Learn About ENCODE-FM

Overview

Electronic Nomenclature and Classification of Disorders and Encounters for Family Medicine

ENCODE-FM is a systematic and hierarchical controlled clinical terminology for family medicine, intended for use in electronic medical records incorporated into the software of any vendor. It was derived from our knowledge of ICPC, ICD-10, and our aggregate 100 + years of clinical family medicine experience. Development occurred over a ten-year period, and was initially presented internationally at the Symposium on Computer Applications in Medical Care (SCAMC) 1991 under its original name SIN-FM. The product was subsequently enhanced in order to be the standard terminology for the national database of the College of Family Physicians of Canada "Clinical Practice Management Network"

ENCODE-FM has been designed expressly for use at point of service in primary care. It addresses the issues of ease of data entry and accuracy of aggregate data retrieval in its design, the mapping to other classifications, and choice of words and terms. Published research (J. Amer. Medical Informatics Assoc. 3(3): 224-233, 1996; J. Amer. Medical Informatics Assoc., Symposium Supplement 1995, Vol 20: 135-139. 1996.) has shown that none of the large nomenclatures, each over 100,000 terms, intended to cover the whole health care system, describe all clinical content or even all diseases. Alternatively, ENCODE-FM was designed to do one part of that task well - namely to be a clinical terminology of only symptoms, complaints, diagnoses, disorders and reasons for encounter for use in primary care electronic records.

It is intended to facilitate data entry by primary health providers (physicians, social workers, nurse practitioners, lactation consultants, podiatrists, dieticians), and to allow data aggregation by the three internationally recognized classifications of disease used most commonly in primary care – ICPC, ICD-10, ICD-9-CM as well as Diagnostic Billing Codes for Ontario.

It contains current terminology related to gender fluidity and sexual health, a section related to health issues of Indigenous Peoples, and terms for social determinants of health and health risk.

It was also designed to be an evolving terminology, so that as the terminology and usage of medical terms changes, ENCODE-FM can be readily updated. ENCODE-FM currently contains more than 10,000 terms.

History

The Ontario Family and General Practice Data Standards Project determined that in 1992, there was no acceptable primary care nomenclature. ENCODE-FM was constructed with the recommendations of the data standards report in mind. It is a standardized nomenclature of medical terms for both symptoms and diagnoses specifically designed to be used in an electronic record. Our research shows that classifying data using ENCODE-FM is highly reliable.

• Designed for primary care, uniquely and specifically
• Maps all terms to ICD-10, ICD-9-CM, ICPC, and Ontario Diagnostic Billing Codes
• Used in all the Ontario community health centers as mandated by the province
• Fully bilingual, allowing data input in French and providing a bi-directional term translator
• Hierarchical, allowing optimal degree of specificity of symptoms or diagnosis
• Proven reliability when classifying data to the Canadian standard, ICD-10

Objectives

This is a standardized tool that we believe is essential to entering useful and usable information into computer systems in a facile and user-friendly fashion. Once valid information is entered, it becomes accessible for analysis and for interpretation.

Individual User

• Coded information can enhance patient care directly, as it can be associated with various decision aids.
• It allows a physician to assess their own practice profile and to determine their CME requirements.

Systemic Users

• Coded aggregated information on diagnoses and reasons for encounter enables an understanding of the nature of medical care provided by the primary care physicians.
• It is the first step in assessing outcomes. Clearly there is a need to also assess the investigations and therapies provided as well, but that can only be understood on the backdrop of the initial presentation.
• The measurement of primary care is critically important for understanding health care trends and costs.
• ENCODE-FM is already in use in all of Ontario's Community Health Centers (CHC's) and the primary HIV network.

Background on Standardized Coding and Classification

Why Standardize Coding and Classification?

Reliability of the current community-based health service encounter databases regarding diagnoses is dreadful and has always been recognized as such. This is well-iterated in Graham C. Scott’s 1991 report of the task force on use and provision of medical services to the Minister of Health for Ontario:

The quality of most health care information systems is abysmal when examined from the perspective of system planning. While there is an almost unlimited amount of information on paper, most of it is of very limited use. The result is that we simply do not know enough about what is happening in doctors' offices, hospitals, laboratories and community health centres to assess these trends, motivations, incentives, practice patterns and health outcomes.

Without the development of this kind of basic management information, we are doomed to continue making policy decisions without an adequate appreciation of the possible downstream implications. This weakness has contributed to the system becoming more costly. In the shadow of ever growing cost pressures, the common response has been to contain them with the blunt instruments of supply management, an approach that often increases distortions and thereby indirectly contributes to lower quality health care.

It is the experience of the task force that much of the data is simply not of a quality to provide the desirable support for planning and research initiatives, and is too often in such a form as to be of limited value in making judgments on system management. There must be a major thrust to address management information systems, and this undertaking should meaningfully involve the major stakeholders and potential users in the system.

• Suffice it to say that little has changed since 1991.
• To obtain analyzable information from health service encounter data requires an acceptable standard vocabulary to be used by care providers for recording the process of care.
• This vocabulary, to be acceptable to providers, must reflect the current usage of clinical terms. Because the majority of visits have no definitive diagnosis, it must enable effective capture of symptoms and reasons for encounter.
• CIHI (Canadian Institute of Health Information) has declared that ICD-10 (International Classification of Diseases revision 10) will be Canada's standard by 2001. Unfortunately ICD-10 is not by itself suitable for use in an electronic record and is inadequate for capturing most symptoms.

Cost and Availability

• Single User

Please have your EMR vendor contact us.

• Software Vendor Licenses

License and Maintenance Fees are dependent on the size of the customer data base.

• Systemic Users

Inquiries are welcomed from both governmental agencies and ministries as well as health maintenance organizations interested in implementing standards.

To send us your orders, please contact us.