Klinkman M S, Green L A
Department of Family Practice, University of Michigan, Ann Arbor, USA.
Fam Med. 1995 Jul-Aug;27(7):449-56.
Although the framework of the episode of care offers much promise in examining the process of primary health care, the development of episode-oriented, automated data sources has proceeded slowly. Experience with the International Classification of Primary Care (ICPC) in the European Community has confirmed its usefulness in creating and analyzing episodes of care, but it has seen little use in the United States. We describe the development of a Primary Care Information System (PCIS), which employs ICPC to create episodes of care from routinely collected clinical data.
The PCIS is a partially computerized medical information system running on a standard Macintosh microcomputer. The PCIS integrates ICPC, ICD-9-CM, and CPT-4 coding structures to provide episode-oriented data for clinical, administrative, research, and reimbursement needs. The performance of the PCIS was assessed based on five major issues: clinician cooperation, data-entry accuracy, validity of episode data, cost, and perceived value to users.
The data collection and entry process required minimal additional effort from clinicians and data-entry personnel, and data-entry accuracy exceeded published estimates for other primary care data sources. Data management costs of about $1 per encounter compare favorably to published estimates for other office-based clinical information systems. The major problem seen during pilot testing was inaccurate tracking of episode boundaries through changes in providers and consequent changes in labels for problems and diagnoses. This problem has been addressed in development of the second-generation PCIS.
The combination of an episode-oriented framework such as ICPC and a flexible medical information system provides a promising platform for the study of the content and process of primary health care.
尽管照护事件框架在审视初级卫生保健过程方面前景广阔，但面向照护事件的自动化数据源的开发进展缓慢。欧洲共同体在国际初级保健分类法（ICPC）方面的经验已证实其在创建和分析照护事件方面的有用性，但在美国却很少使用。我们描述了一个初级保健信息系统（PCIS）的开发过程，该系统采用ICPC从常规收集的临床数据中创建照护事件。
PCIS是一个在标准麦金塔微型计算机上运行的部分计算机化的医学信息系统。PCIS整合了ICPC、ICD - 9 - CM和CPT - 4编码结构，以提供面向照护事件的数据，满足临床、管理、研究和报销需求。基于五个主要问题对PCIS的性能进行了评估：临床医生的合作、数据录入准确性、照护事件数据的有效性、成本以及用户感知价值。
数据收集和录入过程只需临床医生和数据录入人员付出极少的额外努力，且数据录入准确性超过了已公布的其他初级保健数据源的估计值。每次诊疗的数据管理成本约为1美元，与已公布的其他基于办公室的临床信息系统的估计成本相比具有优势。试点测试期间发现的主要问题是，由于提供者的变更以及随之而来的问题和诊断标签的变更，照护事件边界的跟踪不准确。在第二代PCIS的开发中已解决了这个问题。
诸如ICPC这样的面向照护事件的框架与灵活的医学信息系统相结合，为研究初级卫生保健的内容和过程提供了一个有前景的平台。
