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 Updated : June 2001
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
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.Brûlet. (Eds)). Traitement de l'information médicale
par la Classification Internationale des Soins Primaires 2ème 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
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)
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 Congrès 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 BRÛLET Union Professionnelle
des Médecins de la Région Rhône-Alpes 20, rue Barrier 69006 LYON
Mail : jean.francois.brulet@freesbee.fr
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
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
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
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
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@mail.sorostm.ro
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
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
http://www.ulb.ac.be/esp/wicc/icpc_2001.html
