Assessing ICD-9-CM and ICPC-2 Use in Primary Care. An Italian Case Study

Controlled vocabularies and standardized coding systems play a fundamental role in the healthcare domain. The International Classification of Diseases (ICD) is one of the most widely used classification systems for clinical problems and procedures. In Italy the 9th revision of the standard is used and recommended in primary care for encoding prescription documents. This paper describes a statistical and terminological study to assess ICD-9-CM use in primary care and its comparison to the International Classification of Primary Care (ICPC), specifically designed for primary care. The study has been conducted by analyzing the clinical records of about 199,000 patients provided by a set of 166 General Practitioners (GPs) in different Italian areas. The analysis has been based on several techniques for detecting coding practice and errors, like natural language processing and text-similarity comparison. Results showed that the selected GPs do not fully exploit the diseases and procedures descriptive capabilities of ICD-9-CM due to its complexity. Furthermore, compared to ICPC-2, it resulted less feasible in the primary care setting, particularly for the high granularity of the structure and for the lack of reasons for encounters

Towards a rule-based support system for the coding of health conditions in the patient summary

In the frame of federated and interoperable Electronic Health Records (EHRs), specific coding systems are mandatory for filling out healthcare documents such as the Patient Summary (PS). PS cannot be automatically generated from the patient’s EHR data, because of the sensitivity of its content. For this reason it needs to be validated by a General Practitioner (GP), who is the sole responsible of this document. The literature shows that the practice of coding is recognized as a difficult task for GPs and it often generates coding errors and misspecifications of clinical data. To overcome this issue, a support system based on standardized and formalized coding rules for the domain of application is proposed, to facilitate a more accurate coding process without breaking the law

ALPHA: an eAsy inteLligent service Platform for Healthy Ageing

Dementia is one of the biggest global public health challenges facing our generation. Alzheimers disease (AD) is the most frequent cause of dementia in elderly people over 65 years of age. The typical characteristic of AD is impairment of memory. As the disease progresses, other cognitive domains such as language, praxis, visuo-spatial and executive functions become involved, eventually resulting in global cognitive decline. Behavioral Psychological Symptoms of Dementia (BPSD) problems are constant in AD and have highly negative impact on the quality of life of patients and their families. ALPHA project aims at developing an intelligent situation-aware system to collect and process information about Alzheimer Disease patients? life style. Starting from various data provided by caregivers and a set of non-invasive sensors and devices. ALPHA will provide clinicians with new quantitative and qualitative information about patients? abnormal behavior which, along with medical data, will enhance the accuracy and reliability of monitoring and assessing the patient?s health status. Clinicians will be supported by a suite of specifically designed tools and interfaces to analyze the metadata captured, improve management of personalized care plans and better interact with patients and caregivers. Studies of antique records of former psychiatric hospital will enable us towiden the knowledge of behavioral disorders thus allowing to compare the ancient ones and the curcurrent and to probabilistically determine relation between type of dementia and behavioral disorders

Towards a rule-based support system for the coding of health conditions in the Patient Summary

Abstract. In the frame of federated and interoperable Electronic Health Records (EHRs), specific coding systems are mandatory for filling out healthcare documents such as the Patient Summary (PS). PS cannot be automatically generated from the patient's EHR data, because of the sensitivity of its content. For this reason it needs to be validated by a General Practitioner (GP), who is the sole responsible of this document. The literature shows that the practice of coding is recognized as a difficult task for GPs and it often generates coding errors and misspecifications of clinical data. To overcome this issue, a support system based on standardized and formalized coding rules for the domain of application is proposed, to facilitate a more accurate coding process without breaking the law

Captura de culicídeos em área urbana: avaliação do método das caixas de repouso

OBJECTIVE: To evaluate the occurrence of adult culicid populations in urban areas and measure the sensitivity of the resting box collection method. METHODS: Mosquito were collected in 1999 and 2000, in two cities in the State of São Paulo, Brazil: Ocauçu and Uchoa. In each city, 15 blocks were drawn by lots and then one home in each block was drawn. Two resting boxes were installed at each home: one inside and the other outside the house. Monthly collections were carried out at each home, over a 13-month period, using manual aspirators inside and outside the home and inside the boxes. The captured specimens were taken to the laboratory for screening and identification according to species and sex. RESULTS: Out of the 2,112 culicid specimens collected, 99.7% were of four species: Culex quinquefasciatus, Aedes aegypti, Cx. declarator and Cx. coronator. The distribution of these species in Ocauçu was 83.3%, 3.2%, 10.8% and 24%, respectively, and in Uchoa it was 83.8%, 8.4%, 4.4% and 3.0%, respectively. Among the females of the genus Culex, 34.3% were captured in the resting boxes and 59.9% were collected from inside the house. Among the females of Ae. aegypti, 17.6% were found in the resting boxes and 82.4% inside the home. CONCLUSIONS: The great majority of the specimens collected belonged to four species of culicids, and Cx. quinquefasciatus was the most common. Proportionally, the females of Ae. aegypti were found more inside the home than were those of the genus Culex. Resting boxes present potential for use as surveillance devices, but their use needs to be more thoroughly evaluated.OBJETIVO: Avaliar a ocorrência de população adulta de culicídeos em área urbana e medir a sensibilidade do método de coleta em caixa de repouso MÉTODOS: Foram coletados mosquitos entre 1999 e 2000, em duas cidades do Estado de São Paulo: Ocauçu e Uchoa. Em cada uma delas, sortearam-se 15 quadras, e em cada quadra um domicílio, onde foram instaladas duas caixas de repouso, no intra e no peridomicílio. Realizaram-se coletas mensais por domicílio, durante 13 meses, utilizando aspiradores manuais no intra e peridomicílio e no interior das caixas. Os espécimes capturados foram levados ao laboratório para triagem e identificação por espécie e sexo. RESULTADOS: Dos 2.112 espécimes de culicídeos coletados, 99,7% corresponderam a quatro espécies: Culex quinquefasciatus, Aedes aegypti, Cx. declarator e Cx. coronator. A distribuição percentual dessas espécies foi, respectivamente, em Ocauçu: 83,3%, 3,2%, 10,8% e 2,4%, e em Uchoa: 83,8%, 8,4%, 4,4% e 3,0%. Das fêmeas do gênero Culex, 34,3% foram coletadas nas caixas de repouso e 59,9% encontravam-se no intradomicílio. Das fêmeas de Ae. aegypti, 17,6% foram coletadas nas caixas de repouso e 82,4% encontraram-se no intradomicílio. CONCLUSÕES: A grande maioria dos espécimes coletados pertenciam a quatro espécies de culicídeos, sendo Cx. quinquefasciatus a mais freqüente. Proporcionalmente, as fêmeas de Ae. aegypti ocuparam mais o intradomicílio do que as do gênero Culex. A caixa de repouso apresenta potencial de utilização como dispositivo de vigilância, mas precisa ser mais bem avaliada

Le cartelle dell'ex ospedale psichiatrico di Girifalco. Lessico, strumenti e terapie

Il contributo prende in esame il lessico usato alla fine del XIX secolo dai medici del manicomio di Girifalco (CZ), relativamente agli strumenti e alle terapie adottate nella pratica quotidiana delle cure psichiatriche e rilevato in un campione significativo di cartelle cliniche (CC). L’obiettivo è quello di identificare gli usi specifici e/o allargati dei lemmi presenti nel campione in oggetto, lungo un periodo, che va dal 1881 al 1894, nel quale non si era ancora formata né tantomeno specializzata la terminologia tecnica di settore. Gli archivi storici di ex ospedali psichiatrici sono preziose fonti di informazione e di particolare interesse, ai fini di questo studio, è il linguaggio adottato dai medici in fase di compilazione del diario clinico, facente parte della cartella clinica, in cui sono riportate in testo libero l’anamnesi e tutte le informazioni cliniche raccolte durante il periodo di ricovero del paziente, ivi comprese le cure praticate e gli strumenti utilizzati. La ricerca ha riguardato un campione di 536 CC, all’interno delle quali sono stati rilevati 63 lemmi designanti strumenti, terapie e patologie per un insieme di 975 occorrenze totali; di alcuni di questi lemmi viene inoltre tracciata brevemente la storia e l'etimologia

I sistemi di codifica nell'era dell'e-Healt: traduzione ed implementazione di LOINC® in Italia

Dottorato di ricerca in Storie, popolazioni, culture, Ciclo XXV, a.a. 2011-2012Università della Calabri

Ensuring the Long-Term Preservation of and Access to the Italian Federated Electronic Health Record

The Italian Electronic Health Record (called the FSE) is based on a federated architectural model and involves various types of health data and documents deriving from public and private health stakeholders. Clinical documents are stored in repositories and indexed in a central regional index (registry) according to a defined metadata schema. The FSE repositories can be distributed in the regional network or centralized at the regional level, or regions can use subsidiarity services offered by the National Infrastructure for the regional FSEs Interoperability. In this scenario, this study addresses the open issue of the FSE documents’ long-term preservation and access over time, since the responsibility of their preservation is distributed among different stakeholders. As a consequence, the process traceability is necessary to ensure that a document indexed in an FSE is accessible over time, regardless of the document local discard policies applied for legal fulfilments. The results of this study show that the enhancement of metadata use could support the management and long-term preservation of the FSE documents. Addressing this issue is, finally, fundamental to guarantee the correct tracing and access to the clinical path of a patient and to ensure the efficiency of the entire care setting

Towards a Rule-based Support System for the Coding of Health Conditions in the Patient Summary

In the frame of federated and interoperable Electronic Health Records (EHRs), specific coding systems are mandatory for filling out healthcare documents such as the Patient Summary (PS). PS cannot be automatically generated from the patient’s EHR data, because of the sensitivity of its content. For this reason it needs to be validated by a General Practitioner (GP), who is the sole responsible of this document. The literature shows that the practice of coding is recognized as a difficult task for GPs and it often generates coding errors and misspecifications of clinical data. To overcome this issue, a support system based on standardized and formalized coding rules for the domain of application is proposed, to facilitate a more accurate coding process without breaking the law