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October 2016 | Version 3.2

ICPC-2 PLUS FUNCTIONALITY REQUIREMENTS FOR DEVELOPERS

National Centre for Classification in Health

Faculty of Health Sciences

University of Sydney

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This booklet is designed to provide the information needed to incorporate ICPC-2 PLUS into computerised clinical systems.

If you have any questions regarding the application of ICPC-2 PLUS in your software, please contact us using the details provided below.

Contacts ICPC-2 PLUS Team

Address National Centre for Classification in Health

University of Sydney

PO Box 170, 75 East Street

Lidcombe NSW 1825

Phone: +61 9351 9772

Fax: +61 9351 9603

Email: [email protected]

Website: http://sydney.edu.au/health-sciences/ncch

ICPC-2

© World Organisation of National Colleges, Academics and Academic Associations of General Practitioners/Family Physicians

ICPC-2 PLUS

© University of Sydney, 1998

mailto:[email protected]


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Table of contents Table of contents ................................................................................................................ 2

1. Introduction .................................................................................................................. 3

1.1 Classifications and coding systems ....................................................................... 3

1.2 Structure of ICPC-2 ............................................................................................... 4

1.3 Explanation of ICPC-2 PLUS codes ...................................................................... 5

1.4 Structure of ICPC-2 PLUS terms ........................................................................... 6

1.5 Advantages of using ICPC-2 PLUS ....................................................................... 6

1.6 Obligations regarding end users ........................................................................... 6

1.7 Updates of ICPC-2 PLUS ...................................................................................... 8

1.8 Demonstrator ........................................................................................................ 8

1.9 Glossary ............................................................................................................... 9

1.10 Further information ...............................................................................................10

2. Data entry ...................................................................................................................11

2.1 Background ..........................................................................................................11

2.2 Table Description .................................................................................................11

2.3 Field descriptions .................................................................................................12

2.4 Entity Relationship Diagram .................................................................................13

2.5 Functionality requirements ...................................................................................14

2.6 Temporary codes .................................................................................................16

3. Supplementary information for data entry ....................................................................17

3.1 Natural Language ................................................................................................17

3.2 Inactive codes ......................................................................................................18

4. Additional reference material on ICPC-2 .....................................................................19

4.1 Background ..........................................................................................................19


4.3 Field descriptions .................................................................................................20


4.5 Use of ICPC-2 reference tables ...........................................................................22

4.6 Functionality requirements ...................................................................................22

5. Data reports ................................................................................................................23

5.1 Background ..........................................................................................................23



5.4 Use of grouper files for data output ......................................................................27

5.5 Additional grouper for use with the PEN Clinical Audit Tool .................................32

6. Map from ICPC-2 PLUS to ICD-10-AM, 9th edition ......................................................34

7. Object identifiers for ICPC-2 and ICPC-2 PLUS ..........................................................36

8. Information for users ...................................................................................................37

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1. Introduction

1.1 Classifications and coding systems

The International Classification of Primary Care, Version 2 (ICPC-2)

Classifications organise information into logical groups and facilitate the timely and accurate collection and analysis of grouped data. The International Classification of Primary Care (ICPC-2) is a classification designed for primary care, or general practice. It was developed by the World Organisation of Family Doctors (Wonca), and classifies information in primary care relating to:

reason(s) for encounter (why the patient has come for the consultation)

problems managed

diagnostic and therapeutic interventions, including: o procedures o referrals o pathology tests o imaging orders.

ICPC-2 is a related member of the World Health Organisation’s Family of International Classifications.

ICPC-2 is an excellent epidemiological tool. It logically groups conditions that are commonly found in general practice, using body systems as the primary identifier. This facilitates meaningful data analysis. However, ICPC-2 has only 1,380 codes, and as such is too broad to accurately code specific individual conditions. For this reason, the former Family Medicine Research Centre (FMRC) at the University of Sydney created ICPC-2 PLUS, a clinical terminology classified to ICPC-2. ICPC-2 PLUS is designed for use in Australian general practice electronic health records (EHRs).

ICPC-2 PLUS

ICPC-2 PLUS is an interface terminology classified to ICPC-2, developed using over 1.8 million general practice encounter records. ICPC-2 PLUS is a coding system. It has been designed specifically for use in electronic health records, and includes terms that are commonly used in Australian general practice. It is used in numerous commercially available software packages, and in various research projects.

In your clinical system, ICPC-2 PLUS can be used to enter data relating to reasons for encounter, problems managed and treatments provided, in more specific terms than available in ICPC-2. Data stored in medical records can then be extracted for data reports, at varying levels of specificity.

For more information on classification and coding, refer to your User’s Guide. Copies of the User’s Guide can be downloaded from our website: http://sydney.edu.au/health-sciences/ncch/icpc-2-plus/end-users.shtml

http://sydney.edu.au/health-sciences/ncch/icpc-2-plus/end-users.shtml

http://sydney.edu.au/health-sciences/ncch/icpc-2-plus/end-users.shtml

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1.2 Structure of ICPC-2 ICPC-2 has a bi-axial structure, with 17 chapters on one axis (each with an alphabetic code) and seven components on the other (numeric codes) (see Figure 1). Chapters are based on body systems, with additional chapters for psychological and social problems. Component 1 includes symptoms and complaints, while Component 7 covers diagnoses and diseases. These are independent in each chapter and both can be used for patient reasons for encounter and for problems managed.

Components 2 to 6 are common throughout all chapters. The processes of care, including referrals, non-pharmacological treatments and orders for pathology and imaging are classified in these process components of ICPC-2.

Component 2 (diagnostic screening and prevention) is also often applied in describing the problem managed (e.g. check-up, immunisation).

Components A B D F H K L N P R S T U W X Y Z

1. Symptoms, complaints

2. Diagnostic, screening, prevention

3.Treatment, procedures, medication

4. Test results

5. Administrative

6. Other

7. Diagnoses, disease

A

General

L

Musculoskeletal

U

Urinary

B Blood, blood-forming N Neurological W Pregnancy, family planning

D Digestive P Psychological X Female genital

F Eye R Respiratory Y Male genital

H Ear S Skin Z Social

K Circulatory T Metabolic, endocrine, nutritional

ICPC-2 PLUS code ranges for management

Within the ‘process’ components, ICPC-2 codes can be further broken down into specific types of care. These groups can then be used to limit the ranges of codes available in different fields within your software. There are two ways this can be done:

1. Generic management fields – if you have a single ‘management’ field in your record. Within this field, any ICPC-2 PLUS code within the ranges of -30 to -69 could be entered (see Table 1 for explanation).

2. Specific management fields – multiple management fields may be available in your software. If you wish, you can limit the user to enter codes for specific management types only in the ‘correct’ fields. For example, using this option, codes for pathology tests could only be entered in the pathology field(s) in the record.

If you choose to implement Option 2, code ranges are provided in Table 1 for the specific types of management. Limit users to enter data only from the rubrics provided in the table.

Figure 1: The structure of the International Classification of Primary Care, Version 2 (ICPC-2)

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In the ‘reasons for encounter’ (RFEs) (i.e. the presenting problem) and ‘problems managed’ fields, we recommend that all ICPC-2 PLUS codes are available for data entry. This ensures that process codes, such as immunisations and medication requests can be entered as either RFEs or problems.

Table 1: Ranges for ICPC-2 codes related to problem management

Code type Data range(a)

Management – all -30 to –69

Check-ups -30,-31

Pathology tests -33, -34, -35, -36, -37, -38

Imaging tests -41

Other tests and investigations -39, -40, -43

Immunisation -44

Non-pharmacological management

Advice/counselling -45, -58

Therapeutic procedures -51, -52, -53, -54, -55, -56, -57, -59

Referrals -66, -67, -68

Other management -32,-42,-46,-47,-48,-49,-50,-60,-61,-62,-63,-64, -65,-69

(a) a dash (-) in front of the numeric code indicates that the code is used consistently across all chapters. Alpha codes should replace the dashes across each chapter, e.g. –41 would include all ICPC-2 PLUS codes beginning with A41, B41, D41, F41 etc.

1.3 Explanation of ICPC-2 PLUS codes

ICPC-2 PLUS codes are 6 digits long, and can be broken down into two parts, the ICPC-2 code, and the ‘plus’ code.

Figure 2: Description of the ICPC-2 PLUS code structure

The first 3 characters are the ICPC-2 code. The alphabetic part (A) indicates the chapter of the ICPC-2 code, while the numeric part (86) identifies the location of the code within the chapter.

The last three digits act as the identifier in the ICPC-2 PLUS code. As each ‘PLUS’ term is entered, it is assigned the next available 3 digit number in the rubric. As such, there is no meaning to the order of these codes.

A86 001

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1.4 Structure of ICPC-2 PLUS terms

ICPC-2 PLUS terms appear in the files as one of two structures:

Common usage expression – e.g. ‘Restless legs syndrome’

Problem/Procedure;type;site – e.g. ‘Pain;musculoskeletal;leg’

‘Problems’ include terms such as lesion, inability, infection, disease, fracture etc.

‘Procedures’ include terms such as excision, destruction, test, etc.

‘Type’ further specifies the nature of the problem, and may refer to the status of the problem, e.g. acute, chronic. The ‘type’ section of the structure is not always present in problem and procedure codes.

‘Site’ specifies the location of the problem. The ‘site’ section of the structure is not always present in problem and procedure codes.

This structure is adhered to ensure the uniformity of codes in ICPC-2 PLUS and minimises the risk of duplicating a term.

1.5 Advantages of using ICPC-2 PLUS

ICPC-2 has been endorsed as the Australian standard for classification in general practice and patient self-reported data by the National Health and Information Management Group (NHIMG) [a working group of the Australian Health Ministers Advisory Council].

ICPC-2 PLUS is a dynamic coding system which is updated regularly. We aim to provide users with a comprehensive set of terms used in Australian general practice. As such, we encourage the participation of both ICPC-2 PLUS developers and users in the further development of the coding system, so that it reflects the terms actually used in general practice. We also appreciate the input of developers regarding both the content and technical aspects of the system.

Through the use of logical links between keywords and terms, ICPC-2 PLUS aims to be user-friendly. Users simply have to enter the first few letters of a keyword and select the most appropriate term to record, rather than manually typing the name of the condition they wish to enter. Users do not have to be aware of the codes saved, or even know they are coding. Creating data reports is also easy using ICPC-2 PLUS, as the codes are automatically saved, and can be quickly and accurately retrieved from the system.

1.6 Obligations regarding end users

ICPC-2 PLUS has been incorporated into commercially available medical software, as well as being used exclusively for research.

All sites using ICPC-2 PLUS within commercially available software must be licensed through the National Centre for Classification in Health (NCCH).

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Licence fees

Licence fees for the use of ICPC-2 PLUS are payable annually. Initial membership includes a once only payment (for the life-long use of ICPC-2) which is passed on in full to the World Organisation of Family Doctors (Wonca). This money is used for the further development of classifications in general practice. An annual site licence fee is also payable to the NCCH. In subsequent years, only the annual site licence fee is payable. Licence fees for countries outside Australia are available by quotation. In Australia, licence fees for general practices, are as follows:

INITIAL MEMBERSHIP YEAR 1 ONLY

ANNUAL SITE LICENCE FEE FROM YEAR 2

Single user site: $220* Single user site: $120*

2-4 user site: $330* 2-4 user site: $180*




21+ user site: $620* 21+ user site: $420*

* 10% GST is calculated only on the annual site licence fee, and is included in this amount.

How to calculate the number of users

The number of users is calculated according to the clinical users of ICPC-2 PLUS sharing medical records. The total number of users is then calculated by determining the number of full-time equivalents (FTEs) in a practice, where 2 sessions or 1 day equates to 0.2 FTEs, rounding this figure to the nearest whole number.

Licensing your end users

When your software is nearing release, please contact the NCCH so we can discuss the licensing arrangements for ICPC-2 PLUS. Large group licences can be negotiated, or licensing can be arranged for each individual practice.

An information sheet for potential users of ICPC-2 PLUS is included in Section 6, and is included electronically with each ICPC-2 PLUS release. Please print these out and distribute to any practices considering using ICPC-2 PLUS in their medical records. The information sheet outlines the purpose of ICPC-2 PLUS, gives an example of how ICPC-2 PLUS should work in your software and tells the user where they can find more information about ICPC-2 PLUS. A section at the bottom of the sheet serves as a subscription form, which the user can then forward to the NCCH.

If a user does not pay their annual renewal fee, we will notify you that the practice is no longer a licensed ICPC-2 PLUS user, and that access to ICPC-2 PLUS should be removed.

Any practice that is not licensed to use ICPC-2 PLUS should not be able to access the coding system for data entry.

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1.7 Updates of ICPC-2 PLUS

You will receive regular updates of the ICPC-2 PLUS data files. Updates may take the form of updates to the terms available for use in ICPC-2 PLUS, or updates to other aspects of the coding system, such as structural revisions. Feedback is constantly sought from Developers and users, to help us improve ICPC-2 PLUS.

Updates are sent to developers on the 12th day of the month, in the months of April, July and October. If there is sufficient need, an update is also sent on the 12th of January.

The Developer’s package you are sent every release will include information on the content of the release.

1.8 Demonstrator

The NCCH has developed an ICPC-2 PLUS Demonstrator package, which may help you when you are incorporating ICPC-2 PLUS into your clinical system. The Demonstrator outlines the uses of ICPC-2 PLUS from both the data entry and data reporting perspectives. It adheres to the functionality specifications that are outlined in this document, and can therefore be used to check how ICPC-2 PLUS is supposed to work. It may also be used to demonstrate ICPC-2 PLUS to potential users of your system.

The ICPC-2 PLUS Demonstrator is available on our website to be used online or downloaded as a zipped Microsoft Access database at: http://sydney.edu.au/health-sciences/ncch/icpc-2-plus/demonstrator.shtml

The ICPC-2 PLUS Demonstrator is updated at the same time as each update is sent, and can therefore be used to check that your search mechanisms give the correct result.

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1.9 Glossary

TERM DESCRIPTION

ACTIVE codes marked as active (‘A’) are those available for data entry in ICPC-2 PLUS.

Chapter ICPC-2 has 17 chapters based mostly on body systems, e.g. circulatory system, respiratory system. In the ICPC-2 diagram in Figure 1, the chapters run across the horizontal axis. Chapters are identified through the use of a single alphabetic letter

Component There are 7 components in ICPC-2. In the ICPC-2 diagram in Figure 1, the components are situated on the vertical axis

ICPC code also referred to as ICPC-2 codes. ICPC codes are 3 digit alpha-numeric codes. Each represent a broad heading of a concept within the ICPC-2 classification.

ICPC-2 an international classification designed for primary care, which facilitates the timely and accurate collection of data in general practice.

ICPC-2 PLUS an extended terminology classified in ICPC-2, designed for use in electronic health records in Australian general practice.

ICPC-2 PLUS code

the 6-digit alpha-numeric code, combining the 3-digit ICPC-2 code and the 3-digit plus code (or term code).

INACTIVE terms marked as inactive (‘I’) which are no longer valid for data entry, but must be retained in the medical record for historical data reporting. For more information, see Section 3.

Keyword words or abbreviations, of up to 10 characters long, which are linked to ICPC-2 PLUS terms, and used for searching.

Natural language ICPC-2 PLUS terms converted into the way terms are commonly spoken. For more information, see Section 3

Plus code also called the ‘term code’. The three digit code that makes up the extension of ICPC-2 for Australia. In combination with the ICPC code it provides a more specific six digit code to record a concept in the classification.

Rubric descriptor of the concept that is represented by the ICPC code. The label of the three digit alpha-numeric ICPC code which represents the broad heading of a concept within the ICPC-2 classification.

Status indicates whether the code is valid for use in data entry (A= active; I= inactive). For more information, see Section 3.

Term The description of an ICPC-2 PLUS term, attached to the 6 digit alphanumeric code

Term code also called the ‘plus code’. The three digit code that makes up the extension of ICPC-2 for Australia. In combination with the ICPC code it provides a more specific six digit code to record a concept in the classification.

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1.10 Further information Please refer to the following publications for further information on the development of ICPC-2 PLUS and the ICPC-2 classification.

ICPC-2 PLUS User Guide

The National Centre for Classification website: http://sydney.edu.au/health-sciences/ncch/

Britt H. A new coding system for computerised clinical systems in primary care - ICPC PLUS. Aust Fam Physician.1997;26 (Suppl 2); S79-S82

Britt H, Scahill S, Miller G. ICPC PLUS for community health? - a feasibility study. Health Information Management 1997; 27: 4: 171-175.

Britt H. Which code? Which classification? Informatics in Healthcare Australia, 1996, 5:4; 140-44.

Britt H, Beaton N, Miller G. Coding and classification in computerised general practice medical records: Why code? Why classify? Aust Fam Physician 1995; 24: 612-615.

http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9254947&form=6&db=m&Dopt=b

http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=10178424&form=6&db=m&Dopt=b

http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m_s

http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m_s

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2. Data entry

2.1 Background

The purpose of data entry is to enter information into a clinical system to enable the timely, accurate and consistent collection of data.

When using ICPC-2 PLUS, data is entered through the use of keywords. Keywords are linked to ICPC-2 PLUS terms to provide the user with a picklist of all the related terms. Once the user selects the required term from the picklist the term and its ICPC-2 PLUS code are saved. This saved code may then be retrieved at any time e.g. for data reports.

2.2 Table Description The tables needed for data entry are icpc2key.csv, icpc2lnk.csv and icpc2trm.csv. The field contents and descriptions are listed below for these three CSV files. The order of the fields in the CSV files from left to right corresponds with the field order from top to bottom in the tables below. An Entity-Relationship diagram is also enclosed.

KEY TABLE (icpc2key.csv)

keyid Integer

keyword Char(10)

TERM KEY TABLE (icpc2lnk.csv)

keyid Integer

termid Integer

TERM TABLE (icpc2trm.csv)

termid Integer

term30 Char(30)

nalan50 Char(50)

icpccode Char(3)

termcode Char(3)

status Char(1)

replacement Char(6)

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2.3 Field descriptions

Field Name Field Description

Icpccode The 3 digit alpha-numeric ICPC-2 code.

Keyid The unique identifier automatically generated when each keyword is entered into the ICPC-2 PLUS database.

Keyword A word, or abbreviation of a word, of up to 10 characters.

Nalan50 The natural language term, up to 50 characters (for further information on natural language, see Section 3).

Replacement The replacement code field is used when a term is made inactive, and states the code that should be used in its place (for further information on inactive codes see Section 3.2)

Status Indicates whether the code is active (A) or inactive (I) (for further information on inactive codes, see Section 3).

Term30 The description of the ICPC-2 PLUS code, up to 30 characters

Termcode The 3 digit numeric ‘plus’ code

Termid The unique identifier automatically generated when the term is added into the ICPC-2 PLUS database.

Note: Icpccode and Termcode combine to make the six character ICPC-2 PLUS code

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2.4 Entity Relationship Diagram

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2.5 Functionality requirements

Keyword background

Keywords are essential when entering data using ICPC-2 PLUS. Keywords facilitate data entry by linking to ICPC-2 PLUS terms, enabling a user to select the term they want to record simply by entering a few letters rather than typing the whole expression.

Keywords always have a logical link to the ICPC-2 PLUS term and can be fragments of words, whole words, abbreviations, synonyms or acronyms. Keywords can be up to 10 characters in length. Keywords tend to be plural rather than singular words and are formatted without spaces, slashes (/) or dashes (-). Multiple keywords are linked to a single term. Similarly, multiple terms may be linked to a single keyword.

Data entry functionality

Keyword functionality

For data entry, the user should enter the first few (approx 4) letters of a keyword that is related to the term the user wants to record. Only keywords supplied by the National Centre for Classification in Health in the icpc2key.csv file may be used. Users must not be able to create their own keywords.

The clinical system must be able to search on the first characters of a keyword. The minimum number of keyword characters required to search on is one. Therefore entering the letter ‘d’ as a keyword will give a picklist of terms that have a linked keyword that starts with the letter ‘d’. The more keyword characters that are entered, the more specific the search results.

Picklist functionality

After entering a keyword:

The resulting search must only be based on the keyword, not the keyword and term.

The keyword search must display a list of all terms (field name: term30) linked to that keyword from which the user can select the one required.

The list of displayed terms must be in alphabetical order.

The terms shown in the picklist must only be those that are active (field name: status = A).

The keyword search must not display a picklist of natural language terms (field name: nalan50) linked to that keyword.

The picklist result of a search must be void of duplicate terms. If you have duplicates in the picklist you may have included Inactive terms (field name: status = I), or have run the search based on both the keyword and the term (see Section 3 for information on inactive codes).

The picklist must only include ICPC-2 PLUS terms (i.e. those with six digit codes) and not the ICPC-2 codes (three digit codes).

When the user selects the term required from the picklist, its ICPC-2 PLUS code must be stored in the medical record for future retrieval purposes.

You can store the ICPC-2 PLUS code alone and use links to pull up either the term (field name: term30) OR the natural language term (field name: nalan50) OR you can store either of these in the record along with its ICPC-2 PLUS code. Displaying the ICPC-2 PLUS code on the screen in both the picklists and the medical record is optional.

Do not allow users to run searches for keyword fragments that are located anywhere within an ICPC-2 PLUS term. For example, an incorrect search for ‘leg’ situated

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anywhere in an ICPC-2 PLUS keyword or term would result in a picklist that would include terms such as ‘Paraplegia’ and ‘Pregnancy;illegitimate’, neither of which are associated with the keyword ‘LEG’. Duplicates may also result from a search of this kind.

Example

To record a diagnosis of leg ulcer, type in “leg” as your keyword because you are looking for a term associated with leg(s). The correct search function will return a picklist of terms that are linked to keywords beginning with leg (i.e. keywords ‘legs’, ‘legal’ and ‘legionnair’). The result is a picklist containing 42 terms in alphabetical order (see Figure 2). Leg ulcer is listed under ‘U’ because ulcer is the problem and the leg is the site (for information on the structure of ICPC-2 PLUS terms see Section 1.4). (Note–if you had entered ulcer as the keyword you would have got a smaller picklist).

Table 2: Results of ICPC-2 PLUS term search using keyword ‘LEG’

Term description Keyword

Adjusting;brace;leg LEGS

Admin;advanced health directive LEGAL

Admin;legal report LEGAL

Advice/education;legal LEGAL

Bruise/bruising;leg LEGS

Cellulitis;leg LEGS

Corked leg LEGS

Cramp(s);calf LEGS

Cramp(s);leg LEGS

Cramp(s);thigh LEGS

CT scan;leg LEGS

Deformity;limb;acquired LEGS

Disease;Legg-Calve;Perthes LEGG

Disease;Legionnaires LEGIONNAIR

Fitting (of);brace;leg LEGS

Footdrop LEGS

Fracture;leg LEGS

Fracture;tibia and fibula LEGS

Inflammation;musculo LEGS

Injury;degloving;leg LEGS

Injury;leg LEGS

Injury;limb LEGS

Injury;soft tissue;leg LEGS

Laceration(s);leg LEGS

Mononeuritis;legs LEGS

MRI;leg LEGS

Numbness;leg LEGS

Oedema;leg LEGS

Pain;leg LEGS

Pain;musculoskeletal;leg LEGS

Problem;legal LEGAL

Referral;financial/legal serv LEGAL

Restless legs syndrome LEGS

Scar;leg LEGS Continued over page

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Shin splints LEGS

Swollen;leg LEGS

Sympt/complaint;leg LEGS

Test;Legionnaires antibodies LEGIONNAIR

Ulcer;leg LEGS

Ultrasound;leg LEGS

Varicose veins;inflamed;leg LEGS

Varicose veins;leg LEGS

Weakness;leg LEGS

X-ray;femur LEGS

X-ray;leg LEGS

X-ray;leg lower LEGS

X-ray;tibia/fibula LEGS

NB: the number of terms linked to the keyword search ‘leg’ was correct as at October 2015. To check this example for releases dated after October 2015 refer to the Demonstrator (see Section 1).

2.6 Temporary codes There will be times where a user cannot find an appropriate ICPC-2 PLUS term (and thus a code) when using ICPC-2 PLUS. The user can ring our Help Line on +61 2 9351 9772. However, he/she may not have the time to telephone, or our Help Line may not be able to provide an immediate answer. Therefore, the system must provide for the user to enter his/her own term until the correct term can be added to ICPC-2 PLUS. These "terms" will be allocated the code J99 (see below for functionality of J codes).

These "J99" codes will be unique to each end user’s clinical system. A "Code Confirmation" form is supplied to users (Appendix ‘J Codes’ in the User’s guide). It can be faxed or posted to the indicating the medical concept for which a code could not be found and noting the J99 code allocated by the clinical system. Upon notification of a J99 code the will either determine the appropriate existing code this concept should be allocated to and notify the user, or create a new code in ICPC-2 PLUS for this concept. If a new code is created it will be included in the next ICPC-2 PLUS release, making it available for all users.

Functionality of J codes

A user must be able to create a J code to capture concepts for which he/she cannot find a term in ICPC-2 PLUS. The user must give each J code a term.

J codes must always be assigned to the ICPC-2 code J99. Each term must be assigned a six digit ICPC-2 PLUS code. The first three digits of the code are J99 followed by a three digit plus code which is allocated consecutively, the first being 001, then 002 etc.

The system should allow the user to select J99 as a legitimate ICPC code and display its terms for selection.

The users’ clinical system must be able to replace all instances of a selected J99 code in his/her medical records with the correct ICPC-2 PLUS code as directed by the. This may be most easily done through mapping the J code to an ICPC-2 PLUS code.

After the medical record is corrected the J99 ICPC-2 PLUS code should be flagged ‘inactive’ so it cannot be selected again.

The clinical system should never re-use a J99 term code after it has been allocated.

It is imperative that J codes are temporary. This is necessary because J codes are not grouped within the ICPC-2 classification and hence will not be counted in data reports, resulting in incorrect numbers. There is also the risk that a J code will duplicate an existing ICPC-2 PLUS code leading to double ups in the picklist.

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3. Supplementary information for data entry

3.1 Natural Language

Background

‘Natural language’ terms are simplified descriptions of existing ICPC-2 PLUS terms. ICPC-2 PLUS terms are structured with the generic ‘problem’ or ‘procedure’ entered first, followed by terms that give greater specificity, such as the site of the problem. Semicolons separate the terms. This ensures uniformity between the terms. However, this is not the way the terms are commonly spoken.

When an ICPC-2 PLUS term is selected, the corresponding natural language term can be stored instead of the original term description. The stored natural language term allows easier understanding of the ICPC-2 PLUS concept, as it is in plain English.

Integrating the natural language functionality

Depending on the infrastructure of your clinical software, the natural language function can be integrated in different ways.

Option 1:

When an ICPC-2 PLUS term is selected, your software can store the ICPC-2 PLUS code alone – and not store either the original term or natural language term. Depending on the type of term preferred, a query can be executed to extract the desired term (original or natural language term).

Option 2:

Your software can be designed to store either or both the original term and the natural language term when an ICPC-2 PLUS term is selected (as well as the ICPC-2 PLUS code).

This function can then be incorporated into automatic referral letters, patient reports and medical certificates.

Example

If the user wants to code ‘leg pain’, the ICPC-2 PLUS term is ‘Pain;leg’ and its corresponding natural language term is ‘leg pain’. Natural language terms are basically the common terms that medical practitioners use.

If the keyword ‘leg’ is used to search for leg pain, the picklist generated from that keyword must list all original ICPC-2 PLUS terms attached to the keyword ‘leg’ (as demonstrated in Figure 2). It is important that natural language terms are not substituted for the ICPC-2 PLUS terms in the picklist.

Field Description

All active ICPC-2 PLUS terms have an associated natural language term. The natural language term of the corresponding ICPC-2 PLUS term is added into an extra field in the ICPC-2 PLUS Term Table (icpc2trm.csv). This is one of the CSV files sent to developers for each ICPC-2 PLUS release. The field name for natural language terms is ‘nalan50’ and it has a field length of 50 characters.

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For a full description of the ICPC-2 PLUS Term Table and the Entity-Relationship diagram, see Section 2.

3.2 Inactive codes

Background

Only active ICPC-2 PLUS codes are available for data entry. However if an ICPC-2 PLUS code becomes obsolete it must be removed from data entry, this is done by making these codes inactive. ICPC-2 PLUS codes are never deleted. Instead, their status is changed to “I” for inactive. Terms may be made inactive when:

the term is no longer used in general practice

the location of the code is incorrect

the term has been incorrectly duplicated.

Terms that are marked as inactive should not be able to be entered into medical records. An easy way of identifying inactive terms in your system is to check that you don’t have duplicate terms available.

Inactive codes should, however, be available for data reporting purposes. Users may have inactive terms saved in their records (entered previously when the term was marked as active). These terms must still be accessible when the user runs a historical data report. All terms that are made inactive are ‘mapped’ to an active term. This means that, even though the term is no longer used, there is a similar term that can be used to record and report the data.

Table Description

The status of terms within ICPC-2 PLUS is found as an extra field in the ICPC-2 PLUS Term Table (icpc2trm.csv). This is one of the datafiles sent to developers for each ICPC-2 PLUS release. The field name is ‘status’ and it has a field length of 1. There are two valid values entered in this field:

‘A’: indicates that the term is active, and can be used for data entry in ICPC-2 PLUS.

‘I’: indicates that the term is inactive. These terms should only be used for data reporting purposes. Any term with a status of ‘I’ should not be used for data entry.

Replacement codes for inactive terms

The ICPC-2 PLUS term table (icpc2trm.csv) contains a field called ‘replacement’, which is 6 characters in length (Please see Sections 2.2-2.4 for more details about design). This field is used when terms are made inactive, and states the active term to which the inactive term is mapped.

The replacement codes (where applicable) should be used for selection and groupings to generate correct report output. This may require an extra step during the report generation process. You may update the patient record with the new replacement code only if the system keeps a history of changes.

When the term is active, this field will be null.

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4. Additional reference material on ICPC-2

4.1 Background There are four tables provided as part of each ICPC-2 PLUS update, which are additional to the tables updated regularly. These tables usually remain unchanged during each update, and are sent to you as CSV files. The purpose of these tables is to apply different aspects of the ICPC-2 classification to the data coded in the clinical system.

4.2 Table Description There are three tables included in this section: icpc2cha, icpc2com and icpc2cod. An Entity-Relationship diagram is also enclosed.

Chapter table (icpc2cha.csv)

This table outlines the ICPC-2 chapters, as described in Section 1.

CHAPTER TABLE (icpc2cha.csv)

chapter Char(1)

chapname Char(50)

Component table (icpc2com.csv)

This table outlines the ICPC-2 components, described in Section 1.

Note that, when component is used elsewhere, Component '7' (Diagnoses and diseases) has been replaced by Components 8, 9, 10, 11 and 12 and that ICPC-2 Component 7 is made up of Components 8 – 12 inclusive.

COMPONENT TABLE (icpc2com.csv)

component Char(2)

compname Char(50)

ICPC-2 code table (icpc2cod.csv)

This table summarises each ICPC-2 code (or rubric). It states the alpha-numeric code and its rubric, along with the chapter and component each ICPC-2 code belongs to.

The ‘note’ and ‘icd10’ fields are currently not used. Developers may also ignore/delete the contents of the ‘note’ and ‘icd10’ columns from their systems without impairing functionality of the coding system.

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ICPC-2 CODE TABLE (icpc2cod.csv)

icpccode Char(3)

rubric Char(50)

component Char(2)

chapter Char(1)

note Char(5)

icd10 Char(15)

4.3 Field descriptions

Field Name Field Description

Chapname Label for ICPC-2 chapter code.

Chapter Single alphabetic character of chapter as defined by ICPC-2.

Compname Label for ICPC-2 chapter code.

Component Numeric code of components as defined by ICPC-2 (1-7) and extended by the former FMRC so that chapter 7 is further defined as components 8 to 12.

Grouping Currently not used and is blank.

icd10 ICPC-2 to ICD10 map. Currently not used and is blank.

icpccode The 3 digit alpha-numeric ICPC-2 code.

Note Currently not used and is blank.

Rfrom Starting ICPC-2 code of range (inclusive).

Rto Ending ICPC-2 code of range (inclusive).

Rubric Label of the ICPC-2 code.

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As shown in the Entity-Relationship diagram above:

The component from the COMPONENT Table (icpc2com.csv) has a one-to-many relationship with the component from the ICPC-2 CODE Table (icpc2cod.csv).

The chapter from the CHAPTER Table (icpc2cha.csv) has a one-to-many relationship with the component from the ICPC-2 CODE Table (icpc2cod.csv).

1:m

m:1

icpc2cod.csv

icpccode

rubric

component (FK)

chapter (FK)

note

icd10

icpc2com.csv

component

compname

icpc2cha.csv

chapter

chapname

Legend:

FK = Foreign Key

1:m = one-to-many relationship

eg. a one-to-many with the right hand side with at least one.

table_name

Key Attributes

Non-Key Attributes

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4.5 Use of ICPC-2 reference tables These three tables provide greater detail about the information stored within users’ clinical systems by applying different aspects of the ICPC-2 classification to these data. The different structures of ICPC-2 are outlined in Section 1 and are applied to the data in clinical systems using these tables.

The chapter table and component tables are reference tables used by the code table. The ICPC-2 code table is a summary table, however it also lists the ICPC-2 codes and rubrics enabling selection on the ICPC-2 code, component or chapter.

4.6 Functionality requirements Users are encouraged to use the functionality of the output grouper files as outlined in

Section 5 ‘Data Reports’.

There are three possible ways of searching for records using these data tables: searching on chapter or component individually, or combining the two for a more specific search. For example,

A search for all skin related conditions (chapter S) would return all records/encounters containing codes from the skin chapter.

A search for all neoplasms (component 9) would return all records/encounters that contain neoplasm codes.

A search for all skin neoplasms would use a combination of chapter S and component 9. The resulting search should return all records/encounters where a skin neoplasm code was saved.

Note: At least one of the component or chapter fields must be specified to conduct a valid search. If a chapter or component is not specified the search must find all records/encounters in the unspecified field.

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5. Data reports 5.1 Background

ICPC-2 PLUS can also be used to create data reports, using the codes stored within medical records during the data input phase. Users may wish to utilise this part of the system for a variety of reasons, including:

self audit

to count the number of cases of a selected problem

for patient recall or mail merge

to report to external bodies (e.g. governments, the Collaboratives Program) about the specific problems they manage.

The former FMRC has therefore developed files for data reports, based on ICPC-2 PLUS, which are based on two levels within the coding system:

1. ICPC-2 Classification

As described in Section 1, classifying data is about ordering data into meaningful groups. The ICPC-2 classification groups concepts that can then be used to create data reports.

An example:

If the users want to find, or count, all their patients who have Insulin dependent diabetes— IDDM is classified in ICPC-2 as Diabetes, insulin dependent – code T89.

T89 contains many PLUS terms, each of which has its own code, allowing the user to select the term they prefer when putting the data IN. These PLUS terms include:

T89 001 Diabetes;insulin dependent T89 002 Diabete;Type 1 T89 003 Diabetes;complicated T89 004 Diabetes;juvenile onset T89 005 Coma;diabetic T89 006 Hyperglycaemia (diabetic)

However, for data reports when they want to identify or count patients with IDDM, they have to find all the records with ANY of these PLUS terms in them. They do this by using the ICPC-2 classification code T89 (diabetes, insulin dependent) which is common to all the above term codes.

2. Higher level groupers (G codes)

Sometimes, there are similar terms that fall into different ICPC-2 codes. This requires grouping of multiple ICPC-2 codes (and sometimes, as in osteoarthritis, grouping of multiple PLUS codes that cross over the ICPC-2 classification codes). We have created standard groupers (G codes) to facilitate searches in such circumstances.

An example:

What about if the users wanted to identify or count all the patients with ANY kind of diabetes?

In that case they would need to find all the records that included ANY of three ICPC-2 classification codes- T89 (IDDM); T90 (NIDDM) and W85 (gestational diabetes). This is time consuming and may be inaccurate. Instead, they could select a GROUPER code rather than any of the ICPC-2 codes alone.

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If you enter ‘DIAB’ or ‘IDDM’ or ‘NIDDM’ (etc) as a key word in the reporting mechanism of your software, the system must offer the end-user a list of classification codes and grouper codes that are linked to this key word. (Note there are two Grouper codes included in the resulting list of possible concepts available for a search).

These would include:

G40 Diabetes (all)

G77 Diabetes (non-gestational)

T89 IDDM

T90 NIDDM

The end user can then select the concept at the level of specificity required. Your program then needs to find all records that include any of the codes attached to this concept (counting or identifying each record only once, irrespective of possible multiple cases within an individual record).

The concepts provided for data reports are limited to:

all individual ICPC-2 codes; AND (within the same file)

an additional set of higher level grouper codes (the codes of which all start with the letter ‘G’)

The users should NOT be allowed (at this stage) to search on an individual ICPC-2 PLUS term for diagnosis/symptom/disease. They must only be able to get data out in the classified/grouped manner. Otherwise they find it difficult to retrieve reliable output.

Keywords in the output file

We have created a keyword list specifically for use with the files for data reports. Users can then use this list to choose the level at which they would like to analyse their data. The keyword list has been shortened for data reports, and only the most logical and likely connections between keywords and concepts are retained.

You MUST use the output keyword list when working with these files for reporting output.

Do not use the much larger data input keyword file for data output.

Remember:

PLUS terms are for getting the data IN to the record: The PLUS terms used in the health record are provided so that the user has sufficient specificity in the record, for quality and continuity of care – these are provided to ensure the user can record the problem in their preferred form and that this will be retained in the record for continuity of individual care.

Getting the data OUT should rely on use of the ICPC-2 classification or grouped ICPC-2 classification codes – not on the PLUS terms. The classification allows you to group like with like in a logical manner. The first three digits of the ICPC-2 PLUS (6 digit) code, designate its place in the ICPC-2 CLASSIFICATION.

Like the keyword search system used by data input (Section 2) the output Keyword search system matches the start of the word. A 4-character word (e.g. diab) would match all keywords with the matching first four characters (e.g. DIABETES, DIABETIC).

Spelling differences can cause a false negative result. If no groupers are found then the users should be encouraged to type in the first 3 or 4 characters of the word being searched. You can assist the user by providing a picklist of keywords, but users must also be able to enter free text in this field (i.e. cannot allow keywords to be pick list only).

If there is any problem with finding data or keyword connections then the user or developer should contact us.

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We believe it essential that we work together to ensure the users can get reliable and meaningful data out of their records easily. Otherwise they will lose interest in using their computerised medical records for data retrieval.

5.2 Table Description Four grouper tables have been created. These are:-

1. grp_Keyword 2. grp_Keyword_Grouper 3. grp_Grouper 4. grp_Grouper_Icpc

A description of these is shown in the tables below.

An Entity-Relationship diagram is shown in Section 5.3. The column definitions for each of the tables are provided below.

grp_Keyword (grp_keyword.csv)

keyword_id Integer

keyword Char(20)

grp_Keyword_Grouper (grp_kwd_grp.csv)

keyword_id Integer

grouper_id Integer

grp_Grouper (grp_grouper.csv)

grouper_id Integer

grouper Char(3)

grouper_description Char(60)

grp_Grouper_Icpc (grp_grp_icpc.csv)

grouper_id Integer

icpc_code Char(6)

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grp_Keyword_Grouper

keyword_id (FK)

grouper_id (FK)

grp_Grouper_Icpc

grouper_id (FK)

ICPC_code (FK)

1:m

1:m

1:m

Legend:

FK = Foreign Key

1:m = one-to-many relationship

eg. a one-to-many with the right hand side with at least one.

The ICPC_code is used to identify matching ICPC codes in other data tables

grp_Grouper

grouper_id

Grouper

Grouper_Description

table_name

Key Attributes

Non-Key Attributes

grp_Keyword

keyword_id

keyword

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The keyword_id from the grp_Keyword Table has a one-to-many relationship with the keyword_id of the grp_Keyword_Grouper Table.

The grouper_id of the grp_Keyword_Grouper Table has a many-to-one relationship to the grouper_id of the grp_Grouper Table.

The grouper_id of the grp_Grouper Table has a one-to-many relationship with the grouper_id of the grp_Grouper_Icpc Table.

The icpc_code of the grp_Grouper_Icpc Table will have a many-to-many relationship with icpc_code fields of other data tables. This seems to be unavoidable but we will show you later how to make use of it.

5.4 Use of grouper files for data output This section details the use of these tables and functionality to include for the user. It includes examples using Microsoft Access SQL queries. You will need to investigate different techniques to develop the best method for implementation with your software.

It is recommended to save the 6 character combined ICPC-2 code and term code. You may need to create search optimised tables by joining some tables together (denormalise) before updating the client software. Also be aware that grouper files apply to the replacement code of an inactive term and not the inactive term itself.

1. Keyword entry – list matching groupers

The User must be able to type in a keyword and given the choice of groupers which are linked to the keywords. ‘ALCOHOL’ would be a ‘ALCOHOL*’ pattern match to any grouper linked to ‘ALCOHOL’, ‘ALCOHOLIC’ or ‘ALCOHOLISM’ keywords.

The user will then select the grouper that they are interested in.

For example, when using MS Access a SQL query would use search criteria such as:

SELECT DISTINCT grp_Grouper.Grouper, grp_Grouper.Grouper_Description

FROM grp_Keyword INNER JOIN (grp_Grouper INNER JOIN grp_Keyword_Grouper

ON grp_Grouper.Grouper_id = grp_Keyword_Grouper.Grouper_id) ON

grp_Keyword.Keyword_id = grp_Keyword_Grouper.Keyword_id

WHERE (((grp_Keyword.Keyword) Like "cancer*"))

ORDER BY grp_Grouper.Grouper;

For more generic searches build the query using a variable in the WHERE clause, for example:

WHERE (((grp_Keyword.Keyword) Like [kwd] & "*"))

The groupers for the keyword ‘cancer’ are

Grouper Grouper_Description

A26 FEAR, CANCER NOS

A79 MALIGNANCY NOS

B26 FEAR, CANCER BLOOD/LYMPH

D26 FEAR, CANCER DIGESTIVE SYSTEM

D77 MALIGNT NEOPLASM DIGEST OTHER

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F74 NEOPLASM OF EYE/ADNEXA

G71 NEOPLASMS MALIGNANT (ALL)

G74 NEOPLASMS (ALL)

L26 FEAR, CANCER MUSCULOSKELETA

N26 FEAR OF CANCER OF NEUROLOGICAL SYSTEM

R26 FEAR, CANCER RESPIRATORY SYS

S26 FEAR, CANCER SKIN

T26 FEAR, CANCER ENDOCRINE SYSTE

U26 FEAR OF CANCER OF URINARY SYSTEM

X25 FEAR, CANCER GENITAL (F)

X26 FEAR, CANCER BREAST(F)

Y26 FEAR, CANCER GENITAL (M)

2. Grouper selection – make temporary list of ICPC codes to match

The grouper selected by the user is used to filter the grp_Grouper_Icpc table. This list of ICPC-2 codes and ICPC-2 PLUS codes is used as selection criteria for the ICPC-2 PLUS codes stored in patient records.

For example, selecting the group G74, NEOPLASMS (ALL):

SELECT grp_Grouper_Icpc.ICPC_code

FROM grp_Grouper INNER JOIN grp_Grouper_Icpc ON grp_Grouper.Grouper_id =

grp_Grouper_Icpc.Grouper_id

WHERE (((grp_Grouper.Grouper)="G74"))

ORDER BY grp_Grouper_Icpc.ICPC_code;

ICPC_code

A79

A99018

A99019

B72

B73

B74

B75

D74

D75

D76

D77

D78

F74

H75

K72

L71

…

L97

N74

N75

N76

R84

R85

R86

R92

S77

S78

S79

S80

S81

T71

T72

T73

U75

…

U76

U77

U78

U79

W72

W73

X75

X76

X77

X78

X79

X80

X81

Y77

Y78

Y79

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3. Search data file for records with matching ICPC-2 PLUS codes

Records are retrieved that have ICPC codes belonging to the selected group.

It is important to understand that if an ICPC-2 code is tied to the grouper (e.g. A94), the query to be undertaken must pick up all the ICPC-2 PLUS codes of A94 (i.e. A94001, A94002, A94003 etc.).

Remember that if the ICPC-2 code is a rubric (e.g. Y88) all the ICPC-2 PLUS codes underneath Y88 (i.e. Y88001, Y88002 etc) should be included as part of the query.

There are many different ways to implement this step depending on the database system, record structure, SQL features used, programming and user interface. Step 2 & 3 can be joined and executed in a single step.

You may have to search many patient related records to find patients who had a condition that matches the selected grouper.

If the user is locating patients with a particular problem, the patient details (and relevant conditions) should appear together in the output. If there is a count of patients having had a particular condition then multiple occurrences for the same patient should be counted as one patient.

For example:

a) Creating a list of ICPC-2 PLUS codes belonging to the grouper ‘G47’ using a table of ICPC-2 PLUS codes named ‘tblicpccode’. Query is named “qry ICPC code expansion”

SELECT tblicpccode.ICPCCODE

FROM (grp_Grouper INNER JOIN grp_Grouper_Icpc ON grp_Grouper.Grouper_id

= grp_Grouper_Icpc.Grouper_id) INNER JOIN tblicpccode ON

tblicpccode.ICPCCODE like (grp_Grouper_Icpc.ICPC_code & "*")

WHERE (((grp_Grouper.Grouper)="G74"));

b) Use above query as a sub-query to locate patient encounters with a condition in the list.

SELECT EncID, patientid, Problem

FROM encounter

WHERE (((encounter.Problem) In (select icpccode as Problem from [qry

ICPC code expansion])));

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c) Use sub-query to search for patients using in-line statements

(This example a bit more complex)

SELECT DISTINCT patient.patientid, patient.FirstName, patient.LastName

FROM encounter INNER JOIN patient ON encounter.patientid =

patient.patientid

WHERE (encounter.Problem in

(SELECT tblicpccode.ICPCCODE as Problem


= grp_Grouper_Icpc.Grouper_id)

INNER JOIN tblicpccode ON tblicpccode.ICPCCODE like

grp_Grouper_Icpc.ICPC_code + "*"

WHERE (((grp_Grouper.Grouper)='G74'))))

ORDER BY patient.LastName, patient.FirstName;

d) Use a join to select records that match either of two fields using the like operator.

SELECT encid, Problem1, Problem2


= grp_Grouper_Icpc.Grouper_id) INNER JOIN [tbl problem] ON [tbl

problem].Problem1 like (grp_Grouper_Icpc.ICPC_code & "*") or [tbl

problem].Problem2 like (grp_Grouper_Icpc.ICPC_code & "*")

WHERE (((grp_Grouper.Grouper)="G74"));

4. Search optimisation.

You will likely have to create your own custom tables (denormalise) to speed up grouper selection and record searches. These would be indexed and optimised for runtime performance and improve useability.

For example:

1) Create a table for speed selection of grouper:

INSERT INTO SelectGrouper (Keyword, Grouper, Grouper_Description)

SELECT DISTINCT K.Keyword, G.Grouper, G.Grouper_Description

FROM grp_Grouper AS G INNER JOIN (grp_Keyword AS K INNER JOIN grp_Keyword_Grouper AS KG ON K.Keyword_id = KG.Keyword_id) ON G.Grouper_id = KG.Grouper_id;

2) Create a table to speed in the resolution of ICPC codes (3 or 6 character) to match stored medical records.

INSERT INTO SearchGrouper (Grouper, ICPCCODE)

SELECT G.Grouper, ICPC.ICPCcode

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FROM (grp_Grouper AS G INNER JOIN grp_Grouper_Icpc AS GI ON G.Grouper_id = GI.Grouper_id) INNER JOIN icpc2trm AS ICPC ON GI.ICPC_code = ICPC.ICPCcode

ORDER BY G.Grouper, ICPC.ICPCcode;

3) Use the "grp_Keyword" table if you have a keyword picklist.

4) The user enters a keyword or the start of a keyword.

E.g. "diab"

5) Search the groupers using the "SelectGrouper" custom table using the Keyword like search_keyword*. Present the list of groupers and description for user to pick from.

SELECT DISTINCT SG.Grouper_Description, SG.Grouper

FROM SelectGrouper as SG

WHERE (SG.Keyword Like [Grouperkw] & "*")

ORDER BY Left([Grouper],1)="G", SG.Grouper_Description;

Eg. for "diab" (keyword shown for developer reference and would not be shown to users)

Keyword Grouper Grouper_Description

DIABETES G40 DIABETES (ALL)

DIABETES G77 DIABETES (NON-GESTATIONAL)

DIABETES T27 FEAR, ENDOCRINE/METABOLIC DI

DIABETES T89 DIABETES, INSULIN DEPENDENT

DIABETES T90 DIABETES, NON-INSULIN DEPENDEN

DIABETES W85 GESTATIONAL DIABETES

DIABETIC F83 RETINOPATHY

DIABETIC N94 PERIPHERAL NEURITIS/NEUROPATHY

7) Search the medical records using the icpccodes returned from the "SearchGrouper" custom table using the selected grouper code. eg. "T89" for insulin dependent Diabetes which excludes gestational diabetes.

SELECT encdata.diag, encdata.patientid

FROM encdata INNER JOIN SearchGrouper ON encdata.diag like SearchGrouper.diag & "*"

WHERE grouper = [selectedgrouper];

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For example, for "T89":

Grouper icpccode TermDescription

T89 T89001 Diabetes;insulin dependent

T89 T89002 Diabetes;Type 1

T89 T89003 Diabetes;juvenile onset

T89 T89004 Diabetes;complicated

T89 T89005 Coma;diabetic

T89 T89006 Hyperglycaemia (diabetic)

T89 T89007 Ulcer;diabetic

8) Display listing of medical records found to match. Report summary would include the description of the selected grouper. Each encounter listed in the result would show the ICPC-2 PLUS term description or corresponding natural language term (see Section 2).

Example for "T89"

Report Page 1 of 1

All patients with a diagnosis of "DIABETES, INSULIN DEPENDENT (T89)".

Date Last Name First Name Age Gender Diagnosis

1/5/2003 Dee Jenny 12 F Diabetes;juvenile

12/6/2003 Doe John 8 M Diabetes;Type 1

18/5/2003 Nobody Jake 14 M Hyperglycaemia

5.5 Additional grouper for use with the PEN Clinical Audit Tool Grouper files containing relevant ICPC-2 PLUS codes for the PenCS Clinical Audit Tool (CAT) condition categories were developed in a collaboration between the former FMRC and PenCS. These groupers standardise the ICPC-2 PLUS codes used for clinical audit/quality assurance purposes. Although most of the condition categories fell into the standard ICPC-2 PLUS rubrics or G codes, some additional groupers were required that were not suitable for inclusion as a G code. As a result we created additional ‘Q’ codes that incorporate these clinical audit groupers.

CSV files for the clinical audit groupers

There are four CSV files that relate to the clinical audit groupers:

grp_CA_Grouper.csv (equivalent to the grp_Grouper.csv file)

grp_CA_grp_icpc.csv (equivalent to the grp_grp_icpc.csv file)

grp_CA_Keyword.csv (equivalent to the grp_keyword.csv file)

grp_CA_kwd_grp.csv (equivalent to the grp_kwd_grp.csv file)

These four CSV files follow the same format as the standard grouper CSV files described in Section 5.2.

We have deliberately kept these separate from the standard grouper CSV files so they can be easily differentiated from the standard grouper files. As with the standard grouper codes,

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the Clinical Audit groupers have a three character code (represented as ANN). The easiest way to differentiate between a standard grouper code and a Clinical Audit grouper code is through the alphabetic character in the code—standard groupers start with the letter G (e.g. G86 – Metabolic syndrome) and Clinical Audit groupers start with the letter Q (e.g. Q03 – Stroke (ischaemic)).

If you do not use the PEN CAT tool, you should only use the standard grouper files for data analysis and extraction. If you do use the PEN CAT tool (or any other tool for clinical audit activities) you should implement both the standard grouper files and the Clinical Audit grouper files.

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6. Map from ICPC-2 PLUS to ICD-10-AM, 9th edition

6.1 ICD-10-AM ICD-10-AM is the Australian modification of the International Classification of Diseases, Version 10 (ICD-10).

ICD-10-AM is updated by the Australian Consortium for Classification Development (ACCD), which includes the National Centre for Classification in Health (University of Sydney), the University of Western Sydney and KPMG. Information about the ACCD can be found at: https://www.accd.net.au/.

ICD-10-AM codes are up to five characters in length, with the alpha-numeric format ANN.(N)(N). ICD-10 codes contain a maximum of four characters, with the alpha-numeric format ANN.(N).

6.2 Map purpose The map from the ICPC-2 PLUS terms to ICD-10-AM was created to promote interoperability between the classifications and terminologies used in the Australian health care system.

Potential uses of the map include the conversion of information collected in ICPC-2 PLUS for:

reporting to authorities who require data coded in ICD-10-AM

transfer of clinical information between general practice and other sectors of the health system.

6.3 Current map version ICD-10-AM 9th edition was released in July 2015 by the ACCD. During the April 2016 ICPC-2 PLUS release, the map was updated from ICD-10-AM 8th edition to ICD-10-AM 9th edition.

Only the most recent version of the map is supplied to ICPC-2 PLUS Developers. That is, the most recent release of ICPC-2 PLUS terms is currently mapped to ICD-10-AM 9th edition.

6.4 Mapping rules The international ICPC-2 to ICD-10 map was used to facilitate the mapping from ICPC-2 PLUS to ICD-10-AM. Specific rules used in the development of the ICPC-2 PLUS to ICD-10-AM map are listed below.

1. The map from ICPC-2 PLUS terms to ICD-10-AM is a one-to-one map of best fit. This means we have identified the most appropriate equivalent match in ICD-10-AM for each ICPC-2 PLUS term.

2. The map direction is from ICPC-2 PLUS to ICD-10-AM. It is not appropriate to use the map in reverse (that is, from ICD-10-AM to ICPC-2 PLUS).

3. Each ICPC-2 PLUS term has been mapped to ICD-10-AM at the most specific level available, including to the 5th character in ICD-10-AM where applicable.

4. Map scope: ICPC-2 PLUS terms classified to ICD-10-AM include:

all symptom and complaint (Component 1) terms (code range: –01 to –29)

https://www.accd.net.au/

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check-ups (code range: –30 to –31)

immunisations (code range: –44)

all disease/diagnosis (Component 7) terms (code range: –70 to –99).

Please note that the process terms in ICPC-2 PLUS have not been mapped to the Australian Classification of Health Interventions (ACHI).

5. In relation to the ICD-10-AM aetiology and manifestation convention (the dagger and asterisk system), each ICPC-2 PLUS term is only mapped to the dagger (aetiology) code.

6.5 Receiving the map The ICPC-2 PLUS to ICD-10-AM map is only provided on request, and is not included in the standard CSV files provided to developers during each ICPC-2 PLUS release. If you wish to receive the CSV files that contain the map, please contact the ICPC-2 PLUS support team ([email protected]).

6.6 Table description For developers who request the ICPC-2 PLUS to ICD-10-AM map, the standard icpc2trm.csv file is replaced with a file called icpc2trm-icd10am.csv.

TERM TABLE (icpc2trm-icd10am.csv)

termid Integer

term30 Char(30)

nalan50 Char(50)

icpccode Char(3)

termcode Char(3)

status Char(1)

replacement Char(6)

ICD10AM-9ed Char(6)

ICD10 Char(5)

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6.7 Field descriptions for the icpc2trm-icd10am.csv Field Name Field Description

Termid The unique identifier automatically generated when the term is added into the ICPC-2 PLUS database.

Term30 The description of the ICPC-2 PLUS code, up to 30 characters

Nalan50 The natural language term, up to 50 characters.

Icpccode The 3 digit alpha-numeric ICPC-2 code.

Termcode The 3 digit numeric ‘plus’ code

Status Indicates whether the code is active (A) or inactive (I).

Replacement The replacement code field is used when an ICPC-2 PLUS term is made inactive, and states the ICPC-2 PLUS code that should be used in its place.

ICD10AM-9ed The ICD-10-AM 9th edition code mapped from ICPC-2 PLUS, up to 6 characters in total – ANN.(N)(N).

ICD10 The ICD-10 code, up to 5 characters in total – ANN.(N). This is derived from a map from ICD-10-AM 9th edition to ICD-10, provided by the Australian Consortium for Classification Development.

Note: The fields icpccode and termcode combine to make the six character ICPC-2 PLUS code.

7. Object identifiers for ICPC-2 and ICPC-2 PLUS

The International Organisation for Standardization (ISO) have developed globally unique identifiers for a various products, called object identifiers (OIDs). These OIDs are used by HL7 as unique identifiers within HL7 messaging.

If you need to use them, the correct OIDs for ICPC-2 and ICPC-2 PLUS are:

More information about OIDs can be found at: https://www.hl7.org/oid/index.cfm.

ICPC-2 2.16.840.1.113883.6.139.1

ICPC-2 PLUS 2.16.840.1.113883.6.140.1

https://www.hl7.org/oid/index.cfm

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8. Information for users Version 3.2: October 2016

An information sheet for potential ICPC-2 PLUS users is provided on the next two pages. This document provides some basic information about how ICPC-2 PLUS works, the costs involved and a subscription section (on the second page), which can be returned to the NCCH. On receipt of this form we will organise a licence for the user.

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National Centre for Classification in Health

University of Sydney Phone: (02) 9351 9772

Fax: (02) 9351 9603 http://sydney.edu.au/health-sciences/ncch/

ICPC-2 PLUS INFORMATION FOR USERS

WHAT IS ICPC-2 PLUS? The International Classification of Primary Care (ICPC-2) is a classification designed for primary care, developed by the World Organisation of Family Doctors (Wonca). It classifies information relating to why the patient has come for the consultation (the reasons for encounter), the problems managed during the encounter, procedures, referrals, imaging and pathology tests. ICPC-2 has been endorsed as the Australian standard for classification in general practice and patient self-reported data, and is distributed exclusively in Australia by the National Centre for Classification in Health (NCCH) at the University of Sydney.

ICPC-2 PLUS is an extended terminology based on ICPC-2. It has been designed specifically for use in electronic health records. It was developed using over one million encounter records and therefore uses terms that are common in Australian general practice. ICPC-2 PLUS can be used in software available from a number of software companies, including Genie Solutions, Zedmed, Intrahealth Systems, CSC Healthcare (practiX), Medtech Healthcare and Stat Health Systems. At present approximately 3,500 GPs in Australia use ICPC-2 PLUS, and it is also used in various research projects and co-ordinated care trials.

HOW DOES IT WORK? ICPC-2 PLUS allows users to record information in electronic health records in a reliable and consistent way, by attaching a ‘code’ to the term you choose. Using keywords that are common in everyday general practice, ICPC-2 PLUS does all the work for you in the background. You won‘t even be aware that you are coding and classifying the information. All you have to do is type in the first part of a keyword and select the term you want to use – you don’t have to type whole words or phrases. When you subscribe to ICPC-2 PLUS we give you a User Guide, which lists all the keywords available. ICPC-2 PLUS is updated regularly, and if there is a term you use that isn’t included, we would love to hear from you!

Example Mr Jones has come in for his regular diabetes check-up. In the reason for encounter section of your record (if your software provider allows for this) you type in ‘CHECK’ (part of the keyword ‘CHECKUP’). You are then presented with a list of terms. One of these terms is Check up;diabetes, which you select. The software automatically assigns a code in the background, in this case T31 005, and stores the term you chose, and its code in the record. Mr Jones has non-insulin dependent diabetes. In ICPC-2 PLUS, you can use any of the synonyms for this type of diabetes, such as Type 2 diabetes or adult onset diabetes. You can also use acronyms, such as NIDDM, as keywords. Simply enter a keyword, such as ‘DIAB’, and you will be offered a picklist of terms. You select your preferred term, non-insulin dependent diabetes, out of the picklist and again the term and its code are stored in the record.

WHY DO I NEED ICPC-2 PLUS? When you record data in medical records using ICPC-2 PLUS, retrieving your data for auditing, quality assurance or continuity of care is easier and more reliable than manually counting patient records to find out how many patients in your practice are being treated for a particular condition. Using ICPC-2 PLUS, it doesn’t matter if other doctors in the practice don’t use the same terms as you, because each term is grouped with similar terms (i.e. the terms are classified according to ICPC-2). When you are ready to analyse your data, you can choose an output file, known as a grouper, which will extract information from your records at a level of specificity that you choose.

Example If you want to find or count all patients in your practice with:

Any type of diabetes - you select the ‘Diabetes (all)’ grouper

All diabetes (except gestational) - you select the ‘Diabetes (non-gestational)’ grouper

insulin dependent diabetes only - you select ‘Diabetes, insulin dependent’

non-insulin dependent diabetes only - you select ‘Diabetes, non-insulin dependent’.

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CAN I LOOK AT ICPC-2 PLUS BEFORE PURCHASING IT? Yes! We have a demonstration package on our website (http://sydney.edu.au/health-sciences/ncch/icpc-2-plus/demonstrator.shtml) that allows you to enter keywords and terms. You can also look at how you can analyse your data using ICPC-2 PLUS groupers. Not all features of ICPC-2 PLUS are available in every software package. Your software provider may be able to give you a demonstration of how ICPC-2 PLUS works in your system. Ask your contact person for more details.

HOW MUCH DOES IT COST?

Initial membership includes a once only payment (for the life-long use of ICPC-2) which is passed on in full to the World Organisation of Family Doctors (Wonca), and an annual site licence fee set by the National Centre for Classification in Health (NCCH) for the ongoing development of ICPC-2 PLUS. In subsequent years, only the annual fee is payable.

INITIAL MEMBERSHIP

YEAR 1 ONLY (Wonca + first year annual fee = total)

ANNUAL SITE LICENCE FEE

FROM YEAR 2

Single user site: $100 + $120* = $220 Single user site: $120* 2-4 user site: $150 + $180* = $330 2-4 user site: $180* 5-10 user site: $200 + $250* = $450 5-10 user site: $250* 11-15 user site: $200 + $310* = $510 11-15 user site: $310* 16-20 user site: $200 + $370* = $570 16-20 user site: $370* 21+ user site: $200 + $420* = $620 21+ user site: $420*

* 10% GST is calculated only on the annual site licence fee, and is included in this amount. The number of users is calculated based on the number of Full Time Equivalent (FTE) clinical users of the system, where 1 day or 2 sessions equals 0.2 FTE. Practice managers and administrative staff should not be included in this calculation.

WHERE CAN I GET MORE INFORMATION? The NCCH website: http://sydney.edu.au/health-sciences/ncch/ where you can look at:

the structure of ICPC-2 PLUS the background of ICPC-2 PLUS the ICPC-2 PLUS Demonstrator

Phone: (02) 9351 9772


Or ask your software provider for more information.

HOW CAN I PURCHASE ICPC-2 PLUS? 1. Please complete this form and return to the National Centre for Classification in Health (NCCH):


i. Fax: (02) 9351 9603

ii. Post: N National Centre for Classification in Health PO Box 170 Lidcombe NSW 1825

2. On receipt of the form the NCCH will forward contracts for completion. 3. On receipt of the signed contracts access to ICPC-2 PLUS will be provided, and the Accounts section of the University

of Sydney will invoice you for the amount owing. Please do not send a cheque with this form. ----------------------------------------------------------------------------------------------------------------------------- ----------------------------

Name of software provider __________________________ Number of FTE clinical users _________________________

Contact name _____________________________________ Signature _________________________________________

Registered business name ________________________________________ ABN/ACN ____________________________

Practice name ____________________________________________________________________ Tick if same as above

Registered business address _____________________________________________________________________________

Practice postal address _____________________________________________________________ Tick if same as above

Phone ____________________ Fax ____________________ Email address ___________________________________


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