Re: [Gnumed-devel] About systems of codification

[Liz]

On Wed, 28 Sep 2011 17:53:11 +1000
richard terry <address@hidden> wrote:

> Liz will probably give you more accurate into - I don't use
> commercial software but my (probably inaccurate take on it is this)
> 
> 1) GP's hate coding and probably in most EMR's do not do it at all
> 2) No govt insistance (currently) on coding for payment (but wait....
> it will be coming)
> 3) No mandatory reporting (but wait it will come)
> 
> > - are the ICPC2+ codes used only within each doctor's own EMR for
> > whatever benefits that affords the GPs in terms of consistency of
> > entry and being able to search among patients (facilitating your
> > doing some of your own praxis review and quality assurance)?  
> 
> for me  the answer would be yes.
> 
> >   
> > --> or do your ICPC2+ codes ever appear in what you send out in a
> > clinical report, or in a referral to a specialist (or even to
> > government) ?  
> 
> Never
> 
> However we get back sometimes coded hospital discharge stuff eg our
> local GpAcess clinics insist on coded consultations, however the
> software is crap and it dosn't enforce this and it is often missed.
> Some departments have coding on their discharge forms (paper).
> 
> So a mess.
> 
> I think eventually SnoMed will rule here.

I use ICD 10 at work, except after years of use I still don't know what
the terms are for at least half the stuff I use. They are not
guessable, and some things like pomphylox aka dyshidrotic eczema I
cannot find at all.
Some of the codes are ridiculous - although I cannot recall one,
imagine a code which describes a joint somewhere between the hip and
ankle, but doesn't call it a knee
Codes are not granular enough. Malignant skin lesion head and neck
region doesn't give enough information for management when a lot of the
population will be treated for more than 10 of them when over 75 years
of age.

At the other place I work the coding is the interesting scheme which is
a local invention, and actually has some intelligent parsing of the
terms. However that software doesn't allow you to perform any searches
according to the codes, and you have to buy an add on program.


At this stage no one other than the clinician is interested in the
codes. so if the clinician doesn't code who cares??