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Clinically Useful Problem Statement Systems
- Steven H. Brown, MS, MD;
- Randolph A. Miller, MD; and
- Dario A. Giuse, DrIng
- Vanderbilt University; Nashville, TN 37232 (Brown) Vanderbilt University; Nashville, TN 37232 (Miller) Vanderbilt University; Nashville, TN 37232 (Giuse)
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IN RESPONSE:
Our goal for the Canonical Clinical Problem Statement System (CCPSS) has been to create a concept-oriented problem statement terminology with clinically useful content. As such, the CCPSS can empower practitioners to describe patient problems in familiar terms that are useful, both for record keeping and transmission to others.
It is possible to create classifications that “lump” several meaningful, clinically precise terms into clinically less meaningful categorizations for the purpose of billing or research. Some have claimed that such “overconsolidation” occurs within diagnostic related groups (DRGs). The CCPSS represents each distinct clinical concept culled from 891 770 real-world problem statements, including concepts that occurred “once in almost a million.” The CCPSS provides a list of “basic” clinical concepts and specifies sets of appropriate modifiers that can be combined with them (for example, history of, left/right, severe, recurrent). The CCPSS synonyms facilitate mapping of clinicians' free-form expressions to the “core” concepts. Thus, CCPSS provides multiple convenient ways for clinicians to initially express a problem statement and enables translation of the problem statement into a clinically identical “core” concept. In addition, because CCPSS represents interconcept linkages, it facilitates creation of relevant subproblem statements and promotes recognition of commonly co-occurring problems. The CCPSS is extensible, and new terms can be added to accommodate concepts not yet present in CCPSS (because of omission or evolution of clinical knowledge). Implementations using CCPSS should allow an “escape valve” for clinicians to add free-text comments to components of the CCPSS terminology in order to promote full patient descriptions and to serve as a trigger for potential extensions of the CCPSS terminology.
Increasingly, many government and regulatory agencies require coding of patient characteristics for billing and other purposes. We believe that clinicians should be the masters of “allowable medical utterances,” not outside agencies. Clinicians must be allowed to practice using terminology that is familiar to them and makes sense for patient care. It should be the responsibility of computer systems to accurately map clinicians' wordings into clinically meaningful terminologies, and from there into the more abstract, cumbersome classifications used for billing and other purposes. This requires development of clinician-friendly, pragmatically derived, flexible, and extensible terminologies such as the CCPSS, which, as Dr. Gorelick suggests, promote recognition and communication of both the unique and common aspects of each case.
- Copyright ©2004 by the American College of Physicians
