1. Indexing EBM guidelines with ICPC-2 and linking guidelines to medical records Ilkka Kunnamo, MD The Finnish Medical Society Duodecim Finland ilkka.kunnamo@duodecim.fi Marc Verbeke, MD University of Gent, Belgium WONCA Europe Kos 6.9.2005

2. Problems with accessing guidelines during encounters Time needed to explore websites and guidelines Different search terms or search systems Physicians’ ability in defining the question Correct spelling in other language No standardized way of assessing keywords Patients are watching what the doctor is doing

3. Aim: creating tools to Improve the accessibility of selected guidelines on-line Make it work during patient encounters Search with a language independent system Search with own terminology in own language Create short-lists of quality controlled sites Find only guidelines linked to your problem

4. Components of the system EPR system that makes the link from ICPC code used by EPR in assessment of the patient’s problem 946 topics in “EBM guidelines” indexed by ICPC: to which question is this guideline an answer? ­ICPC codes 1-29 and 70-99 at assessment / diagnostic level ­ICPC code used at intervention level (process codes *30-*69) ­Guidelines accessible by ICPC instead of search terms

5. Indexing result

6. 372 ICPC codes used as main indexing terms 20 guidelines with a process code as main indexing term 50% of ICPC codes retrieve only one guideline 93% of the ICPC codes retrieve not more than 6 guidelines

7. Search results with ICPC-2 codes L77 –Sprain of the ankle –Joint and ligament injuries in children P20 –Evaluation of a neurological patient –Memory disorders and dementia –Examination of patients with memory disorders and dementia –Treatable causes of dementia and memory disorders –Neuropsychological problems

8. Search results with ICPC-2 codes R78 –Acute brochitis –Acute bronchitis (instructions for patients) –Mycoplasma pneumoniae infections –Wheezing in children –Treatment of obstructive bronchitis and acute asthma in children S70 –Herpes zoster –Herpesvirus skin infections –Fever and rash in a child –Meningitis in children *31 –Diagnostic tests in dermatology

9. ICPC is not always specific enough ICPC –D99 Other diseases of the digestive system ICD-10 –K56.6Bowel obstruction –E73.9Lactose intolerance –K85Acute pancreatitis –K90.0Coeliac disease

10. ICPC code found by using Dutch thesaurus

11. Guidelines searched automatically using the ICPC code as search term

16. Pilot use by 10 Belgian GPs Opened articles 1287 Search 168 Browse 85

17. Comments from test users 4/2005 Very useful during doctor-patient encounter Real improvement and very good tool! 10-20 % new search needed Very user-friendly and high speed search: very quick results and accurate information Evaluation scores of 8-9/10

18. Problems with search terms Atrial fibrilation Basal cell epithelioma Erythema infectiosa Fiever Fistulisation Hydradenitis Intertigo Neuronitis Paulbunnel Prostate malignancy

19. Comments from test users 8/2005 Very user friendly Easy and adequate access Useful information Daily use Can be used in cooperation with patient Better search results compared with using EBMG by entering search terms Seldom second search needed Level (ICPC code) needed during encounter No better search system known Good cost/benefit balance

20. Critical comments Not always congruent with Belgian or Dutch Guidelines (e.g. sometimes too much use of antibiotics) Too Anglo-Saxon Sometimes too general guidelines - nothing more than needed during encounter No automatic login (first use of the day) Problem with ICPC rag-bag (D99, T99): specific diagnostic label links to other guidelines Create use of ICPC/ICD link (-99 codes) Process codes less commonly used

21. Conclusions Indexing guidelines by ICPC codes and linking directly to the EPR –enables quick use during patient encounters –avoids spelling mistakes when searching –improves search results

22. Wishful thinking? All primary care journals and expert systems indexing with ICPC in addition to keywords Guidelines created in ICPC structure Uniformity in the use of ICPC codes Developing links even more patient- oriented (sex/age/history/risk profile)

23. Future developments? Indexing other general or “regional-specific” sites –Prodigy –Trip Database –Dermis –Clinical Evidence Indexing sites in other languages (each in his own country) –e.g. Diagnostisch Kompas –NHG standards Imaging and investigation sites as guidelines –(e.g. “consilium radiologicum”) Indexing drug information sites with ICPC drug codes or ATC Generating pick up lists with all the quality controlled sites giving an answer to the physician’s question