Vol. 141 No. 0304 (2011)
The FIRE project
QUESTIONS UNDER STUDY/PRINCIPLES: Research is scarce where most patients are found . One of the main reasons is the difficulty in extracting data from traditionally conducted paper-based medical records. Thus, until now most existing patient records have originated from invoicing-tools. Endeavours to truly reflect a doctor’s consultation have been rare. FIRE (Family Medicine ICPC-Research using Electronic Medical Records) is an ambitious project to establish a proper knowledge base in primary care by using the ongoing implementation of EPR (electronic patient records). FIRE will enable many questions on epidemiology and performance within the PC (primary care) setting to be answered.
METHODS: GPs (general practitioners) throughout Switzerland working with EPR were eligible for participation. Workshops were held to train and standardise ICPC-coding (International Classification of Primary Care), a classification system especially designed for the PC-setting. The recorded data included administrative information on the GP and patient, vital signs, ICPC codes, laboratory analysis and medication. Data exporter software was developed for extracting anonymised data automatically from the EPR onto a database for further statistical analysis.
RESULTS: From 1.1.2009 until the beginning of April 2010 24 GPs were successfully recruited providing standardised information on 127922 consultations in 29398 patients and 159956 medical problems according to the ICPC-2 classification.
CONCLUSION: The project proves the feasibility of standardised ongoing collection of research data embedded in routine clinical practice. FIRE provides a unique database for research in PC and highlights the potential of broad implementation of EPR in a PC-setting. Studies resulting from the ongoing project have the potential to assess the quality of care provided by GP’s.
- NZZ Online: Wo die meisten Patienten sind, wird am wenigsten geforscht. In.; 2008.
- de Lusignan S, Teasdale S, Little D, Zapp J, Zuckerman A, Bates DW, Steele A. Comprehensive computerised primary care records are an essential component of any national health information strategy: report from an international consensus conference. Inform Prim Care. 2004;12(4):255–64.
- Zoller M, Marty F, Bhend H, Wagner J, Hess L, Rosemann T. Utilization of information technologies in ambulatory care in Switzerland. Swiss Medical Weekly (submitted) 2010.
- Marty F. Das Beach Projekt. Primary Care. 2005;5:32–3.
- De Maeseneer JM, van Driel ML, Green LA, van Weel C. The need for research in primary care. Lancet. 2003;362(9392):1314–9.
- WONCA: ICPC-2: International Classification of Primary Care Oxford: Oxford University Press; 1987.
- Okkes I, Lamberts H. Classification and the domain of family practice. In: Oxford Textbook of Primary Medical Care. Edited by R J, R B, L C, D G, R G, D M, C S. Oxford: Oxford University Press; 2004:139–53.
- WHO: Manual of the International Classification of Diseases, Injuries, and Causes of Death. Tenth revision, ICD-10. Geneva: World Health Organisation; 1993.
- Bhend H, Rosemann T, Zoller M. ICPC-2 – Missing Link. Primary Care. 2008;8:13.
- Meyer RL. Von der ICHPPC zur ICPC. Primary Care. 2005, 10.
- Bhend H, Zoller M. Roadmap für die elektronische Krankengeschichte. Schweizerische Ärztezeitung. 2008;32:1361–3.
- Bhend H. ICPC-2 -First Steps. Primary Care. 2008;8:6.
- http://www.icpc.ch/wiki or http://www.icpc.ch/mediawikifr
- Zoller M. Forschung bei Hausärzten – auf Knopfdruck möglich? Primary Care. 2006, 4.
- Laux G, Koerner T, Rosemann T, Beyer M, Gilbert K, Szecsenyi J. The CONTENT project: a problem-oriented, episode-based electronic patient record in primary care. Inform Prim Care. 2005;13(4):249–55.
- Zentralinstitut für die kassenärztliche Versorgung in der Bundesrepublik Deutschland. http://www.zi-berlin.de/morbilitaetsanalyse/downloads/Beispiel-WWW-Seite.pdf
- http://www.fmh.ch/themen/aerztedemographie.html : FMH-Ärztestatistik 2009. Schweizerische Ärztezeitung. 2010;91:11.
- Körner T. Die Episode als Grundlage der Dokumentation. Deutsches Ärzteblatt. 2005;10:46.
- Okkes I, Jamoulle M, Lamberts H, Bentzen N, ICPC-2-E: Severity of episodes of care assessed by family physicians and patients. The DUSOI/WONCA as an extension of the International Classification of Primary Care (ICPC). Fam Pract. 2002;19:350–6.
- Okkes I, Jamoulle M, Lamberts H, Bentzen N. ICPC-2-E: the electronic version of ICPC-2. Differences from the printed version and the consequences. Fam Pract. 2000;17(2):101–7.
- Britt H, Angelis M, Harris E. The reliability and validity of doctor-recorded morbidity data in active data collection systems. Scandinavian Journal of Primary Health Care 1998;16:50–5.
- Asthma data from the Swiss Sentinel Surveillance Network, 1989–2005 – from monitoring to research (http://www.smw.ch/docs/PdfContent/smw-12767.pdf)
- The new generation of family physicians – career motivation, life goals and work-life balance (http://www.smw.ch/docs/pdf200x/2008/21/smw-12103.PDF)
- Campbell S, Reeves D, Kontopantelis E, Middleton E, Sibbald B, Roland M. Quality of primary care in England with the introduction of pay for performance. N Engl J Med. 2007;357(2):181–90.
- Hummers-Pradier E, Beyer M, Chevallier P, Eilat-Tsanani S, Lionis C, Peremans L, et al. The Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe. Part 1. Background and methodology. Eur J Gen Pract. 2009;15(4):243–50.
- Towards Consensus on Best Practice: Use of patient records from general practice for research. In: The WellcomeTrustReport. 2009.