Report of the ICPC & EMR workshop at the Primafamed conference in Uganda to Wonca International Classification Committee (WICC) and Wonca Informatics Working Party (WIWP)
Primafamed conference was held from 17th to 21st in Kampala, Uganda. Jan De Maeseneer and I conducted a workshop to introduce ICPC for the participants from sub-Saharan African countries. We also demonstrated and distributed the electronic medical record (EMR) for African countries during this workshop.
Primafamed conference was organized by University of Ghent, Belgium, to improve the quality of family medicine training in Sub-Saharan Africa. (http://www.primafamed.ugent.be/Events.html)
The EMR project for Africa resulted from a request in 2007, from Jan De Maeseneer, to the WIWP for an EMR that can be used in Africa.
We conducted the workshop on introduction to ICPC and EMR on two days - 19th and 21st of November, because of the parallel sessions at the conference. Each workshop was 90 minutes in duration. The workshop included an introduction to ICPC followed by a demonstration of the EMR software. I used content from the WICC website by Henk & Inge, Mark Jamuelle’s presentation and my own teaching material from the Diploma in Family Medicine program in Sri Lanka.
The workshop consisted of four parts
a) How and why the EMR project was initiated. (Jan)
b) Introduction to ICPC which included a role play of an consultation about a ‘hearing problem’ which lasted for a few minutes. This was followed by the audience identifying the REFs, POCs and PDs, EOCs in the encounter. (Kumara)
c) Coding of clinical vignettes using ICPC in the comprehensive mode. (Jan)
d) EMR (TranHis) demonstration. (Kumara)
After the workshop, all those who wished to obtain a copy of the EMR (in a CD) were requested to:
a) sign a statement that it will not be used for commercial purposes, and
b) write to CEO Wonca to obtain a three years research license for ICPC2
The CDs were handed after signing the statement at the registration desk.
About 25 attended the first workshop, which was beyond my expectation. I was not sure that we would even get enough participants for the second workshop on the last day of the conference (21st November). Jan was correct again – we had about fifteen for the second workshop (a few even attended for the second time on the 21st).
We hope that there will be at least 5-10 institutions from the different countries that will start using the EMR to record the clinical visits.
We discussed how these data could be aggregated from different countries and institutions. A simple and ethically acceptable way is to de-identify the records from individual practitioners (with only DOB, gender and country of origin from each record as unique) when aggregating data. The data will be collected at a country level by the distributing institution for the country.
The physician, who uses the EMR, has the option of pressing the aggregate button which will make a zip file from records with the de-identified data as explained above. This file can be attached to an email or recorded in a CD/DVD and sent to the respective institution of the country. We will get the all files from the main distributing center in each country and pool the data by different countries.
There were several queries regarding the ICPC-2-R book and I directed them to the Wonca website and/or to the CEO Wonca. To facilitate the uptake of ICPC, I wish to request the WICC consider sending a printed copy to each institution that signed the statement for obtaining the EMR and start recording data.
On my way back to Australia I visited Sri Lanka. I had the opportunity to discuss the EMR project with Faculty of Medicine, University of Kelaniya, which I was attached from 1995 to 2005 before I took up the present post at the University of Sydney.
I met the Dean of the Faculty of Medicine and briefed (informally) about the ICPC/EMR project. The Faculty will give all support and facilities, free of charge, if we were to organize such a workshop for the five Faculties of Medicine and the College of General Practitioners of Sri Lanka (CGPSL). This was followed by a meeting with the Vice President and a few senior members of CGPSL who were very supportive of the ICPC/EMR project. The CGPSL is a member of Wonca, has representations at both WICC & WIMP and has officially declared that the ICPC is the classification of choice for GP research in Sri Lanka. I will await the response (hopefully a positive one) from all concerned before I proceed with the Sri Lankan situation.
I am very keen to obtain reliable and broadly representative data about general/family practice from African and Asian countries before the next version of the ICPC-3 is published. My understanding is that we have time until the end of 2009 to submit this data to the WICC. Giving a basic understanding of ICPC and how to use the EMR for GPs in these countries will be the best approach for both the clinicians and Wonca – a win-win situation for all.
I am thankful to the Jan De Maeseneer for funding this project, the support given to me at the workshop and making one of my dreams come true (an EMR for developing countries), TransHis group from the Netherlands (Kees Van Boven and Sibo Oscam) for allowing to use TransHis free of charge, Mike Klinkman from the WICC for sponsoring my travel, registration & accommodation at the conference, WIWP (Peter Schattner and Michael Kidd) for entrusting me with the project and Joe Canalese, Associate Dean, School of Rural Health, University of Sydney, Australia for allowing me to use all the resources and time needed to complete this project.
Kumara Mendis
2009-07-17
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Informatics 
