[Coding in general practice-Will the ICD-11 be a step forward?] / Codieren in der Hausarztpraxis ­ Wird die ICD-11 ein Fortschritt sein?

Primary care physicians in Germany don't benefit from coding diagnoses-they are coding for the needs of others. For coding, they mostly are using either the thesaurus of the German Institute of Medical Documentation and Information (DIMDI) or self-made cheat-sheets. Coding quality is low but seems to be sufficient for the main use case of the resulting data, which is the morbidity adjusted risk compensation scheme that distributes financial resources between the many German health insurance companies.Neither the International Classification of Diseases and Health Related Problems (ICD-10) nor the German thesaurus as an interface terminology are adequate for coding in primary care. The ICD-11 itself will not recognizably be a step forward from the perspective of primary care. At least the browser database format will be advantageous. An implementation into the 182 different electronic health records (EHR) on the German market would probably standardize the coding process and make code finding easier. This method of coding would still be more cumbersome than the current coding with self-made cheat-sheets.The first steps towards a useful official cheat-sheet for primary care have been taken, awaiting implementation and evaluation. The International Classification of Primary Care (ICPC-2) already provides an adequate classification standard for primary care that can also be used in combination with ICD-10. A new version of ICPC (ICPC-3) is under development. As the ICPC-2 has already been integrated into the foundation layer of ICD-11 it might easily become the future standard for coding in primary care. Improving communication between the different EHR would make taking over codes from other healthcare providers possible. Another opportunity to improve the coding quality might be creating use cases for the resulting data for the primary care physicians themselves.

Towards an International Classification for Patient Safety: the conceptual framework.

Global advances in patient safety have been hampered by the lack of a uniform classification of patient safety concepts. This is a significant barrier to developing strategies to reduce risk, performing evidence-based research and evaluating existing healthcare policies relevant to patient safety. Since 2005, the World Health Organization's World Alliance for Patient Safety has undertaken the Project to Develop an International Classification for Patient Safety (ICPS) to devise a classification which transforms patient safety information collected from disparate systems into a common format to facilitate aggregation, analysis and learning across disciplines, borders and time. A drafting group, comprised of experts from the fields of patient safety, classification theory, health informatics, consumer/patient advocacy, law and medicine, identified and defined key patient safety concepts and developed an internationally agreed conceptual framework for the ICPS based upon existing patient safety classifications. The conceptual framework was iteratively improved through technical expert meetings and a two-stage web-based modified Delphi survey of over 250 international experts. This work culminated in a conceptual framework consisting of ten high level classes: incident type, patient outcomes, patient characteristics, incident characteristics, contributing factors/hazards, organizational outcomes, detection, mitigating factors, ameliorating actions and actions taken to reduce risk. While the framework for the ICPS is in place, several challenges remain. Concepts need to be defined, guidance for using the classification needs to be provided, and further real-world testing needs to occur to progressively refine the ICPS to ensure it is fit for purpose.

A deployment and Research Roadmap for Semantic Interoperability: the EU semantic health project.

The purpose of this EU funded project is to describe a short and medium term Research and Deployment Roadmap for Semantic Interoperability in e-health. It started by defining 4 levels and 3 dimensions for Semantic Interoperability. The vision is to reconcile the needs for the direct patient care safety, biomedical and clinical research and for public health by the reuse of direct care data: from gene to individuals and populations. The methodology is presented and preliminary results and milestones for the short and the long term are set. We conclude by statements on the main characteristics and needs of the roadmap to sustain better health for individual and populations in the changing EU health care systems.

Maternal asthma is associated with increased risk of perinatal mortality.

BACKGROUND: Asthma is the most common chronic disease during pregnancy and it may have influence on pregnancy outcome. OBJECTIVES: Our goal was to assess the association between maternal asthma and the perinatal risks as well as possible effects of asthma medication. METHODS: The study was based on a nationwide Finnish register-based cohort between the years 1996 and 2012 in the Drug and Pregnancy Database. The register data comprised 962 405 singleton live and stillbirths, 898 333 (93.3%) pregnancies in mothers with neither confirmed asthma nor use of asthma medication (controls), and 26 674 (2.8%) pregnancies with confirmed maternal asthma. 71% of mothers with asthma used asthma medication. The diagnosis of asthma was based on the mothers' right for subsidised medication which is carefully evaluated by strict criteria including pulmonary function testing. Odds ratio was used in comparison. Premature birth (PB), low birth weight, small for gestational age (SGA), neonatal death were the main outcome measures. RESULTS: Maternal asthma was associated with adjusted odds ratios (aORs) for perinatal mortality 1.24 (95% CI 1.05 to 1.46), preterm birth 1.18 (1.11 to 1.25), low birth weight 1.29 (1.21 to 1.37), fetal growth restriction (SGA) 1.32, (1.24 to 1.40), and asphyxia 1.09 (1.02 to 1.17). Asthma treatment reduced the increased risk of preterm birth aOR 0.85 (95% CI 0.76 to 0.96) but mothers with treated asthma had higher risks of fetal growth restriction (SGA) aOR 1.26 (1.10 to 1.45), and asphyxia aOR 1.37 (1.17 to 1.61) than mothers with untreated asthma. CONCLUSION: Asthma is associated with increased risks of perinatal mortality, preterm birth, low birth weight, fetal growth restriction (SGA), and asphyxia. Asthma treatment reduces the risk of preterm delivery, but it does not seem to reduce other complications such as perinatal mortality.

No improvement in outcome of nationwide extremely low birth weight infant populations between 1996-1997 and 1999-2000.

OBJECTIVE: Our goal was to investigate whether outcome in extremely low birth weight infants changes over time in Finland. PATIENTS AND METHODS: All infants with a birth weight <1000 g born in Finland in 1996-1997 and 1999-2000 were included in the study. Perinatal and follow-up data were collected in a national extremely low birth weight infant research register. Data concerning cerebral palsy and visual impairment were obtained from hospitals, the national discharge, and visual impairment registers. RESULTS: A total of 529 and 511 extremely low birth weight infants were born during 1996-1997 and 1999-2000. No changes were detected in prenatal, perinatal, neonatal, and postneonatal mortality rates between the periods. The survival rates including stillborn infants were 40% and 44%. The incidence of respiratory distress syndrome and septicemia increased from 1996-1997 to 1999-2000 (75% vs 83% and 23% vs 31%). The overall incidence of intraventricular hemorrhage increased (29% vs 37%), but the incidence of intraventricular hemorrhage grades 3 through 4 did not (16% vs 17%). The rates of oxygen dependency at the age corresponding with 36 gestational weeks, retinopathy of prematurity stages 3 to 5, cerebral palsy, and severe visual impairment did not change. Mortality remained higher in 1 university hospital area during both periods compared with the other 4 areas, but no regional differences in morbidity were detected during the later period. CONCLUSIONS: No significant changes were detected in birth or mortality rate in extremely low birth weight infants born in Finland during the late 1990s, but some neonatal morbidities seemed to increase. Regional differences in mortality were detected in both cohorts. Repeated long-term follow-up studies on geographically defined very preterm infant cohorts are needed for establishing reliable outcome data of current perinatal care. Regional differences warrant thorough audits to assess causalities.

The Use of Clinical Classifications in the Nordic Countries.

This article gives an overview of the current use of the main clinical classifications in the Nordic countries. A brief introduction describes the background and content of Nordic co-operation in the areas of health statistics and health-related classifications. The use of the current international classifications is well established in the Nordic countries. Some Nordic classifications have been developed in co-operation with maintenance and updating performed as a joint Nordic responsibility.