses has an ICPC code as well as a
corresponding ICD-10 code in the electronic medical record. This provides good
opportunities for research and quality development across the primary and
secondary health sector
Contact : Dr Eric Falkoe University of Odense, Dep. of General practice
Winslowparken 19 3rd floor Dk-500O Odense
Mail
e-falkoe@dadlnet.dk
Finland
o
ICPC has been used in research and demonstration projects from 1985 to 1998.
Through these demonstration projects over half of Finnish GPs have tried ICPC.
According to a survey among GPs in 1998, ICPC works well in primary health
care and is more feasible than ICD-10. In the demonstration projects and in
health centres actively using ICPC, over 95 % of the encounters get coded,
whereas 50 % or less are coded in centres using ICD-10.
ICPC is used in Finland in 5-10 Healthcare Centres which are responsible for
the public primary health care in the areas where they are located. This is
only a few percent of the population. The Student health care organisation,
which is a private fund which gives health services to the majority of
university students in Finland for a very low yearly charge, is using a
combination of ICPC and ICD-10 for diagnosis coding.
Helsinki, Espoo and Vantaa the tree largest cities have been interested in
ICPC, but for technical reasons the pilot projects have not been very
successful. It is important to note that it is not obligatory on a national
level to collect any diagnostic information from primary care. The units using
ICPC are a substantial proportion of the primary care units collecting
diagnostic information systematically.
Contact : Dr Martti Virtanen (martti.virtanen@nordclass.uu.se)
or Dr Matti Liukko (Matti.Liukko@Kuntaliitto.fi)
France
o
The Sentinel
Surveillance of Referral to Hospital in French Primary Care
Methods: A follow-up outcome study nested
within a surveillance system of hospital referrals
performed by GPs from the French Sentinel network since July 1997. Data on
each referral to hospital are collected by Sentinel GPs and transmitted on a
weekly basis via tele-informatics (Internet or Minitel) to the database
centre, where systematic quality control is performed. In particular, reason(s)
for referral are entered in a free-text format, and subsequently coded
according to the ICPC classification, using an automated tool based on string
matching specifically developed to that end. Each reported case of
complication that occurred within 30 days of discharge has been investigated
through a telephone interview with the GP and the responsible hospital
physician. This project was covered by an overall approval of the French
Commission Nationale de l'Informatique et des Libertés (CNIL) allowing surveys
to be conducted on the Sentinel system.
Results: Since July 1997, 12 000 referrals to hospital have been individually
described by 305 GPs. This system provides information on the characteristics
of patients referred to hospital and on the circumstances of the referral,
including the reason(s) for referral. By using the statistical procedures
applied on the Sentinel system for the incidence estimation of communicable
disease, we could estimate that around 1.3 million hospital admissions result
each year from GPs' referrals, which accounts for 10 % of all admissions in
French hospitals. Moreover, we observed a seasonal variation in GPs' hospital
referrals, with a regular increase during summer. Ninety-two cases of
nosocomial complications have been reported and investigated during the first
two years of the project, including 21 nosocomial infections, 31 adverse drug
reactions and 40 complications of other type. We estimated at 1.2 per thousand
admissions (95%CI, 1.0-1.5 per thousand) the rate of nosocomial adverse events
detected in general practice within 30 days of discharge.
Contact Dr
Laurent Letrilliard
Mail :
l.letrilliart@wanadoo.fr
o
The ICPC in an
emergency call centre in Bordeaux
Medical practitioners of "Centre 15 Gironde" has studied the feasibility of
using CISP (French ICPC) in an emergency call centre as a coding an assessment
tool . A terminological database of the usual emergency term has been
extensively developed and tested.
The study has been presented at the recent Congrčs de recherche en Médecine
générale in Biarritz under the title ;
Maryse
Bonnet, Arnaud Castets, Philippe Moreaud, Philippe Souleau, médecins
régulateurs libéraux de l'ASSUM 33. Adaptation de la CISP (Classification
Internationale des Soins Primaires) au travail de régulation médicale du
Centre 15 Gironde (http://www.urmla.org/programme.htm)
Contact Dr
Maryse Bonnet or Dr Luc Ribeton
Mail :
m.bonnet33@wanadoo.fr luc.Ribeton@wanadoo.fr
o
Classification survey in Paris
Studying ICPC as a coding tool is on the agenda of the
URML IDF
the French medical professional association "Unions Régionales des Médecins
Libéraux de l'Ile de France" That's means that GPs should begin to classify
and code data in general practice in 2001 with the help of various members of
the CISP Club.
Contact : Dr Bernard Ortolan URML IDF Bld Montparnasse Paris
Mail :
b.ortolan@wanadoo.f
o
Episodus in
Lyon
The Episodus project is the fruit of research on classifications, semantic,
ergonomic medical data gathering and epidemiological treatment of data.
Episodus is being developed by the French medical professional association "Unions
Régionales des Médecins Libéraux" of Lyon
and will be placed under
Open Source Licence.
It encompasses the gathering, organisation and treatment of information
recorded during the medical consultation. This information, classified
primarily with ICPC, is organised into episodes of care. The episodes are
entered into a central computer, and are then ready for use in quality
assurance by feedback to the practitioner and for epidemiological research.
The practitioner would have many rewards from Episodus to assist his work, the
first being the very short time spent for gathering, coding and organising the
data, and the second the ergonomic and user friendly software system.
Contact :
Dr Jean François BRŰLET Union Professionnelle des Médecins de la Région
Rhône-Alpes 20, rue Barrier 69006 LYON
Mail :
jean.francois.brulet@freesbee.fr
Greece
o
The use of classification systems is generally quite limited in general
practice in Greece. ICPC-1 was translated into Greek in 1992. As a result of
the continuing efforts of the Clinic of Social and Family Medicine, University
of Crete and the Anogia Health Centre, an electronic patient record database
named "Fakelos" was created and used in several primary care centres in Crete
and in Greece. ICPC-1 together with ICD-9 is used in this program. Recently,
another joint effort of the University of Crete and the Greek Association of
General Practitioners aims to translate the ICPC-2-E into Greek. The
evaluation of a computer program based on the ICPC-2 and Episodes of Care is
also in progress. The objective of this latter effort is for it to be
implemented in all Primary Health Centres of Greece. A general conclusion is
that the ICPC-2E is the most suitable classification for general practice in
Greece. Special cases, like referrals to hospitals and specific diseases, are
very well handled with the ICPC-2 to ICD10 conversion.
Contact,
Kounalakis Dimitris Mail :
dcoun@galinos.med.uoc.gr
Malta
o
The
Malta College of Family Doctors
has accepted ICPC and ICPC-2 as the standard classification for Maltese
General Practice. The College is currently encouraging use of ICPC in
electronic medical records. A group of doctors is using TRANSHIS, an ICPC
based software in their day-to-day practice.
Contact : Dr. Jean Karl Soler MD "Josephine", St. Catherine Street, Attard BZN
04, Malta.
Mail:
jksoler@synapse.net.mt
The
Netherlands
o
National level
ICPC has been mandatory in EMRs for several years. In the Netherlands more and
more GP's are familiar with and use ICPC. It is obligatory for GP trainees to
learn about it. Education materials and examinations for GP qualification are
organised around ICPC codes. When research is done in practices it is not
difficult to get the data from the GPs and they are willing to code the data
in ICPC. For example research to the health effects of the firework-disaster
in 'Enschede' had all 40 GP's there code all their consultations. There is
ICPC training available across the country. The NHG published a new CD-rom
called EVS (electronic prescription system), which is based on ICPC codes and
many GP's are happy to use it. See NHG website
http://www.artsennet.nl/ (click NHG click EVS) Computer
software systems are a major problem. Almost all developers are threatened
with bankruptcy and therefore the national GP organisation is considering the
development of a non commercial software system. This is still under
consideration.. Meanwhile no new updates are available for commercial systems
and GPs have to manage with out-dated systems.
Note by Marga Vintges, MD
Mail :
marga.vintges@planet.nl
o
The Transhis
project, Department of General practice, University of Amsterdam
TRANSHIS is an episode oriented, ICPC based
software developed at the Department of General practice of the
UVA
(Prof Henk Lamberts).
TRANSHIS is currently implemented in research centres in The Netherlands,
Malta, Poland, Greece, Japan and USA.
Contact : Prof Lamberts, MD, Phd. Meibergdreef 15, AZ Amsterdam
Mail :
h.lamberts@amc.uva.nl
o
The Registration
Network Family Practices
On 1 December 2000, the RNH (Registration Network Family Practices)(www.unimaas.nl/~rnh)
consisted of 55 general practitioners in 21 practices covering approximately
100.000 patients. In all practices computerised health information systems
were installed, replacing the hand written records. Classification: The set of
patient characteristics to be registered is well defined. There is a clear
definition of "a relevant health problem". All problems are coded using the
International Classification of Primary Care (ICPC) using the criteria of the
International Classification of Health Problems in Primary Care (ICHPPC-2
Defined), if appropriate. Structure of the data: On 1 September 2000 patient
characteristics and problem lists for 82.411 patients (women 51.2%) had been
entered in the database. A total of 341.800 problems have been identified for
these patients: 188.219 (55.1%) active and 153.381 (44.9%) inactive.
Contact: Dr Job Metsemakers, Department of General Practice, Maastricht
University PO 616, 6200 Maastricht, The Netherlands
Mail :
job.metsemakers@hag.unimaas.nl
o
Netherlands
Information Network in General Practice (NIN GP)
Aim of NIN GP (
http://www.linh.nl/index.htm
) is to collect national, representative data on GP care. The data are used
for health services research and quality-of-care research. Continuously,
morbidity data are gathered on GP's patient list, consultations, prescriptions
and referrals. Ad hoc extra registrations around specific subjects also take
place (influenza vaccination, cervical screening, low back pain, diabetes).
123 computerized practices using five different GP information systems
participate in NIN GP involving 228 general practitioners with a total of
about 450.000 listed patients. The network mirrors the national distribution
of the population according to age, sex, type of insurance, region and degree
of urbanization. Morbidity is classified with the ICPC, prescriptions with the
ATC classification system.
Data are used in several monitoring projects: process data in general
practice, influenza vaccination, cervical cancer screening and the
introduction of electronic formularies. Other types of studies that take place
are state-of-the-art studies (prescribing of Ritalin, repeat prescribing,
prescribing of benzodiazepines in general practice), guideline adherence
studies (low back pain, diabetes), development of quality indicators,
evaluation of policy measures (i.e. reduction of insurance coverage for self
care medication). In 2000/2001 the Second Dutch Morbidity study is undertaken
within the framework of NIN GP (in 104 practices). Based on an extensive
research program extra data are collected on: morbidity in all consultations
during one year (with episode construction), socio-demographic data of all
listed patients, experienced health and health behaviour among a sample of
patients and doctor-patient communication by video taping one day per GP.
Contact : Mr Dinny Debakker, Phd Netherlands Network of General Practitioner
Drieharingstraat 6 Postbus 1568 Utrecht , The Netherlands
Mail : dinny.debakker@nivel.nl
Norway
o
ICPC is in use in GP/FM and Occupational medicine in Norway since 1992.
An official standard for the EMR has been developed, but is only partially
implemented. All the information GPs need on the bill to collect money from
the social security system, are standardised and in place in all EMR software.
These data include: unique person identifier of the patient, sex, date of
birth, address, encounter (date, time, type), diagnoses (ICPC) and many
processes
o
In October this year Norway Statistics will run a pilot collecting data from
EMR in general practice. The project is a continuation of previous work.
Contact : Anders Grimsmo, Dep of Community Health and General Practice, Skei,
N-6656 Surnadal Norway
Mail:
anders.grimsmo@medisin.ntnu.no
Romania
o
The Romanian Society of Family Medicine / General Medicine has received a
copyright license to translate and use the ICPC. The book ICPC-2, with
corrections from ICPC-2-E has been translated into Romanian and edited. (http://www.ispt.ro/medinet/
press ICPC-2). ICPC-2 is used in the software MEDINS, made and used in the
Sentinel Station Network, GP-Medinet, involving 100 GP's from all around the
country. The project began with ICPC-2000 (where the infrastructure was
prepared for the Sentinel Station Network) and continues with GP-Medinet
Project (2000-2002) with registration of patient data. Doctors began the pilot
registration of data on 1 April 2001, and continued until 30 September 2001.
Data are transferred monthly by each doctor to a central server using the
Internet.
The software Medins use ICPC codes for RFE and symptoms. For diagnosis the
codification begin with ICPC codes and is finished with ICD-10 codes (double
coding, because ICD-10 is more specific). For procedures internal codes are
used which are then translated into ICPC-2 codes.
Contact : Marius Marginean: National Coordinator of Romanian Sentinel Station
Network Str.Lidia 37 Timisoara Romania
Mail :
mmarginean@medfam.ro
Spain
o
National level
In Spain ICPC is well known both in practice and research. ICPC-1 is still in
use in a software program in public health centres. Some researchers have used
it in emergency care. The future is problematic because of the strong
influence of case-mix classification with ICD-9-CM. There are translations of
ICPC 1 and 2, both published by Masson, into Spanish and Catalan. ICPC-1 is
used in Andorra.
Contact : Juan Gervas, MD, PHD Equipo Cesca, Madrid
Mail :
jgervasc@meditex.es
o
ICPC in
Catalonia.
ICPC is the most used classification in Primary Care in Catalonia and all
around Spain, but this does not mean that is used very much. ICPC is not
widely known and used, and research is still the main reason for use. As the
telematics is increasingly available in practices, this situation will change
dramatically. The most common software programs for managing patients and
health centres use ICPC to classify diseases as well as a translating to
ICD-9-CM. This will allow large and comparable databases in the near future.
Contact : Sebastian Juncosa
Mail :
sjuncosa@sapcll.scs.es
Switzerland
o
Dr Brunner,
president of the
Swiss Medical Association
has recently (Feb. 2001) announced that ICPC, ICD10 and ICIDH would be the
leading coding systems for EMRs in Switzerland. ICPC is used on a daily base
in the outpatient clinic of the
Hopitaux Cantonaux de Genève.
Dr Laura Pult has recently published a paper on this subject in Médecine et
Hygiène, a French medical review. After studying 1600 reasons for encounter
annotated in free text, a terminological software has been designed allowing
to retrieve easily and in a standard way the reasons for encounter in the
emergency outpatient clinic of the Hopitaux Cantonaux de Genève. Feasibility
study of the day to day coding is under way.
Contact ; Dr Laura Pult
Mail :
laura.pult@dim.hcuge.ch
o
Dr Vincent
Griesser of the Hopitaux Cantonaux de Genève
has invited
the next CISP Club workshop in Neuchatel
in November 2001.
Contact ;
Dr Vincent Griesser
Mail :
Vincent.Griesser@hcuge.ch