MRS ADEN WANTS TO SEE YOU TODAY….

1. MRS ADEN WANTS TO SEE YOU TODAY…. A housecall for a 73-year old lady with increasing stomach pain since a week, and vomiting since this morning Henk Lamberts & Inge Okkes

2. DEMONSTRATING: • TRANSHIS-WINDOWS AS AN EPR (ELECTRONIC PATIENT RECORD) • PRIOR AND POSTERIOR PROBABILITIES FROM ‘EPISODES IN FAMILY PRACTICE’ (EFP & EFP-EXTENDED) • THE ICPC-2/ICD-10 THESAURUS AS A TOOL FOR CODING. all to be downloaded for free from: www.transitieproject.nl

3. PRESENTING: • MRS. ADEN’S MEDICAL HISTORY AS REPRESENTED IN THE EPR TRANSHIS-WINDOWS • SEX/AGE SPECIFIC PRIOR PROBABILITIES FROM EFP-EXTENDED • POSTERIOR PROBABILITIES FROM EFP AND EFP-EXTENDED • USE OF THE ICPC-2/ICD-10 THESAURUS

4. 1.MRS. ADEN’S MEDICAL HISTORY AS REPRESENTEDIN THE EPR TRANSHIS-WINDOWS

5. THE OPENING PAGE OF MRS. ADEN’S MEDICAL HISTORY IN THE EPR: IN PRACTICE 1989-2007; LIVING TOGETHER WITH HUSBAND AND GRANDCHILD; NUMBERS AND AVERAGES PER YEAR OF ENCOUNTERS, EPISODES, REFERRALS, MEDICATION AND MEASUREMENTS.NOTE: when working with this program after downloading, you may switch to English under ‘Options’. Under ‘Help’ you’ll find more about the structure of the EPR on the basis of an artificial, anonymous database without free text, with approx. 1000 patients

7. MRS. ADEN’S EPISODE LIST95 episodes, 71 different ones, 24 recurrences

8. MRS. ADEN’S PROBLEM LIST21 important and/or recent episodes derived from her episode listNote: most FPs use this as their standard opening screen for a patient

9. HER MEDICATION LIST OVER THE LAST 5 YEARS: 41 prescriptions, 16 different drugs

10. RESULTS OF HER MOST RECENT BLOOD TESTS (ABNORMAL ONES IN RED)111 total, 36 different types

11. BROWSING HER HEMOGLOBIN TESTS

12. BROWSING HER ENCOUNTERS FOR EPISODE T90 (DIABETES)

13. ALL REFERRALS OF MRS. ADEN TO SPECIALISTS AND PRIMARY CARE PROVIDERS, WITH THE POSSIBILITY TO BROWSE

14. 2. SEX AND AGE SPECIFIC PRIOR PROBABILITIES FROM EFP-EXTENDED, WHICH INCLUDES 142.159PATIENT YEARS, DOCUMENTED FOR 24.730 LISTED PATIENTS IN 10 PRACTICES, JANUARY 1995 - DECEMBER 2004

15. AVAILABLE EXPLANATORY INFORMATION FOR THE USE OF EFP (TASK BAR)

17. DISTRIBUTION OF EPISODESPER PATIENT YEAR

18. PRIOR PROBABILITIES:TOP20 INCIDENT (NEW) EPISODES IN WOMEN 65-74 YRS (p1000py)

19. PRIOR PROBABILITIES:TOP20 PREVALENT EPISODES IN WOMEN 65-74 YRS (p1000 py)

20. PRIOR PROBABILITIES:TOP 20 REASONS FOR ENCOUNTER (SYMPTOMS/COMPLAINTS) AT THE START OF AN EPISODE IN WOMEN 65-74 YRS (p1000 py)

21. PRIOR PROBABILITIES: TOP 20 SYPTOMS/COMPLAINTS FROM HISTORY TAKING AT THE START OF AN EPISODE IN WOMEN 65-74 YRS (p1000py)

22. PRIOR PROBABILITIES:TOP 20 FOLLOW UP REASONS FOR ENCOUNTER (NOW MAINLY REQUESTS FOR AN INTERVENTION!) IN WOMEN 65-74 YRS (p1000 py)

23. PRIOR PROBABILITIES:TOP 20 INTERVENTIONS IN WOMEN 65-74 YRS (p 1000 py)

24. PRIOR PROBABILITIES:TOP 20 MEDICATION (PDD’S) WITH ATC 5-DIGIT CODES FOR WOMEN 65-74 YRS (p 1000 py)

25. PRIOR PROBABILITIES:TOP 20 TESTS IN WOMEN 65-74 YRS (p 1000 py)

26. PRIOR PROBABILITIES: TOP 20 TESTS WITH ABNORMAL RESULTS (33% OVERALL)

27. PRIOR PROBABILITIES:TOP 20 REFERRALS TO A SPECIALIST/HOSPITAL (women 65-74 yrs p1000py)

28. AND NOW: BACK TO THE ELECTRONIC PATIENT RECORDAND DATA ENTRY OF A NEW ENCOUNTER FOR MRS ADEN

29. DATA ENTRY FOR THE FIRST ENCOUNTER FOR A NEW EPISODEIN MRS. ADEN’S EPR: CHOLECYSTITIS/CHOLELITHIASIS, CODE D98(With additional free text)

30. AUTOMATIC SAFEGUARDING CORRECT DOCUMENTATION OF EPISODES: WARNING WHEN FP TRIES TO ERRONEOUSLY CHOOSE: ‘OLD EPISODE’

31. AUTOMATIC SAFEGUARDING CORRECT DOCUMENTATION OF EPISODES: WARNING WHEN FP TRIES TO ERRONEOUSLY CHOOSE: ‘NEW EPISODE’

32. PRIOR PROBABILITIES:INCIDENCE AND PREVALENCE OF D98, CHOLECYSTITS/CHOLELITHIASIS

33. MODIFICATION OF THE DIAGNOSIS D98 OCCURS, OVER TIME,IN 25% OF CASES

34. REASONS FOR ENCOUNTER AT THE START OF AN EPISODE OF D98 (PRIOR PROBABILITIES OF THE DIAGNOSIS, GIVEN A PRESENTING SYMPTOM/COMPLAINT)

35. PRIOR PROBABILITIES: TOP 20 ABNORMAL TEST RESULTS FOR EPISODE D98

36. 3.POSTERIOR PROBABILITIES FROM EFP AND EFP-EXTENDED

37. POSTERIOR PROBABILITY OF THE DIAGNOSIS D98 AT THE START OF AN EPISODE WITH THE PRESENTING REASON FOR ENCOUNTER D06 (LOCALIZED ABD.PAIN)Data from EFP

38. POSTERIOR PROBABILITIES:ODDS RATIOS FOR THE DIAGNOSISD98 (CHOLELITHIASIS/CHOLECYSTITIS)Data from EFP-Extended • Abdominal pain-generalized: 7 • Abdominal pain localized: 20 • Stomach pain: 12 • Chest pain: 2 • Back pain: 1 • Nausea: 7 • Vomiting: 5 • Fever: 0,5 • Gallstones: >100 • Jaundice: 0 (no cases in EFP-Extended)

39. TOP 20 COMORDIDITIES FOR ALL PATIENTS WITH THE DIAGNOSIS D98 (POSTERIOR PROBABILITIES: ODD’S RATIOS)Data from EFP

40. POSTERIOR PROBABILITIES:ANNUAL COMORBIDITY BETWEEN CHOLECYSTITIS/CHOLELITHISASIS (D98) AND DIABETES (T90)Data from EFP

41. THE USE OF PRESCRIPTOR, THE PRESCRIBING MODULE, FOR D98

42. 4. USE OF THE ICPC-2/ICD-10 THESAURUS THE RELATIONS OF ICPC WITH: • ICD-10 • ICD-9-CM • SNOMED-CT (AS INCLUDED IN UMLS)

43. AUTOMATIC DOUBLECODING WITH THE ICPC2/ICD10 THESAURUS

44. 30 DIAGNOSTIC TERMS IN ICD-10 TO CHOOSE FROM FOR THE ICPC CODE D98: CHOLECYSTITS/CHOLELITHIASIS

45. ICPC CODE D98 IN ICD-9-CM AND READ-CODES(cont’d in next slide)

46. ICPC CODE D98 IN ICD-9-CM AND READ-CODES(cont’d from last slide)

47. SELECTION FROM THE METATHESAURUS OF UMLS (NLM) INCLUDING THE FOLLOWING CLASSIFICATIONS (TREE BROWSER)

48. 20 ATOMS IN THOSE CLASSIFICATIONS FOR ICPC CODE D98

49. THIS PRESENTATION WAS GIVEN AT THE CONFERENCE ‘HARMONIZING PRIMARY CARE CLINICAL CLASSIFICATION AND DATA STANDARDS’, HELD OCTOBER 10TH AND 11TH, 2007 IN WASHINGTON, DC. IT WAS MEANT TO ILLUSTRATE THE THREE MAJOR AREAS OF USEFULNESS OF THE ROUTINE CODING OF THE CONTENT OF ENCOUNTERS IN AN EPISODE OF CARE STRUCTURE, USING ICPC, WHICH ARE….

50. 1. The data allow FPs to precisely document and easily retrieve the medical history of their patients, which is essential for daily practice. The clinical interpretation of these data by an individual FP underpins decision making for an individual patient.