Leaving the Walkman and ICD-9 Behind: Modernizing the Disease Classification System Used by Canadian Physicians.

The International Classification of Diseases, Ninth Revision (ICD-9) was released in the 1970s and adopted in Canada for physician billing claims in 1979 (CIHI n.d.b.; WHO & International Conference for the Ninth Revision of the International Classification of Diseases 1977). ICD-9 is no longer adequate for representing our modern healthcare environment and patient needs. We summarize the findings from a small survey of ICD-9 users across Canada - such as family physicians, researchers and decision makers - who describe the limitations of ICD-9 and the features that they would desire in a new or updated classification system.

Describing agreement in the main condition coding field using Canadian ICD-11 inpatient data.

INTRODUCTION: Countries use varying coding standards, which impact international coded data comparability. The 'main condition' (MC) field is coded within the Discharge Abstract Database as "reason for admission" or "largest resource use". OBJECTIVE: We offer a preliminary analysis on the frequency of and contributing factors to MC definition agreements within an inpatient Canadian dataset. METHODS: Six professional coders performed a chart review between August 2016 and June 2017 on 3,000 randomly selected inpatient charts from three acute care hospitals in Calgary, Alberta. Coders classified the MC as "reason for admission", "largest resource use" or "both". Patients were admitted between 1st January and 30th June 2015 and met the inclusion criteria if they were ≥18 years, had an Alberta personal health care number, and had an inpatient visit for any service outside of obstetrics. Agreement between the two MC definitions was stratified by length of stay (LOS), emergency department admission, hospital of origin, discharge location, age, sex, procedures, and comorbidities. Chi-square analysis and frequency of inconsistencies were reported. RESULTS: Only 34 (1.51%) of the 2,250 patient charts had disagreeing MC definitions. Age, emergency visit on admit, LOS, hospital, and discharge location were associated with MC agreement. Chronic conditions were seen more often in MC definition agreements, and acute conditions seen within those disagreeing. CONCLUSION: There was a small proportion of cases in which the condition bringing the patient to hospital was not also the condition occupying the largest resources. Within disagreements, further research using a larger sample size is needed to explore the presence of MC in a secondary/tertiary condition, the association between patient complexity and disagreeing MC definitions, and the nature of the conditions seen in the inconsistent MC definitions.

Exploring the differences in ICD and hospital morbidity data collection features across countries: an international survey.

BACKGROUND: The International Classification of Diseases (ICD) is the reference standard for reporting diseases and health conditions globally. Variations in ICD use and data collection across countries can hinder meaningful comparisons of morbidity data. Thus, we aimed to characterize ICD and hospital morbidity data collection features worldwide. METHODS: An online questionnaire was created to poll the World Health Organization (WHO) member countries that were using ICD. The survey included questions focused on ICD meta-features and hospital data collection systems, and was distributed via SurveyMonkey using purposive and snowball sampling. Accordingly, senior representatives from organizations specialized in the topic, such as WHO Collaborating Centers, and other experts in ICD coding were invited to fill out the survey and forward the questionnaire to their peers. Answers were collated by country, analyzed, and presented in a narrative form with descriptive analysis. RESULTS: Responses from 47 participants were collected, representing 26 different countries using ICD. Results indicated worldwide disparities in the ICD meta-features regarding the maximum allowable coding fields for diagnosis, the definition of main condition, and the mandatory type of data fields in the hospital morbidity database. Accordingly, the most frequently reported answers were "reason for admission" as main condition definition (n = 14), having 31 or more diagnostic fields available (n = 12), and "Diagnoses" (n = 26) and "Patient demographics" (n = 25) for mandatory data fields. Discrepancies in data collection systems occurred between but also within countries, thereby revealing a lack of standardization both at the international and national level. Additionally, some countries reported specific data collection features, including the use or misuse of ICD coding, the national standards for coding or lack thereof, and the electronic abstracting systems utilized in hospitals. CONCLUSIONS: Harmonizing ICD coding standards/guidelines should be a common goal to enhance international comparisons of health data. The current international status of ICD data collection highlights the need for the promotion of ICD and the adoption of the newest version, ICD-11. Furthermore, it will encourage further research on how to improve and standardize ICD coding.

Indicators of missing Electronic Medical Record (EMR) discharge summaries: A retrospective study on Canadian data.

INTRODUCTION AND OBJECTIVES: Electronic medical records (EMRs), specifically the discharge summary (DS), can improve secondary use data availability and interprofessional communication. We aimed to describe the completeness of our EMRs by assessing the presence of a DS in the EMR. Additionally, we assessed for indicators of a missing DS. METHODS: A chart review was conducted on 3,011 non-obstetric adult inpatient charts in Calgary, Alberta. 893 charts were missing an electronic DS. A 10% sample was drawn to evaluate the presence of a paper DS. A Chi-square test, Fisher's test and logistic regression measured the associations between electronic DS absence and i) patient and hospital characteristics, and ii) patient comorbidities. RESULTS: The univariate analyses showed that age, being a surgical patient, a Charlson Comorbidity Index (CCI) of

Capture--recapture and anchored prevalence estimation of injecting drug users in England: national and regional estimates.

Capture-recapture (C-RC) using four data sources, one of which accounted for 81% of captured injectors, and multiple indicator methods (MIM) were used to obtain national, regional and local estimates of the prevalence of injecting drug use among opiate and/or crack cocaine users in England. Persons aged 15 to 64 years, in contact with health and/or criminal justice services during 2005/2006, and known to be using opiates and/or crack cocaine and injecting drugs were included in the C-RC analysis. The MIM analysis included indicators relating to drug treatment, drug-related deaths, population density and drug offences.There were an estimated 130,000 opiate and/or crack cocaine users who injected drugs in 2005/06 (95% confidence interval 125,800 to 137,000), corresponding to 3.9 per thousand of the population aged 15 to 64 years (95% confidence interval 3.8-4.1). Regional variation in the prevalence of injecting was evident, ranging from 6.1 per thousand of the population aged 15 to 64 years in Yorkshire and the Humber (95% confidence interval 5.6 to 6.6) to 2.3 per thousand in the East of England (95% confidence interval 1.8 to 2.9). Application of gender and age-group distributions for treated injecting drug users (IDUs) to the prevalence estimates suggested that there were 97,200 male injectors (95% confidence interval 94,000 to 102,500) and 63,600 female injectors aged 25 to 34 years (95% confidence interval 61,500 to 67,000).The prevalence estimates provide a basis from which numbers of current IDUs infected with hepatitis C virus (HCV) can be approximated.