1.    Background

An Access database has been created to compliment the white paper: ‘’ICPC–3 development:
review processes and considerations” prepared by Helena Britt.

This database provides WICC members with read-only Access database which you will need to use as a Reference Document in you considerations of issues needing to be addressed in ICPC-2.

We had been hoping to build all reference material into the web based ICPC-3 Development Software, but this has proved too difficult.

The actual recording of decisions, links between ICPC-3 back to ICPC-2 (for later creation of ‘maps’), etc will all happen on the Web based ICPC-3 Development software, which is currently in early beta-test phase.

2.    Download and copy to local computer

• Find the link to the download page in this email  
• Click the download link and save the “ICPC-2 reference for ICPC-3 dev.mdb” file to your local disk.
• Open the database “ICPC-2 reference for ICPC-3 dev.mdb” file with Access 2003 or better.
• You may get a message on the top left of the Screen, telling you “certain content has been disabled”, because Access 2007 automatically disabled the built in macros.
• If you get this message—
  •  Click on ‘Options” (in the box next to the message).
  • A Security Alert box will appear with two options
  • Select Enable.

It will automatically open in whichever chapter it was last open in.

3.    The opening page

The opening page will show you the ICPC-2 list for the chapter you are currently in:

• Col 1: gives you the ICPC-2 code
• Col 2: the rubric
• Col 3: component number
• Col 4: criteria
• Col 5: Inclusions
• Col 6: Exclusions:
• Col 7: Consider
• Col 8: Notes
• Col 9: ICD 10 map

All of these data have come from the ICPC-2 Version 4.2 on the KITH Website.

4.        Selecting a chapter

At the top of the form, there is a box called Chap:

Go to the box and hit the arrow. You will get a drop down menu. Select the chapter you want to see.

Your chosen chapter will open as per above.

To work through this document: Please go to Chapter S—Skin

5.        ‘Comments about this chapter ‘

‘Comments’ include those recorded by the ICPC-2 Update group about issues needing consideration, but that could not be fixed in an update because of wider consequences for other rubrics; plus some comments  submitted by other individuals.

Go to the top of the screen and click the “View ICPC-2 comments” button to view comments regarding ICPC-2 and suggestions of changes needed or issues that need consideration in development of ICPC-3 I in this example— Chapter S)

The page you are on now is called: “ICPC-2 and 3 suggestions”

6.        ICPC-2 and 3 suggestions

Some comments are quite broad, and apply to all parts of ICPC-2.

Because they are attached to every chapter, broad comments or suggestions will always come up first in every chapter.

Other comments apply to multiple chapters but not all chapters. These will come up next.

Then gradually you will get down to comments that only apply to your chapter, then to comments that only apply to a single rubric.

On the opening page you will see on the right that there is a tick box in every chapter in the list. This means this comment will appear in every chapter you look at.

Comment ID: The first comment that comes up in Chapter S has comment ID of 59. This is of no great significance—it is just the mechanism by which the particular comment is linked to the chapters, or rubric(s).

Rubric code box. You will see there is no ICPC-2 code in the Rubric box on this page, because this comment is very broad, and not centring on a specific rubric.

Chapter Boxes: Each chapter to which this comment applies has a tick in the box beside it. (In this case all chapters are ticked)

Component boxes: Each component, to which this comment relates, is ticked.
There are none on this page because this comment applies to all chapters and all components.

Other: On the far right had side, the “Other” column has a series of explanatory markers with tick boxes. In this very broad example, the ‘reason‘ box that is ticked is ‘inconsistency across chapters”.

To scroll through the comments, use “PAGE down”, and each time you hit “PAGE down” it will take you to the next comment associated with this chapter.

Let’s go to a more specific rubric in Chapter S.

‘Page down’ on your keyboard  until you get to Comment ID 41 which is labelled in the rubric box as H76.

The comment ID is 41, and the comment is about H76. The problem with this rubric is stated.

Why is a comment about H76 in the comments section related to Chapter S?

The comment is: How do we look at dysplasia? Is this a risk factor for malignancy? Is it an abnormal test result?  Is it a benign neoplasm? For a major update we might consider this handling differently.

It has been associated with three other chapters, including SKIN so this comment will arise in each of the chapters  ticked in the Chapter list, because the decision of what to do about it in the H chapter, may have implications that need to be considered by working groups for the other marked chapters ( including Chapter S).

Two possible solutions are put forward for discussion.

‘Page up’  ONCE on your keyboard  until you get to Comment ID 75, which is labelled in the rubric box as ‘dysplasia'.

No ICPC-2 code was entered by the reporter of this issue. However, I assume it pertains in the skin chapter to ectodermal dysplasia (which we code as in S83.. However, it relates to dysplasia in other chapters so what is done with it in this chapter needs to be a uniform approach in other chapters with dysplasia, so it isn’t only related to the S chapter.

I hope  these examples have given you an idea of how the “Comments” section has been set up.

Note: that the comments are provided here in the words of the person who recorded the comment.

Close this page, by clicking on “CLOSE”. You will now be back at the Chapter ICPC-2 list you were in before.

7.    Rubric usage data

We want to look now at the usage of an individual rubric. Is it used often, or is it not used at all? How does usage vary between countries?

Notes:

1. 1.     Usage data includes data submitted by people in many countries. It does not include ALL data that have been submitted, because 2 or 3 of the submitted data sets lack vital information ( e.g. ICPC-2 code), and Julie cannot read the rubric in other languages. Julie will be in contact with suppliers of these few data sets when she returns from leave, and these will be added if the data is resubmitted in a useable form.
2. 2.     Some  of the data submitted did not specify whether the data were from RFEs, problems managed by clinicians, or BOTH. Therefore all data have been put together, and in some countries may include data from both, while in others it may be only RFEs or only problem labels.

We will use as an example of rubric usage data for S04, lump/swelling, localised

Double-Click the ICPC-2 code (in the first column) ‘S04’

This opens the “ICPC-2 Usage”  data page for Chapter S, and highlights the row for data on S04.

It may present in order of “top %” (Col 3), in order of frequency (Col 4), or any other order that was last used in the previous session.

In this case, it may be useful to consider usage of S04 and S05 together. So  if the table is NOT in ICPC-2 order, Select the first column (Rubric), right click, and select “Sort A to Z"). This will reorder the whole table into ICPC-2 code order.

S04 remains highlighted because that was your choice entering this page.

We can see, that across the 14 data sets, S04 accounted for an average 1.7% of all Chapter S coding use.

It accounted for more in Australia, France and the Netherlands, and was not used at all in the Canadian data set, other countries sat around the average.

I wondered why it wasn’t used at all in Canada so used the bar at the bottom to move across the screen and see what the sample size was in Chapter S in the Canadian data supplied to us. I find there were only 22  in Chapter S in  that data set – so the lack of use of S04 in the Canadian data, is probably due to the size of the dataset rather than anything else.

Now, how about  S05 (lumps/swelling, general—How often was that used?

Move back to the left hand section of the Table and click on S05 ( it becomes highlighted when you do).

It accounted for  0.1% of all usage in Chapter S and there was little variance across countries.  This may mean the S chapter working group could consider whether or not the two rubrics are needed, and are they better combined into one which covers both localised and general?

They may also wish to consider how these two codes relate to A08 – Swelling (incl: lump/mass); how they relate to S10 boil/carbuncle ( furuncle is very close to   papule), and how S05 relates to Acnes (S96). (These are just a few thoughts that arose when I was looking at the frequency of use of these two rubrics.)

Note that if Iyou did want to find out about the usage of A08, you  would have to close this page and change my chapter selection to Chapter A on the ICPC-2 page, then double click A08 to see the frequency data.

You may want to refer to the ICD 10 map from ICPC-2, to assist you in your thinking. So let’s go there.

8.    The ICD 10 Map

Because you entered this page from a selection of “S04’’ on the ICPC-2 page, you will see that the information presented at the tope of the Usage Table still refers to S04 ( not to S05 which you were looking at most recently). This information includes the ICD 10 map from ICPC-2 (Veres 4.2) for S04

Now stay on this page for the next step.

Notes: If you want to find out the ICD 10 map for S05, you need to close this page (by clicking on the Close box at the top, select S05 ( double click the code S05) and it will take you to the Usage data page again, but this time it has the ICD10 map for S05.

You can always look at the ICD-10 map for a rubric on the ICPC-2 Page, but it is a bit cramped, and it is easier to read on the Usage Table page.

9.    Term usage data

To date we only have  on the Access database term usage data from the Netherlands and Australia.  Julie was unable to bring together the term usage data we hold from another few countries before she  went ton leave.

 Julie and Tim will add the other countries and update the Reference Database as soon as Julie has prepared  the other countries’ data.

As these terms usage data will be most useful when considering things that have been put in “other….” Rubrics, let’s go to S99 as the example.

Remember:  Close the Usage data page,  go to S99 on the ICPC-2 page and double click the S99 CODE.

First we see from the RFE +Problem usage data, that S99 makes up 4.0% of all the usage in the S chapter across the countries, but usage varies widely between countries 9,5% in the US, 18.6% in Canada ( remember small sample size may be contributing here), 11.3% in Belgium2 data set.  That is very wide variance.

This might lead you to ask, what is being included in this rubric?
Now click on the blue Box Labelled ’Term Usage”

Australia comes up first because it starts with A, and Netherlands with N.
For each country it gives you: the frequency with which each term (in that country’s term list) was used (i.e. the actual number of cases in the dataset); the per cent of all usage in the S chapter in that country; and the % accounted for by that term in the selected rubric (in this case S99).

The Aus term usage data show that: the top two terms on the list accounted for almost half of all terms used in S99.  Switch to the data from the Netherlands (from the selection list in the country box.  In the Netherlands data the top 2 accounted for more than three quarters of usage of S99.

(Screen shots of the top two in each country are provided below)

Seborrhoeic keratosis is in the top two in both data sets.

You then need to consider why Seborrhoeic keratosis is in S99 and if that is the best place for it.

In the Netherlands data, this term accounted for 16.70% of all term usage in S99. In the Australian data it accounted for 34.7%.

In both term usage data sets, it accounted for almost 1% of all Chapter S recorded events. This is a far higher per cent of Chapter S than we saw in ( for example)  S05 above. Given the increasing prevalence of senile keratosis among an ageing population, perhaps it should be considered as possibly needing its own rubric. Alternatively, should Solar Keratosis be broadened to include senile and unspecified? Remember I am not a clinician, I am just putting forward ideas of the think you might need to think about.

Netherlands