Appendix 4:
ICPC-2 stands for International Classification
of Primary Care
Information Technology
Primary Care Toolkit for Family Physicians
The College of Family Physicians of Canada
Introduction
Our Canadian healthcare system is moving rapidly toward integration of various aspects of Primary Care Renewal, including electronic information systems for recording and information sharing, and team-based care. Canadian experience has recognized that many activities of primary care providers are not well captured using our current classification and coding systems.
The International Classification of Primary Care (ICPC) was published in 1987 by WONCA (World Organization of Family Doctors). It is a classification which reflects the distribution and content of primary care, and was designed for family physicians and other primary health care providers in order that they could classify, within a single system, three important elements of the health care encounter; the reason(s) for encounter (RFE), diagnoses or problems, and the processes of care, including site of care and team-based elements of care.
In 1998 Wonca published a revised version of ICPC (ICPC-2) with mapping to ICD-10 and SNOWMED-(CT), the currently adopted standard vocabulary for US health information and statistical electronic recording systems. A revised electronic version, known as the International Classification of Primary Care Version 2- Electronic (ICPC-2-E) was released in 2000 . ICPC-2 has been translated into French (Classification Internationale des Soins Primaires), with an electronic version available in French as well.
Classifying Primary Care Encounters
Currently, what we do is coded and classified using the International Classification of Diseases (lCD). This classification, originally designed for application to mortality statistics, and developed from an episodic, disease-based, and hospital oriented perspective, does not capture the many symptoms and non-disease conditions that present in daily in a primary care setting. Using this system, it is estimated that only fifty-five per cent of diseases in general practice can be diagnosed accurately in terms of etiology, pathology and morphology. Others can only be described in terms of symptoms or complaints.
There is clear need for a system that enables direct and indirect encounters with patients to be appropriately identified and routinely collected in such a way that it most accurately reflects what we do in frontline primary care practices.
Reasons for Encounter (RFEs) are the reason(s) why a patient enters the health care system - symptoms or complaints (headache or fear of cancer), known diseases (flu or diabetes), requests for preventive or diagnostic services (a blood pressure check or an ECG), a request for treatment (repeat prescription), to get test results, or administrative (a medical certificate). These reasons are usually related to one or more underlying problems, which are formulated at the end of the encounter as the conditions that have been treated. These may or may not be the same as the reasons for encounter.
A Reason for Encounter classification focuses on data elements from the patient’s perspective. In this respect, it is patient oriented rather than disease or provider oriented. There is a natural progression from ill-defined symptoms to formal diagnosis in family practice. This usually occurs over time and through repeat visits. By using a problem based orientation and linkage of episodic encounters, this system recognizes this progression.
Technical Characteristics of ICPC-2
ICPC has a biaxial structure with 17 chapters on one axis and seven components on the other.
Chapters are based on body systems with an additional chapter for psychological problems and one for social problems. Each chapter is identified by a single alpha code, which is the first character of all rubrics belonging in the chapter. Each chapter is divided into seven components:
Symptoms and Complaints
Diagnostic Screening and prevention
Treatments, Procedures, and Medications
Test Results
Administrative
Other
Diagnoses, and Diseases
All encounters are further classified using process modifiers that define the site of care, and team based activities.
Future Opportunities
This classification system is being used extensively in other countries, most notably Australia and Europe. As we move into a new era of rapidly expanding use of electronic information management, and a renewed emphasis on primary care as central to the health care system, this standardized e-language becomes increasingly relevant.
ICPC-2-E represents an opportunity for provincial and national information management to make significant advances - not only in the documentation and recording of the various elements of primary care in an accurate, accessible, applicable, reliable, valid, and consistent way - but also advances in performance measurement through indicators that allow an appropriate analysis of the activities of primary care providers.
See Okkes IM, Jamoulle M, Lamberts H, Bentzen N. ICPC-2-E, the electronic version of ICPC-2. Differences with the printed version and the consequences. Family Practice 2000; 17:101-106 available at: http://fampra.oupjournals.org/cgi/content/full/17/2/101/DC1