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Controlled vocabularies: "@*%!!!" ?

Publication date: Sep 01, 2003

There is a marked increase in interest in coding by European healthcare provider organizations. Instead of using free text, observations will have to be coded by means of a code from a controlled vocabulary. I see two main reasons for the current increase in interest in coding: the requirement by governments for the coding of diagnoses and procedures as a cost controlling mechanism, and the increased cooperation between healthcare providers.

As a direct result of legislation healthcare provider organizations have a financial incentive to improve their cost management, i.e. to calculate -and lower- their costs in relationship to diagnoses or treatment categories. The impetus to decrease costs also leads to a desire to increase efficiency by establishing ever closer cooperation with other healthcare providers. The trend for cooperation between healthcare providers into healthcare provider networks is also driven by various healthcare reform laws that mandate closer cooperation between providers (e.g. The German 'Gesundheidsreform 2000'). The use of common coding standards is an essential prerequisite for close cooperation.

The change in attitude towards coding is mainly driven by a restructuring of the reimbursement process towards the use of DRGs/DBCs. DRGs are used as a means of capturing diagnoses/procedures. Dutch DBCs are an identifier /classification for clinical pathways. DRGs/DBCs require the coding of diagnoses and procedures using coding standards such as ICD-10 and ICPC. Once diagnoses and procedures have been coded they can be used for both financial as well as clinical purposes. The coding requirements related to financial issues will lead to a higher acceptance of coding methods and technologies, of coding standards such as LOINC, ICD-10 and SNOMED, and of a new middleware product: the terminology server.
A terminology server is a product that contains all codes from a range of coding standards, and maintains a database / expert system of the relationships between the individual concepts coded within these vocabularies. If you use a DRG-grouper, you already have a terminology server: all DRG groupers have an embedded terminology server to aid in the process of determining the correct diagnoses codes.
The interest in the area of coding is also shown by an increasing number of requests to healthcare related standardisation organisations such as the HL7 Affiliates, CEN or NICTIZ, to assist with the selection of coding standards.

In order to support the reimbursement process coding is gaining in popularity. Even though most clinicians are rather resistant to the idea of having to do coding for purely financial reasons (their reaction may very well be something like "@;$#*!!!"), it will expose a large amount of clinicians to coding in general. This will prove to be very beneficial to the chances of (regional) electronic patient record systems. Money is a very powerful motivator when it comes to introducing new practices.

-Rene

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