“We Fill in Our Working Understanding”: On Codes, Classifications and the Production of Accurate Data

Summary

Objectives: This paper describes differences in the way general practitioners in Denmark, The Netherlands and Great Britain make codes fit into the local conditions under which they work.

Methods: An ethnographic study method has been used to collect data in Dutch, British and Danish general practices.

Results and Conclusions: The paper argues that what counts as “accurate data” is locally constructed. As codes are produced in local networks of human and technological actors, the way accuracy is constructed is dependent on the extra work that is carried out (by actors inside the clinic as well as outside of it). On the basis of differences between coding practices and classification systems the paper discusses how inherent tensions between coding for primary and secondary purposes can be solved. The paper concludes that instead of evaluating data in terms of how accurate they are in general, they should be looked at in terms of pertinence to specific research questions.

Keywords

Diagnostic codes - classification systems - general practice - electronic patient record - localization - accuracy - ethnography

• References

• 1 De Maeseneer JB. (ed.). Telematics in primary care. Amsterdam: IOS Press; 1995
• 2 Knottnerus JA. Role of the electronic patient record in the development of general practice in the Netherlands. Methods Inf Med 1999; 38: 350-4.
• 3 Lawrenson R, Williams T, Farmer R. Clinical information for research; the use of general practice databases. Journal of Public Health Medicine 1999; 21 (Suppl. 03) 299-304.
• 4 Bentzen NSH. ICPC – hvad skal vi dog med den?. Maanedsskrift for Praktisk Laegegerning 1991; 69: 659-63.
• 5 Berg M. Accumulation and coordination, occasions for information technologies in medical work. Comput Supp Coop Work 1999; 8: 373-401.
• 6 Bowker G, Star SL. Sorting things out, classification and its consequences. Cambridge (MA): MIT Press; 1999
• 7 Berg M. Rationalizing medical work, decision-support techniques and medical practices. Cambridge (MA): MIT Press; 1997
• 8 Silverman D. Doing qualitative research, a practical handbook. London: Sage; 2000
• 9 Winthereik BR, de Bont A. Accessing the world of doctors and their computers: ‘making available’ objects of study and the research site through ethnographic engagement. Scandinavian Journal of Information Systems 2002; 14 (Suppl. 02) 47-58.
• 10 WONCA. International Classification of Primary Care ICPC-2. Oxford: Oxford University Press; 1998
• 11 Roscoe T. Classification Systems: ICD SNOMED, Read Codes. The WISDOM Centre; 2000
• 12 Kay S, Purves IN. Medical records and other stories: a narratological framework. Methods Inf Med 1996; 35: 72-87.
• 13 Aeskulap. Introduktion til overblik journalen (distribueret i forbindelse med overgang til Aeskulap 6.0). Aeskulap Brugerforening og Ascott Software a/s; 2000
• 14 Jensen CB, Winthereik BR. Political and moralizing moments: on visions of IT in Danish Health Care. Information Technology and People 2002; 15 (Suppl. 03) 227-41.
• 15 Lagendijk PJB, Schuring RW, Spil TAM. Electronisch Voorschrijf Systeem, “van kwaal tot medicijn”. Enschede: Universiteit Twente; 2001
• 16 van der Lei J. Use and abuse of computer-stored medical records (editorial). Methods Inf Med 1991; 30: 79-80.
• 17 Hassey A, Gerrett D, Wilson A. A survey of validity and utility of electronic patient records in a general practice. BMJ; 2001. 322 1401-5.
• 18 Pringle M, Ward P, Chilvers C. Assessment of the completeness and accuracy of computer medical records in four practices committed to recording data on computer. Br J Gen Pract 1995; 45: 537-41.
• 19 Nilsson G, Petersson H, Aalfeldt H, Strender LE. Evaluation of three Swedish ICD-10 primary care versions, reliability and ease of use in diagnostic coding. Methods Inf Med 2000; 39 4-5 325-31.
• 20 Berg M, Timmermans S. Orders and their others, on the constitution of universalities in medical work. Configurations 2000; 8: 31-61.
• 21 Gomart E. Eloge of methadone at the Blue Clinic. Body and Society; forthcoming.: