Automated Control of Codes Accuracy in Case-Mix Databases by Evaluating Coherence with Available Information in the Electronic Health Record.

Coding accuracy in case-mix databases enables efficient funding of health facilities and accurate epidemiological statistics based on patients' stays information. We assume that the data collected in the electronic health record, especially drug prescriptions and medical reports are relevant for checking the consistency of the coding of diagnoses. We evaluated a new coding control tool, "TOLBIAC control", embedded in the Web100T coding assistant. This tool interacts with the Vidal Application Programming Interface and the electronic health record of the University Hospital of Saint-Etienne. The micro-average F-measure was 0.76 for drug prescriptions and 0.55 for free text medical reports. This initial evaluation has revealed that drug prescriptions in EHRs can successfully be used to develop an automated ICD-10 code-control tool. Nevertheless the "TOLBIAC control" tool is not yet fully effective for widespread use because of its limited performance in text analysis, a feature that is currently undergoing improvements.

[Not Available]. / Chocs anaphylactiques d'origine médicamenteuse : sous-notification et PMSI.

AIM: To evaluate the value of research in the case-mix database to identify cases of drug-related anaphylactic or anaphylactoid shock. METHODS: Hospital stays of patients discharged from the University Hospital of Saint-Étienne between July 1st 2009 and June 30th 2012. Five codes from the international classification of diseases were selected: T88.6, T88.2, J39.3, T80.5 and T78.2. RESULTS: Among 89 cases identified by the programme for medicalization of information system (programme de médicalisation des systèmes d'information, PMSI), 40 were selected (45%). Of these, 16 cases were spontaneously reported by physicians. The unspecific code "anaphylactic shock unspecified (T78.2)" was coded for 57.5% of cases. CONCLUSION: The study confirms the interest of the PMSI as a tool for health monitoring, in addition to spontaneous reporting. Nevertheless, coding with insufficient precision about the causal role of the drug, requires a return to the medical record and so an important time consuming process.

Development of a new international classification of health interventions based on an ontology framework.

: The WHO International Classification of Diseases is used in many national applications to plan, manage and fund through case mix health care systems and allows international comparisons of the performance of these systems. There is no such measuring tool for health interventions or procedures. To fulfil this requirement the WHO-FIC Network recommended in 2006 to develop an International Classification of Health Interventions (ICHI). This initiative is aimed to harmonise the existing national classifications and to provide a basic system for the countries which have not developed their own classification systems. It is based on the CEN/ISO ontology framework standard named Categorial Structure defined from a non formal bottom up ontology approach. The process of populating the framework is ongoing to start from a common model structure encompassing the ICD 9CM Volume 3 granularity.

From DRG databases to an epidemiological observatory for colorectal cancer in a French small area oncology network.

Following a request from the local health authority, we have organised the permanent linkage of DRG/MBDS databases from different tertiary care hospitals from Saint-Etienne urban area. To made anonymous the MBDS, we used the asymmetric hashing and encrypting software developed and registered by the University hospital of Dijon. In each hospital, the selection of acute care stay MBDS is performed on the presence of at least one malignant tumour ICD code. The output is an anonymous but personal 20,000 patients register. We are presenting the method to estimate the incidence of colorectal cancer (CRC) cured between 1996 and 2000 from DRG databases of four hospitals and checking the validity against the figures coming from a cancer registry. Among the 1953 CRC patients observed, 156 patients have followed a CRC surgical excising in 1999. The DRG activity of the 4 observatory hospitals is 33.5% of the total hospital activity for people of the area recorded by the 1999 regional DRG PMSI data bases. The estimation of the incidence is 465 for 1999, the estimation of the same incidence by applying the incidence rate by sex and age from the Isère cancer register to the population of the Loire area, is 504. The under estimation is 7.7% with the observatory method. It is rather difficult to check an estimation by another estimation but in France the evaluation of oncology care strategies is impeded by the lack of cancer registries. The conclusion of this study is a good feasibility and acceptability of the linking procedure when used with a clear healthcare goal. The use of DRG data bases within an oncology network by linking the mandatory MBDS data bases gives the opportunity to share some clinical data between healthcare professionals.