http://www.ulb.ac.be/esp/wicc/usage-en.html

How does it work?


Marc Jamoulle & Michel Roland,July 1997

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How to use the table? The ICPC tabular list
Alphanumerical codes
The three dimensions of coding Clinical example

  1. How to use the table?

Clicking on the corresponding yellow button brings you to the heading list of the chapter and component chosen. The grey button with a small padlock means that the heading cannot (yet) be accessed. The box at the intersection of D (for digestive) and 1 (for symptoms and complaints) gives the list of the headings of that component in that chapter. The spark in a box indicates that examples from the CISP-2 are available. Clicking on the doctor's bag opens the list of standard procedures for each chapter. Clicking on the red balls brings you to the document you are reading just now.

The underlined terms in this text are linked with a lexicon that gives the definitions developed by the Classification Committee.

The general orientation bar present on nearly all pages successively comprises - from the left to the right - links to contact the members of the CISP-Club or the Classification Committee by e-mail, a document dealing with WONCA copyrights, the present directions for use, the general bibliography (written and electronic), a detailed text on the 25 years of realizations of the Classification Committee, a chessboard that opens the CISP, an introduction to CISP-2 and, at last, the door that enables you to reach the CISP-Club site.

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  • The ICPC tabular list

  • The ICPC tabular list was designed as a grid, similar to a game of chess. The table, of very simple appearance is the fruit of a long developmental work based on the consultation structure, that is well underscored in the ICPC Structure table and in the document that describes the achievements of the WONCA Classification Committee. In the present representation, the chapters fill in the columns whereas the components fill in the rows. Thus, there are 15 body or somatic systems, one psychological chapter and one social chapter. The ICPC thus looks like a chessboard, with 2 axes, numbered rows (the components) and columns (the chapters), that make boxes. A01 (generalized pain), Y99 (other diseases of the male genital tract) and Z28 (limited function/invalidity social problem) are thus global codes resulting from the combination of a chapter and a component.

    The simplicity and the ease of use of the CISP are precisely due to its biaxial structure with a mnemotechnical aim: the axis of the 17 chapters is characterized by a one-character alphanumerical code, whereas the axis of the 7 components, identical for each chapter, is represented by a two-figure numerical code. Both combine to form a three-character global code (e.g. D06: localized abdominal pain).


  • . Alphanumerical codes are organized
    in a structured manner

    1

    Numerical characters are arranged
    according to the components 1, 2 to 6, and 7
    1
    symptoms and complaints
    -01 à -29:
    -26 fear of cancer,
    -27 fear of other disease,
    -28 handicap/invalidity,
    -29 rag-bag,
    2 à 6
    procedures
    -30 à -49: diagnostic/preventive
    -50 à -59: therapeutic/medication
    -60 et -61: tests results
    -62: administrative
    -63 à -69: reference and others
    Rag-bag:
    -49
    -59
    -68
    -69
    7
    diagnoses and diseases
    -70 à -99
    in order:
    infectious diseases
    tumors (benign and malignant)
    trauma
    congenital anomalies
    other specific diseases
    -99 rag-bag
  • The diseases with a prevalence too low to justify a specific code can be placed under the so-called rag-bag codes. This by no means implies that those diseases disappear from the medical record of the patient. Incorporated in a terminological data bank such as Encode-FM or ICPC-Plus, they may appear in the patient's medical record but, for the epidemiological analysis, they are ranked with other uncommon diseases.

    The separation in three component groups:

    1 for symptoms and complaints,
    2 to 6 for procedures,
    7 for diagnoses,
    corresponds to the general structure of a consultation and to the design of the structure of the ICPC. The problem, such as it is verbalized by the patient, forms or will form the subject of actions before or after a working hypothesis has been worded. The diagnosis made for a specific problem at the end of the consultation will become the title of the on-going episode of care.

    The episode may possibly exist only for one single contact, but may be maintained active and may serve as a basis for multiple contacts spread over a period of time.

    The complexity arises from the fact that consultations in general practice usually deal with 1.5 problems per contact and that each of those problems may give rise to an episode that will occur concomitantly with others and will have an unpredictable duration. Moreover, some problems are presented by the patients on a symbolic basis, consciously or not, and mask complex realities. At last, other problems will arise due to physicians, either voluntarily or not.

    The acquisition of sensitive information on the occasion of a help relationship cannot alter the course of the relationship, and the data acquisition system must be effective and integrated in the consultation. The difficulty still increases due to the fact that, in health systems that function without registration, patients may be mobile and may consult several physicians or may be merely lost to follow-up.


  • The three dimensions of coding

    1. Information filing

      The CISP is intended to note down the reasons of contacts, diagnoses and procedures the prevalence of which is in excess of 0.5 per thousand (with some exceptions to the rule). The aim is to contain only necessary but sufficient items: "a place for everything" (exhaustiveness) "and everything in its place" (exclusiveness). Any element that comes under the SOAP must find one and single place there. This explains the existence of so-called "rag-bag" codes that gather what cannot reasonably be filed elsewhere, or the acronyms "NEC" (not elsewhere classified) or "NOS" (not otherwise specified), as well as the relative imprecision of some items (e.g. traumatic urinary tract lesion).

    2. Information processing

      Information gathered by providers may be stored on paper or in the computer. Coding may be done by the provider (decentralized coding) or by a coding centre (centralized coding). The evolution of medical computing has enabled providers to perform computer encoding in countries with such facilities.

      The computer system must be a flexible and high-performance system so that information automatically chained according to the caregiver's instructions may be processed in real time. It is absolutely not easy to set up such a system on a computer. The number of pieces of information is initially variable (from 1 to X reasons of contact; mean: 1.5). The number of on-going episodes also is variable. The status of such episodes must be known (active, inactive, open, closed). Their diagnostic, prognostic and therapeutic value must be considered (significant, non-significant), and their severity must be estimated. Moreover, the various problems show reciprocal interactions, and several episodes may be controlled by a single one. A given episode may be given another name (changed diagnosis). The clinical aims to be reached to realize a consistent medical record, either computerized or not, are examined in the document Fonctions du Dossier médical" (in French only).

      Such an approach is only applicable to the first level of care. The issue of data transmission between the first line system (primary care) and the specialized hospital system (secondary care) can be solved only by using compatible classifications such as the CISP and the CIM-10. It is thus obvious that the issue of crossmapping is a determining factor.

    3. The system transparency

      The profession of family physician is already complex enough without computing making the meeting between the patient and the physician still heavier. Therefore, the system must be sufficiently user-friendly so that the provider, or even the patient, find pleasure to use it. This is the place where terminology and natural language systems that - classified in the ICPC - afford a great user-friendliness in information acquisition, play a role. The significance of current terminology works (see document "History of the Classification Committee", last paragraph) is thus obvious.

    4. Clinical example

    5. A patient calls for a worrying febrile state, otherwise without clear signs. The physician examines the patient, confirms the high temperature, and decides to see the patient again the next day.
      The appreciation is "fever" (A03), since no more specific diagnosis can be made despite a full examination. The clinical examination carried out is a procedure, and the decision to see the patient again is another procedure.

      The information sequence that describes the process implemented is:

      The coding sequence (for the computer) will be:

      A03 - A30 - A31 - A03 - A63

      The A03 chosen as appreciation will become the title of the current episode. If, the next day, pimples have appeared and the diagnosis is obvious, A78, measles, will become the title of the episode, following an examination and the prescription of antibiotics. The coding sequence (for the computer) will be:
      A63 - A31 - A71 - A50

      If the physician is called again by the mother because the child experiences ear pain, and if otitis is diagnosed, the coding sequence (for the computer) will be:
      HO2 - H21 - H70 - H50

      It is thus possible to follow the evolution of the title of the episode from A03 to A71, then to H70.

      Such simple problems may become more and more complicated. The following list of ingredients, for instance, makes it possible to render the problem, its assessment, its treatment and the computer encoding more complex:

      no money for purchasing drugs, complications when using drugs, treatment dropout, disease complications, institutionalized child, child as an object, sour-tempered stepfather or stepmother, anxious mother, anxious physician, insalubrious and allergenic housing, severe comorbidity (other severe concomitant diseases), problems of attestation, truancy, illicit drugs,...
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      For further information about the CISP and the CISP-Club, please contact:

      .M. Jamoulle
      Rue Frère Orban
      B-6040 Jumet( Charleroi)
      J. Humbert
      9, rue du 8 Mai
      F-85230 Beauvoir sur mer
      tél.+32 71 37 14 12 (home)
      +32 71 28 55 77 (office)
      +33 2 51 49 45 51 (home)
      +33 2 51 68 70 23 (office)
      fax+32 71 28 55 70+33 2 51 68 76 05
      Email marc.jamoulle@ulb.ac.be jhumbert@imaginet.fr
      http://www.ulb.ac.be/esp/cisp

       
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