Introduction

In the future, access to affordable high-quality health care, both in the United States and around the world, will depend on effective primary care. The future success of primary care will parallel the development and use of primary care electronic information systems, especially the electronic medical record.

There are wide differences around the world in the use of these systems. The United States, although recognized as a world leader in medical informatics, is years behind other countries, such as Holland and the United Kingdom.

The development and adoption of national and global standards for clinical vocabularies appropriate for primary care are imperative. These standards should be developed by people aware of and involved in the unique problems and opportunities of primary care. Collaboration by a group of people from around the world who have expertise, experience, and interest in these issues, beginning a movement toward the development of consensus, should have a considerable effect toward this end.

Preparation for this conference began in November 1994, at the Symposium of Computer Applications in Medical Care (SCAMC), with informal discussions among the leadership of the Family Practice/Primary Care (FP/PC) Working Group of the American Medical Informatics Association (AMIA), the Primary Health Care Specialist Group of the British Computer Society, and Working Group V of the International Medical Informatics Association (IMIA). Members of the FP/PC Working Group and faculty members of the departments of family practice at the University of Arkansas and the University of South Alabama carried out preliminary work for the conference.

Purpose

The purpose of the meeting was to begin a process of developing consensus about standards for clinical vocabularies for use in primary care ambulatory information systems.

Conference Objectives

The objectives of this conference were as follows:

1. Provide an opportunity for people with expertise, experience, and interest in primary care informatics to come together to:

• Clearly define the current opportunities, issues, and problems in developing and adopting coding standards for primary care.
• Become familiar with models of success from around the globe and identify salient features that might be transportable and useful in other settings.
• Participate in a process designed to develop consensus regarding standards for coding in primary care clinical vocabularies.
• Speculate on the future of informatics in primary care and develop strategies.

2. Strengthen the sense of community among attendees, enabling the group to be more effective in furthering primary care informatics.

3. Document all aspects of the conference by written and electronic means, and communicate the deliberations and conclusion to appropriate individuals and organizations.

Format for Consensus Development and Reporting

This conference extended over time in three phases: Phase I, pre-meeting; Phase II, during the meeting; and Phase III, post-meeting.

During Phase I, prospective participants were given information about both the content and process. Key references were posted on the Internet, as were details of the consensus development process.

Phase II, the actual meeting time in New Orleans, is well described in the Process Overview section.

During Phase III, after the meeting, an edit group used recorded information from the meeting to draft the consensus statement, which was sent to all participants by Internet for approval and/or suggested changes. After a number of changes, the final draft was approved and submitted for publishing. Phase III is ongoing and includes planning for a followup conference.

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