The fractured lens: a controversial revision of the International Classification of Primary Care.

Background: The International Classification of Primary Care (ICPC) has represented the international standard reduction for measuring the content of primary care for over 30 years. In the process of its third revision, its authors, the Wonca International Classification Committee (WICC), delegated a major part of the technical work to a purposely formed Consortium. However, in the process of such revision, standard classification principles and rules have been inconsistently applied with the result that ICPC-3 has been published with major errors and an inconsistent structure. Objectives: To formally describe and critically appraise the revision process of ICPC-3. Methods: The formal review of ICPC-3 performed by an expert group within WICC and commissioned by the Executive Council of Wonca Europe is presented in abridged form. Results: ICPC-3 as currently presented introduces major departures from formal classification principles and rules, besides other major errors and inconsistencies, all of which are listed and described. Conclusion: Major changes in ICPC-3 defy categorisation and conceptualisation standards. ICPC-3 now represents an untested departure from international standard presentations, without a formal academic base. The direct inclusion of measures of functioning in a classification of reasons for encounter and health problems fails to address the dichotomy of these domains, the boundaries of and relationships between which are not satisfactorily resolved by the system. Analysis of ICPC-3 data will require the development and implementation of alternative, as yet undefined, models of the relationships between disease and health. By including different domains without resolving ambiguity, and by splitting function from other body systems, ICPC-3 becomes an internally fractured instrument.

Development, dissemination, and applications of a new terminological resource, the Q-Code taxonomy for professional aspects of general practice/family medicine.

BACKGROUND: While documentation of clinical aspects of General Practice/Family Medicine (GP/FM) is assured by the International Classification of Primary Care (ICPC), there is no taxonomy for the professional aspects (context and management) of GP/FM. OBJECTIVES: To present the development, dissemination, applications, and resulting face validity of the Q-Codes taxonomy specifically designed to describe contextual features of GP/FM, proposed as an extension to the ICPC. DEVELOPMENT: The Q-Codes taxonomy was developed from Lamberts' seminal idea for indexing contextual content (1987) by a multi-disciplinary team of knowledge engineers, linguists and general practitioners, through a qualitative and iterative analysis of 1702 abstracts from six GP/FM conferences using Atlas.ti software. A total of 182 concepts, called Q-Codes, representing professional aspects of GP/FM were identified and organized in a taxonomy. Dissemination: The taxonomy is published as an online terminological resource, using semantic web techniques and web ontology language (OWL) ( http://www.hetop.eu/Q ). Each Q-Code is identified with a unique resource identifier (URI), and provided with preferred terms, and scope notes in ten languages (Portuguese, Spanish, English, French, Dutch, Korean, Vietnamese, Turkish, Georgian, German) and search filters for MEDLINE and web searches. APPLICATIONS: This taxonomy has already been used to support queries in bibliographic databases (e.g., MEDLINE), to facilitate indexing of grey literature in GP/FM as congress abstracts, master theses, websites and as an educational tool in vocational teaching, Conclusions: The rapidly growing list of practical applications provides face-validity for the usefulness of this freely available new terminological resource.

A Terminology in General Practice/Family Medicine to Represent Non-Clinical Aspects for Various Usages: The Q-Codes.

The hereby proposed terminology called "Q-Codes" can be defined as an extension of the International Classification of Primary Care (ICPC-2). It deals with non-clinical concepts that are relevant in General Practice/Family Medicine (GP/FM). This terminology is a good way to put an emphasis on underestimated topics such as Teaching, Patient issues or Ethics. It aims at indexing GP/FM documents such as congress abstracts and theses to get a more comprehensive view about the GP/FM domain. The 182 identified Q-Codes have been very precisely defined by a college of experts (physicians and terminologists) from twelve countries. The result is available on the Health Terminology/Ontology Portal (http://www.hetop.org/Q) and formatted in OWL-2 for further semantic considerations and will be used to index the 2016 WONCA World congress communications.

Analysis of definitions of general practice, family medicine, and primary health care: a terminological analysis.

BACKGROUND: There are numerous definitions of general practice/family medicine (GP/FM) and primary health care (PHC), but the distinction between the two concepts is unclear. AIM: To conduct a terminological analysis of a set of definitions of GP/FM and of PHC, to clarify the commonalities and differences between these two concepts. DESIGN: Sets of 20 definitions were collected in two 'bags of words' (one for GP/FM and one for PHC terms). A terminological analysis of these two collections was performed to prioritise the terms and analyse their universe of discourse. METHOD: The two collections were extracted with VocabGrabber, configured in two 'term clouds' using Wordle, and further explored for similarities using Tropes. The main terms were analysed using the Aristotelian approach to the categorisation of things. RESULTS: Although continuity of care (characterised by a person-centred approach and shared decision making) is common to both sets, the two sets of definitions differ greatly in content. The main terms specific to GP/FM (community, medicine, responsibility, individual, problem, and needs) are different from those specific to PHC (home, team, promotion, collaborator, engagement, neighbourhood, and medical centre). CONCLUSION: Terminological analysis of the definitions for GP/FM and PHC shows two overlapping but distinct entities, necessitating a different taxonomic approach and different bibliographic search strategies.

Mapping French terms in a Belgian guideline on heart failure to international classifications and nomenclatures: the devil is in the detail.

INTRODUCTION: With growing sophistication of eHealth platforms, medical information is increasingly shared across patients, health care providers, institutions and across borders. This implies more stringent demands on the quality of data entry at the point-of-care. Non-native English-speaking general practitioners (GPs) experience difficulties in interacting with international classification systems and nomenclatures to facilitate the secondary use of their data and to ensure semantic interoperability. AIM: To identify words and phrases pertaining to the heart failure domain and to explore the difficulties in mapping to corresponding concepts in ICPC-2, ICD-10, SNOMED-CT and UMLS. METHODS: The medical concepts in a Belgian guideline for GPs in its French version were extracted manually and coded first in ICPC-2, then ICD-10 by a physician, an expert in classification systems. In addition, mappings were sought with SNOMED-CT and UMLS concepts, using the UMLS SNOMED-CT browser. RESULTS: We identified 143 words and phrases, of which 128 referred to a single concept (1-to-1 mapping), while 15 referred to two or more concepts (1-to-n mapping to ICPC rubrics or to the other nomenclatures). In the guideline, words or phrases were often too general for specific mapping to a code or term. Marked discrepancy between semantic tags and types was found. CONCLUSION: This article shows the variability of the various international classifications and nomenclatures, the need for structured guidelines with more attention to precise wording and the need for classification expertise embedded in sophisticated terminological resources. End users need support to perform their clinical work in their own language, while still assuring standardised and semantic interoperable medical registration. Collaboration between computational linguists, knowledge engineers, health informaticians and domain experts is needed.