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Coding Medical Constructs

Assumptions. Creating data structure for electronic useCodes themselves are not important How constructs are presented for use and how they are linked over time are key. The Primary Players. International Classification of DiseaseInternational Classification of Primary CareSystematized Nomenclat

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Coding Medical Constructs

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    1. Coding Medical Constructs Creating Chaos Out of Order Wilson D. Pace, MD

    2. Assumptions Creating data structure for electronic use Codes themselves are not important How constructs are presented for use and how they are linked over time are key

    3. The Primary Players International Classification of Disease International Classification of Primary Care Systematized Nomenclature of Medicine – Clinical Terms Medcin Current Procedural Terminology Logical Observation Identifiers Names and Codes RxNorm

    4. Quick Thoughts LOINC – Initially developed as a standardize approach for transmitting laboratory results Publicly available Overly specific for most clinical users RxNorm – US National Library of Medicine developied system to classify medications Not fully developed Not incorporated into commercial medication systems

    5. Quick Thoughts Current Procedural Terminology Designed to transmit billing data Groups or splits based on reimbursement issues – not clinically relevant issues Chemistry test single component Codes reused over time Not designed to be a clinical system

    6. Quick Thoughts Medcin Commercial nomenclature (270,000 base codes) Extensive “clinical hierarchies” Unclear utility in primary care Developed through “expert” review instead of use Highly detailed – breast cancer returns 200+ options Trying to deal with patient variation at the code level

    7. Quick Thoughts SNOMED CT – granular system designed to codify all clinical data – 370,000 terms Relationships are handled by a separate database – not through code hierarchies Has incorporated and mapped to many other systems – LOINC, ICD, ICPC A reasonably good nomenclature is not a data structure

    8. Quick Thoughts ICPC – specifically designed to include items of reasonable frequency in primary care Organ system oriented Only system to specifically identify the reason an individual seeks care and requests for care Incorporates episodes of care (i.e. time)

    9. Boulders, Rocks and Gravel A decade of debate over “coverage” of various systems related to “medical concepts” – SNOMED v Read Ordering concepts initially linear – SNOMED, Read Next generation of systems moved to relational approaches based on “clinical” considerations – SNOMED CT, Medcin

    10. Crushing Rocks is not Sculpting Moving from tens of thousands of codes to hundreds of thousands of codes does not improve order

    11. Still Holes Even with 370,000 codes there are areas not well covered by SNOMED CT – Allergies Patient preferences Guideline exception tracking Adverse event tracking Medical decision making

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