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.
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.
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
- Clearly define the current opportunities, issues, and
problems in developing and adopting coding standards for primary
- 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
- Speculate on the future of informatics in primary care and
2. Strengthen the sense of community among attendees, enabling
the group to be more effective in furthering primary care
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
This conference extended over time in three phases: Phase I,
pre-meeting; Phase II, during the meeting; and Phase III,
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
Phase II, the actual meeting time in New Orleans, is well
described in the Process Overview
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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