Presented by: Gerry Wheeler on behalf of Claire Collins Irish College of General Practitioners

1. Progress towards the development of a general practice morbidity and epidemiological database in Ireland Presented by: Gerry Wheeler on behalf of Claire Collins Irish College of General Practitioners

2. Study Aim • Feasibility Study in Irish General Practice: • Towards a National Morbidity and Epidemiological Database • Feasibility of: – Consultation Coding – Data Collection – Morbidity and Epidemiological Database

3. Why do we need this capacity?

4. Why do the project? • General practice in Ireland different –Structure –Computer/Software –Data requirements –Coding culture • International evidence on solutions • Stakeholder buy-in

5. Elements • Practice selection and training • Point prevalence study • 18 months of ICPC-2 coding; using standardised instructions • Assessment of reporting capability of PMS systems • Engagement with software vendors, GPIT and GPs • Practice reports and data review • Outline of data considerations • Description of database structure and functionality • International survey and liaison

6. Diagnostic Coding –findings and learning (1) • Variability exists in practice and familiarity - Training - Standardised instructions • Problems with coding systems - Unambiguous; easy collection at point of care - Enhance patient-centred care - Recognise limitations; Supplementary free text

7. Diagnostic Coding –findings and learning (2) • PMS system - Integrated - Thesaurus - Diagnoses and process of care classifications • Biggest obstacle -showing benefit - Flu vaccination - Practice reports - GP and staff buy-in; practice/patient management

8. The practice voice (1) “We would love to see the development of suitable software systems here -coding can do a lot of work for you and improve patient care and safety” 80% of practices requested better integration of coding into software

9. Data collection and extraction –findings and learning • Point prevalence survey • Biggest obstacle -reporting capability of PMS systems - Engagement with vendors - GPIT certification criteria • Practice experience and awareness • Sentinel practice

10. Practice level data -example • 2009: 11,631 consultations; 2,908 per full-time GP in your practice; in respect of 4,135 patients with 5,752 unique presentations • Consultations 1-36; average 2.8; mean 2 per person per year • Patients who attended aged 0-96 years; mean 36.89; median 36 years • 53.2%female 35.5% GMS

11. The practice voice (2)

12. Database –findings and learning (1) • Database structure and functionality requirements - Data transfer-automatically & uploaded manually - Inclusion of direct communication to users - Integrated validation and auditing tools - Reporting mechanism.

13. Database –findings and learning (2) • Build on existing national systems/structures • Data considerations - Minimum dataset - Take account of the complex clinical activity

14. Benefits

15. Where are we now? • Data from participating practices provide a snapshot • Subset of practices continuing to code • Standardised coding instructions available • Software developments & GPIT • Benefit recognise

16. Summary and Conclusions In Ireland Data collection is not widely practiced. The health authority does not know what we do. We do not know what we do. The service providers need to up-grade their software. Doctors are willing to code if they can be shown the real benefits.

17. My Involvement Henk Lemberts did a presentation of Transhis in Dublin in 1995 I computerized in 1996 and did basic ICPC coding I bought the ICPC-2 book I have been to Prof Soler’s Wonca workshops on coding. Prof Soler is coming to Dublin in 2011.

18. My Involvement I want to approach my software provider to upgrade ICPC-2 We are trying to form a small network of GPs We hope to train other interested GPs