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Response to Dr Soler et al.,
- Simon de Lusignan, Chris van Weel (31 July 2006)
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Outlining errors and inaccuracies in this review
- Jean K Soler, Inge M. Okkes (18 July 2006)
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Simon de Lusignan, Senior Lecturer St George's, University of London, Chris van Weel
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Dear Editor, Thank-you for the letter of Dr Soler et al., we will clarify the points they raise. Although they appear to criticise our review of the International Classification of Primary Care (ICPC), we did recognise their work and referenced their publications. Firstly our description of the ICPC fits exactly with the authors of the letter; only we use the phrase “diagnostic and therapeutic procedure” where they use the term “interventions”. We described ICPC as allow recording of: “..reason for encounter, diagnostic and therapeutic procedures and diagnoses.” The authors of the letter as: “…reasons for encounter, the diagnoses, and the interventions.” We think that it is useful that the letter highlights projects that have used ICPC in their second paragraph and how it is being developed through much of the rest of their letter. In our paper we had to draw a line at the level of detail that we could allow to the many databases we reviewed and it is a bit unfair of the letter writers to interpret this as undervaluing of ICPC. One of us (SdL) has co-organised with colleagues from the Netherlands a primary care study the day ahead of the EFMI (European Federation for Medical Informatics) conference in Maastricht in August – to which the authors of this letter would be most welcome and from which they may judge the importance we attribute to the development of ICPC . The scope of our paper was opportunities and challenges for researchers using computer data currently available for research. Whilst we welcome the development of newer versions of ICPC the letter’s authors fully admit that it will take many years for these to become fully operationalised. We feel that these developments were not sufficiently concrete to merit inclusion; such work in progress is difficult to include in a review, though we accept that the authors may feel otherwise. Whilst we respect their advocacy for ICPC and look forward to their work on ICPC coming to fruition and expanding the informatics evidence-base we feel we have given a balanced account of the state of the art. Yours Sincerely, Simon de Lusignon Chris van Weel Conflict of Interest:None declared |
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Jean K Soler, Family Doctor The Family Practice, Attard BZN04, Malta, Inge M. Okkes
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De Lusignan and Van Weel’s contribution to the Medical Informatics Review Series in the March 2006 issue of FP – an overview on an extremely important topic – was unfortunately rather disappointing.1 The article is incomplete and unbalanced in areas, and contains some factual errors, especially (Boxes 1 and 3; Table 3) 1 with regard to describing and assessing the International Classification of Primary Care (ICPC). 2-4 It is important for those of us who are involved with the maintenance and development of ICPC that we set the record straight by listing these inaccuracies and errors. We list some of the most important ones below. 1. ICPC has not been developed as and is not a diagnostic classification for encounter data.5-8 ICPC is meant to document and code episodes of care over time, characterizing the changing relations between the three elements coded for each and every encounter within episodes of care: i.e. the reasons for encounter, the diagnoses, and the interventions. 2. At least five substantial databases, routinely collected from family doctors’ practices, exist that showcase the comprehensive use of ICPC. These have been collected during the Transition Project from: The Netherlands (21 years), Japan (3 years), Poland (five years), Serbia (now 2 years), and Malta (now 5 years).5, 7, 9, 10 Only the Dutch one is mentioned in table 3, although with an incorrect reference (the complete database can be downloaded from http://www.transitieproject.nl ). The five other projects involving the use of ICPC that are mentioned in table 3 1 are based on a use of ICPC for which this classification was not originally developed. The authors should have highlighted this fact, should have discussed the effects of that circumstance on the quality of the data, and could have proffered their thoughts on the utility of (in that sense) incomplete data. In fact, they could have discussed whether in such cases, where ICPC is not used comprehensively, ICD-10 would not have been the preferred classification. 3. The presented bibliographic data on ICPC are riddled with inaccuracies. 1 The authors do not properly refer to ICPC-1, ICPC-2, or to any of its electronic updates, and to top it off, they even do not mention the publication of its most recent update, ICPC-2-R in 2005. 2-4 The latter 4 was presented at the Wonca Asian Pacific meeting in Kyoto, Japan, in May 2005, and it seems incomprehensible that the President-Elect of Wonca, one of the authors, could have missed this. This revision is accompanied by a CD-Rom containing a host of information on the use of ICPC, and data collected using ICPC. 4, 5 This one source should have prevented de Lussignan and Van Weel from making their sweeping statement that ‘the current standards of data collection in family practice are insufficient’. 4. On the CD-Rom mentioned above, 5 an ICPC2-ICD10 Thesaurus, with more than 75,000 diagnostic terms and intended for the use of automatic double-coding within electronic patient records, has been made available. This Thesaurus is included in the Metathesaurus of the National Library of Medicine in the United States of America, and is (since version 2005AA) mapped to the diagnostic concepts in Snomed-CT. Earlier, the same ICPC2/ICD10 structure was mapped to Clinical Terms version 3 (CTV-3). De Lussignan and Van Weel’s discussion concerning the need for granularity in clinical records, and on the strategies to address recording free text could have greatly benefited from addressing these realities. 5. The authors’ remark on chapter Z is erroneous, 1 as it does not reflect on chapter Z in ICPC, but rather on chapter z of ICD10, the latter which will probably be eventually considered for a more detailed mapping to the process codes of ICPC-3. It is our duty to add that the authors give incorrect information about the status of the revision of ICPC-2 towards ICPC-3/ICD-11 within the context of the World Health Organisation’s Family of International Classifications (WHO-FIC). This process is in its infancy, and it is expected to take at least five to ten years before both will be available in an operational form. It is to be expected that the cooperation between Wonca and WHO with regard to the mutual revisions of both classifications will also take considerable time. It seems evident then, that users of ICPC-2-R, whether they use it comprehensively or not, can be quite confident that this classification will be the state of the art for the next ten years. References 1. De Lusignan S, Van Weel C. The use of routinely collected computer data for research in primary care: opportunities and challenges. Fam Pract 2006;23:253-63. 2. Lamberts H, Wood M, eds. ICPC. International Classification of Primary Care. Oxford: Oxford University Press, 1987. 3. ICPC-2. International Classification of Primary Care, Second edition. Oxford: Oxford University Press, 1998. 4. ICPC-2-R. International Classification of Primary Care. Revised Second Edition. Oxford: Oxford University Press, 2005. 5. Okkes IM, Oskam SK, Lamberts H. ICPC in the Amsterdam Transition Project. (CD-Rom). Amsterdam: Academic Medical Center/University of Amsterdam, Department of Family Medicine, 2005. 6. Okkes IM, Becker HW, Bernstein RM, Lamberts H. The March 2002 update of the electronic version of ICPC-2. A step forward to the use of ICD-10 as a nomenclature and a terminology for ICPC-2. Fam Pract 2002;19:543-6. 7. Okkes IM, Polderman GO, Fryer GE, Yamada T, Bujak M, Oskam SK, Green LA, Lamberts H. The role of family practice in different health care systems. A comparison of reasons for encounter, diagnoses, and interventions in primary care populations in the Netherlands, Japan, Poland, and the United States. J Fam Pract 2002; 51(1):72-3. 8. Okkes IM, Lamberts H. Classification and the domain of family practice. In: Jones R, ed. The Oxford Textbook of Primary Medical Care. Oxford: Oxford University Press, 2003. Vol 1: 139-52. 9. Soler JK, Okkes IM. Sick leave certification: an unwelcome administrative burden for the family doctor? The role of sickness certification in Maltese family practice. Eur J Gen Pract 2004;10:50-5. 10. Electronic source: http://www.phckraljevo.org (Accessed May 2006). Dr. Jean Karl Soler, Attard, Malta Dr. Inge Okkes, Amsterdam, The Netherlands Conflict of Interest:None declared |
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