Prometheus: the implementation of clinical coding schemes in French routine general practice

Area of Science:

• Primary Care Medicine
• Health Informatics
• Medical Classification Systems

Background:

• Standardized coding of clinical data enhances its utility at both individual and collective levels.
• Clinicians often lack motivation for routine consultation data coding.
• Key French primary care classification systems include the International Classification of Primary Care (ICPC) and the Dictionary of Consultation Results (DCR).

Purpose of the Study:

• To evaluate the feasibility of using ICPC-2 and DCR for coding health problems in routine French general practice.

Main Methods:

• 61 volunteer general practitioners (GPs) in Paris prospectively coded health problems over six months (Dec 2001-June 2003).
• GPs used either ICPC (36) or DCR (25), with specialized or open-source software.
• Participants received training, financial compensation, and electronic feedback.

Main Results:

• Mean coding time was 2.5 minutes per consultation; 46% deemed this excessive, with an acceptable maximum of 1.2 minutes.
• Coding was perceived as more useful collectively (95%) than individually (69%).
• Only 56% of physicians were willing to continue routine coding post-study.

Conclusions:

• Routine coding of health problems is feasible in primary care.
• Widespread adoption and integration with other data require physician training, rewards, and software with extensive, mapped terminologies.