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How well does ICD9 represent phrases used in the medical record problem list?
T H Payne1, G R Murphy, A A Salazar
1Group Health Cooperative of Puget Sound, Seattle, Washington.
Insights
Physician satisfaction with International Classification of Diseases, Ninth Revision (ICD-9) for automated problem lists was low. Improvements are needed for better clinician user experience in clinical information systems.
Area of Science:
- Medical Informatics
- Health Information Systems
- Clinical Documentation
Background:
- Automated problem lists are crucial for clinical information systems.
- The International Classification of Diseases, Ninth Revision (ICD-9) is a potential basis for these lists.
- Physician satisfaction is key for the adoption and effectiveness of clinical tools.
Purpose of the Study:
- To assess physician satisfaction with ICD-9 representations of medical record problem list phrases.
- To identify areas for improvement in automated problem list generation.
Main Methods:
- Six physicians evaluated 332 phrases from medical record problem lists.
- ICD-9 codes were used to represent these phrases.
- A satisfaction scale (1-5) and intraclass correlation were employed.
Main Results:
- The mean physician satisfaction score was 3.0 out of 5.
- Physicians were dissatisfied with the ICD-9 representation in 45% of phrases.
- Intraclass correlation for phrase evaluation was 0.47.
Conclusions:
- Current ICD-9 representations yield suboptimal physician satisfaction for automated problem lists.
- Modifying ICD-9, using alternative vocabularies, or enhancing code assignment methods are potential solutions.
- Improving user satisfaction is essential for effective clinical information systems.
Abstract:
We are considering using the International Classification of Diseases with Clinical Modifications, Ninth Revision (ICD9) as the basis for an automated problem list for a clinical information system. To determine physician satisfaction with an ICD9 representation of phrases used in the medical record problem list, we asked 6 physicians to evaluate ICD9 representations of 332 phrases taken from medical record problem lists, using a scale of 1(extremely dissatisfied) to 5 (extremely satisfied). The mean score was 3.0; intraclass correlation for 25 phrases given to all 6 evaluators was 0.47. In 45% of the phrases the physicians were dissatisfied with the ICD9 representation. In developing an automated problem list it is desirable to improve the level of satisfaction of clinician users above this level. This could be done by modifying ICD9, using a different vocabulary to represent the problem list, or improving the method of assigning ICD9 codes.