Conference Information

Moving Toward International Standards in Primary Care Information: Clinical Vocabulary

Key Personnel

Conference Chair
H. C. Moon Mullins, M.D.

Conference Co-Chair
Robert D. Price, Ph.D.

Conference Consultants and Facilitators
Nancy M. Lorenzi, Ph.D.
Robert T. Riley, Ph.D.

Organizing Committee
Robert M. Bernstein (Canada)
Nick S. Booth (U.K.)
Robert Elson (U.S.)
Michael Kidd (Australia)
H.C. Mullins (U.S.)
Robert D. Price (U.S.)

Consensus Panel
Robert Elson (U.S.)
Michael D. Hagen (U.S.)
Philip T. Hagen (U.S.)
Stephen Kay (U.K.)
Michael Kidd (Australia)

Telecommunications Officer
Rob Wilson

Suzanne Spiers 

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Moving Toward International Standards in Primary Care Informatics: Clinical Vocabulary
AMIA Family Practice/Primary Care Working Group IMIA Working Group V
New Orleans, November 1-2, 1995

November 1

3:30 p.m.
Henry C. Mullins, M.D.

Conference Overview:
Nancy M. Lorenzi, Ph.D., Conference Facilitator
Robert T. Riley, Ph.D.


Keynote Address
Christopher Chute, M.D., Dr.P.H.

Presentation on UMLS
General Overview: Charles A. Sneiderman, M.D.
Expert Comments: Stuart J. Nelson, M.D.
Application to Primary Care: Michael J. Lincoln, M.D.

Report on Successful Global Programs
Ian Purves, M.D.
Rob Wilson, B.Sc.

Light Meal

Coding Summary Panels

General Overview: Yves A. Lussier, M.D., P.Eng.
Expert Comments: David J. Rothwell, M.D.
Application to Primary Care: Yves A. Lussier, M.D., P.Eng.

General Overview: Robert M. Bernstein,Ph.D., M.D.
Expert Comments : Maurice Wood, M.D.
Application to Primary Care: Michael S. Klinkman, M.D., M.S.

Read Codes
General Overview: Nick S. Booth, M.D.
Expert Comments: Charles Stuart-Buttle, M.D.
Application to Primary Care: Neill Jones, M.D.

8:30 Break

Participant Questions, Discussion, and Testimony

Adjournment and Social Hour

November 2 (Glyn M. Hayes, M.D., Moderator)

7:00 a.m.

Distribution and Overview of Consensus Report
Consensus Panel Members

Discussion Groups


Development of Consensus
Nancy M. Lorenzi, Ph.D.
Robert T. Riley, Ph.D.

Planning for the Future


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Introductory Letters

University of South Alabama
College of Medicine
Department of Family Practice and Community Medicine
1504 Springhill Avenue
Mobile, Alabama 36604-3273
Telephone: (334) 434-3480

Moving Toward International Standards in Primary Care Informatics: Clinical Vocabulary

The purpose of this conference was to begin a process of moving toward international standards in primary care informatics. It succeeded far beyond our expectations, and we believe it to be a "breakthrough" conference for shaping the future. The proceedings that follow were carefully recorded and developed to accurately reflect the conference process, discussions, and outcomes. We suggest that readers focus on the Report of Consensus, which documents the outcomes and is the most valuable and important section of these proceedings.

Among the papers included in this publication, we recommend A View From the Consensus Panel, by Stephen Kay, for an appreciation of the spirit and feel of the meeting. A list of the participants and Process Overview are also included.

The keynote address and the 12 intensive 15-minute presentations covering the International Classification of Primary Care (ICPC), the Read Codes, the Systematized Nomenclature of Human and Veterinary Medicine (SNOMED), and the Unified Medical Language System (UMLS) are not included in this summary but will be published elsewhere.

We would like to share some of our own thoughts on future actions and direction. To be effective, our efforts must be staged. We suggest the following:

Stage I:

  • Work with national and international agencies as soon as possible.
  • Give testimony about what occurred at this conference.
  • Develop a glossary.

Stage II:

  • Work to accomplish all conference action items.
  • Continue to enhance and broaden group activity through electronic communications.
  • Plan and conduct a followup and expanded conference.

Stage III:

  • Identify potential stakeholders.
  • Seek funding from stakeholders for future efforts.
  • Develop methodologies for moving forward.
  • Link with other interested agencies, activities, and professional groups.

It is essential to work with national agencies. We recommend that immediate steps be taken to establish an ongoing working relationship with the Agency for Health Care Policy and Research (AHCPR), the National Library of Medicine, the National Committee on Vital and Health Statistics, and other appropriate U.S. agencies as well as agencies in other countries.

We express our appreciation to the 80 attendees who traveled from 9 countries to contribute to the deliberations, to the 12 presenters who provided key information, to Nancy Lorenzi for developing and then facilitating the process, and to the American Medical Informatics Association (AMIA) and AHCPR for financial support.

This conference was a beginning. A followup conference will be held in Washington, D.C., in October 1996 immediately after the Symposium of Computer Applications in Medical Care (SCAMC), and we invite you and others who are interested to attend and participate as we move closer to the goal of international standards.

H. C. Mullins, M.D.
Conference Chair
Past Chair, Family Practice/
Primary Care Working Group of AMIA

R. D. Price, Ph.D.
Conference Co-Chair
Chair, Family Practice/
Primary Care Working Group of AMIA

Primary Health Care Specialist Group
3 Beech Avenue North
United Kingdom
Telephone: (+44)(0) 905 454705 (home)
Fax: (+44)(0)905 456817

International Medical Informatics Association (IMIA)
Working Group 5
Combined Coding Standards Workshop, New Orleans, November 1995
Conducted with the American Medical Informatics Association (AMIA)
Family Practice/Primary Care Working Group

IMIA Working Group 5 is responsible for information dissemination and collaboration among workers in primary care computing around the world. Part of its specific remit is the development of coding standards for the effective recording of medical conditions in the electronic medical record in such a way as to allow international communication of medical information. It is therefore with great pleasure that the IMIA Working Group acts as cosponsor to this seminal workshop held in collaboration with the AMIA Family Practice/Primary Care Working Group.

Electronic medical records are beginning to become effective vehicles for the delivery of patient care. They are also providing the data for better understanding of medicine and the delivery of health care services. These benefits will be realized only if the data stored within the electronic medical record are in a consistent and transportable form. This requires effective coding systems to provide the standardization required. These coding systems must not only be standardized but must be usable by clinicians when recording medical data.

There have been many attempts to develop medical coding systems in various parts of the world. Sometimes they have been tailored to meet local needs. Sometimes they have been tailored to meet the needs of particular groups of users. There has also been a divergence between those concentrated on a scientifically valid classification structure, which is needed for epidemiological purposes, and those concentrated on developing a nomenclature that suits the needs of the recording clinician. These divergent aims between local and broader requirements and between classification and nomenclature have led to many polarized views about the most appropriate types of coding system, and this argument has been continuing for quite some time.

In order to move the world forward, it is important to come to some overview of coding standards to see if there is such a thing as a potential international standard coding system and, if not, whether there can be some halfway house, some agreed collaboration and interchange between the protagonists of the various coding systems. This agreement would allow users and developers of the systems to know which coding systems are appropriate under which circumstances. It would also provide the basis for communication between the various coding systems in a scientifically valid manner, so that information can be communicated between the users of these various systems.

The conundrum has halted or slowed the development of international medical informatics. The New Orleans conference was indeed an excellent beginning, and the suggested actions and directions reported in these proceedings provide useful material that workers around the world can use to move forward toward international standards.

Dr. Glyn Hayes
IMIA Working Group 5 

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Adams, Bill, M.D.
Assistant Professor of Pediatrics
Boston University School of Medicine
Boston City Hospital
Maternity 412
818 Harrison Avenue
Boston, MA 02118
Phone: 617-534-4233

Bainbridge, Mike, M.D.
Telematics Officer
Primary Health Care Specialist Group
of the British Computer Society
49 Bondgate
Castle Doninaton
Derby DE74 2NS
Fax: 44-1332-812609

Bernstein, Robert M., Ph.D., M.D., CM, CCFP
Assistant Professor, Department of Family Medicine
University of Ottawa
75 Bruyere Street
Ottawa, Ontario K1N 5C8
Phone: 613-241-3344
Fax: 613-241-1971

Bird, David
Legal/Commercial Director
Computer Aided Medical Systems
Tannery Buildings
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Bolinger, Robert E., M.D.
Professor Emeritus
Kansas University Medical Center
3901 Rainbow Boulevard
Kansas City, KS 66160
Phone: 913-588-6063

Booth, Nick S., M.D.
General Practitioner and Research Fellow
The Sowerby Unit
University of Newcastle Upon Tyne
20 Springfield, Ovington
Northumberland NE42 6EH
Phone: 44-1661-835526
Fax: 44-1661-830316

Bormel, Joseph I., M.D, M.P.H..
Physician Executive
Cerner Corporation
11121 Lakespray Way
Reston, VA 22091
Phone: 703-904-1867, ext. 6479
Fax: 703-904-9575

Bouhaddou, Omar, Ph.D.
Vice President, Knowledge Engineering
Applied Medical Informatics
2681 Parleys Way, Suite 101
Salt Lake City, UT 84109
Phone: 801-464-6209 (work)
801-582-6632 (home)
Fax: 801-464-6201

Bourque, Michael
Director of Operations
Phone: 514-392-1592

Brantley, Mikel S., M.D.
Project Coordinator
Clinical Integrated Workstation
Computer Data Systems, Inc.
375 Medical Group/SGSI
310 West Losey Street
Scott Air Force Base, IL 62225-5252

Buvig, Hakon, M.D.
Lifaret 7
N-1410 Kolbotn
Phone: 47-55-12-1990
Fax: 47-55-12-3329

Cheong, Ian R., B.Med.Sc., MBBS, AACS
Information Management Fellow
The Royal Australia College of General Practitioners
49 Christie Street
Canungra QLD 4275
Phone: 61-7-5543-5688
Fax: 61-7-5543-5660

Chute, Christopher, M.D., Dr.P.H.
Assistant Professor of Epidemiology
Department of Health Sciences Research
Mayo Clinic
Harwick 670
Rochester, MN 55905
Phone: 507-284-5506
Fax: 507-284-1516

Nancy B. Clark, M.Ed.
University of South Alabama
College of Medicine
1504 Springhill Avenue
Mobile, AL 36604
Phone: 334-434-3480
Fax: 334-928-0106

Deshazer, Charles R., M.D.
Vice President, Health Care Informatics
Prudential Insurance Company
250 Gibraltar Road, 1 South
Horsham, PA 19044
Phone: 215-443-2221

Elson, Robert, M.D.
Informatics Fellow
National Library of Medicine
Division of Health Computer Sciences
University of Minnesota
Box 511 UMHC
420 Delaware Street, SE
Minneapolis, MN 55455
Phone: 612-625-3246
Fax: 612-625-7166

Gnassi, John Angelo, M.D.
Consultant, Laboratory of Computer Science
Massachusetts General Hospital
50 Staniford Street, 5th Floor
Boston, MA 02114-2517
Phone: 617-724-3543
Fax: 617-726-8481

Grayson, Rebecca R.
Kaiser Permanente Medical Care Program
Clinical Information System Group
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Oakland, CA 94612-2998
Phone: 510-267-5629

Gremp, Jennifer
Associate Editor
8425 Woodfield Crossing
P.O. Box 40930
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Hagen, Michael D., M.D., FAACP
Professor, Department of Family Practice
University of Kentucky
Kentucky Clinic K-322
Lexington, KY 40536-0284
Phone: 606-323-6711
Fax: 606-323-6661

Hagen, Philip T., M.D.
Assistant Professor of Preventive Medicine
Mayo Clinic
Rochester, MN 55905
Phone: 507-284-9203
Fax: 507-284-4251

Hannah, Kathryn J., Ph.D., R.N.
Partner and Leader
Health Informatics Group
Sierra Systems Consultants, Inc.
Suite 660
202-6th Avenue, SW
Calgary, Alberta T2P 2R9
Phone: 403-264-0955
Fax: 403-233-2108

Harmon, Bart J., M.D.
Laboratory of Computer Science
Massachusetts General Hospital
8 Hudson Street
Quincy, MA 02169

Hausam, Robert, M.D.
Postdoctoral Fellow
Department of Family and Preventative
Medicine Hospital and Clinical
Medical Informatics
University of Utah School of Medicine
1138 East Wilmington Avenue
Salt Lake City, UT 84106
Phone: 801-581-2000
Fax: 801-463-0313

Hayes, Glyn M., M.D.
Primary Health Care Specialist Group
British Computer Society
3 Beech Avenue North
Worcester WR3 8PX
Phone: 44-1527-579414
Fax: 44-1905-456817

Hollingworth, Gary R., M.D.
Assistant Professor
Department of Family Medicine
University of Ottawa
75 Bruyere Street
Ottawa, Ontario K1N 5C8
Phone: 613-241-3344
Fax: 613-241-1971

Jenkins, Rolland, M.D.
Senior Staff Internist and Clinical Instructor
Long Beach VA Medical Center Hospital (111-GM)
5901 East Seventh Street
Long Beach, CA 90822
Phone: 310-494-5748
Fax: 310-494-5155

Jernigan, Clarence A., M.D., M.Ph.
Associate Professor, Family Medicine
University of Texas Medical Branch
301 University Boulevard
Galveston, TX 77555-0853
Phone: 409-772-9859
Fax: 409-772-5820

Jones, Neill, M.D.
Clinical Consultant
2 Saxon Close
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Phone: 44-191-519-0136
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Kay, Stephen, Ph.D.
Senior Lecturer
Department of Computer Science
The University of Manchester
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Manchester M13 9PL
Phone: 44-161-275-5719
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Kern, Valerie C., R.N., M.S.
Senior Editor
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University of Washington
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Kidd, Michael, M.D., FRACGP
Professor of General Practice
Central Clinical School
The University of Sydney
37A Booth Street
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Phone: 02-9818-1400
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Klinkman, Michael S., M.D., M.S.
University of Michigan
Assistant Professor, Department of Family Practice
1818 Fuller Street
Ann Arbor, MI 48109-0708
Phone: 313-998-7120, ext. 309
Fax: 313-998-7335

Kokiko, Elaine
South Tower, Suite 1105
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Legler, James D., M.D.
Associate Professor, Family Practice
University of Texas Health Science Center at San Antonio
7703 Floyd Curl Drive
San Antonio, TX 78284
Phone: 210-270-3911
Fax: 210-220-3763

Lincoln, Michael J., M.D.
Assistant Professor of Medicine
Department of Medical Informatics
University of Utah School of Medicine
Room AB-193, Medical Center
Salt Lake City, UT 84132
Phone: 801-581-4080
Fax: 801-581-4297

Lorenzi, Nancy M., Ph.D.
Associate Senior Vice President and Provost
Health Education
University of Cincinnati
Medical Center
250 Health Professions Building
P.O. Box 70663
Cincinnati, OH 45267-0663
Phone: 513-558-3024
Fax: 513-558-2962

Lussier, Yves A., M.D., P.Eng.
Accurate Informatics and Medicine,
250 King
Sherbrooke, Quebec J1G 1A9
Phone: 819-563-0510
Fax: 819-564-6889

McCallie, David P., Jr., M.D.
Cerner Corporation
Director, Core Technologies
Community Products and Services
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Phone: 816-221-1024
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McCormick, Kathleen A., Ph.D., R.N.
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McDaniel, Mary
Salt Lake City, UT

McGuire, Sam A., M.D.
Family and Community Medicine
University of Arkansas
Medical Sciences
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Little Rock, AR 72205
Phone: 501-686-6632
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Milholland, Kathy, Ph.D., R.N.
Senior Policy Fellow
Practice, Economics and Policy
American Nurses Association
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Morrison, Patricia
Manager, Group Systems
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Moshman Associates, Inc.
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Bethesda, MD 20814
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Mullins, Henry C., M.D.
Professor, Family Practice
University of South Alabama
College of Medicine
1504 Springhill Avenue
Mobile, AL 36604
Phone: 334-434-3480
Fax: 334-928-0106

Nelsen, David A., M.D.
Assistant Director
Family and Community Medicine
University of Arkansas
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Little Rock, AR 72205
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Nelson, Brent D., Ph.D.
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Ameritech Health Connections
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Head, Medical Subject Headings
National Library of Medicine
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Family Physician
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National Agency, Welfare and Health
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Pacific Medical Group
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Olson, Kenneth P., M.D.
Family Physician
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Pace, Wilson D., M.D.
Associate Professor, Director of Information
University of Colorado
Department of Family Medicine
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University of Colorado Health Sciences Center
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Denver, CO 80220
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Pedigo, Thurman L., M.D.,
Vanderbilt University
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Price, Robert D., Ph.D.
Professor, Family Medicine
Director, Division of Medical Informatics
University of Arkansas
Department of Family and Community Medicine
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Little Rock, AR 72205
Phone: 501-686-6608
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Purves, Ian, MBBS, MRCGP
Director, Department of Primary Health
Care Informatics
Sowerby Unit for Primary Care Informatics
University of Newcastle
Newcastle Upon Tyne NE2 4HH
Phone: 44-91-222-7884
Fax: 44-91-222-6043

Reynoso, Guillermo A., M.D.
Chief, Medical Informatics Section
CEMIC-Buenos Aires
Argentinean Biomedical Informatics Society
Sanchez de Bustamante 2560
Buenos Aires 1425
Phone: 54-1-788-2201
Fax: 54-1-780-2000

Richmond, Robin, Ph.D.
Healthcare Information
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Riley Associates
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College of American Pathologists
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Shoulders, Harrison H.
Tracy Clinic
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Slager, J.N.
HIS User Group
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Research Medical Officer
National Library of Medicine
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Spiers, Suzanne
Court Reporter/Transcriber
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Stuart-Buttle, Charles
National Health Service Center
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Info. Mat. Group
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Takeda, Hiroshi, M.D., D.Sc.
Associate Professor
Department of Medical Information Science
Osaka University Hospital
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Suita 565
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Teasdale, Sheila
MAAG Manager
Lincolnshire MAAG
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Thornton, Thomas C., M.D.
Family Health Care
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Timka, Toomas, M.D., Ph.D.
Head Physician and Associate Professor
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Departments of Community Medicine and Computer Science
Linkopina University
S-581 85 Linkopina
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Viner, Gary, M.D.
Assistant Professor
University of Ottawa
Department of Family Medicine
770 Broadview Avenue, Suite 105
Ottawa, Ontario K2A 3Z3
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Williams, David, R.N.
U.S. Army
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Wilson, Rob, B.Sc.
Research Assistant
Sowerby Unit for Primary Care Informatics
University of Newcastle
21 Claremont Place
Newcastle Upon Tyne NE 24AA
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Wood, Maurice, M.D.
Emeritus Professor, Family Practice
Medical College of Virginia
Route 1, Box 672
Roseland, VA 22967
Phone and Fax: 804-325-1383

Zee, G.N., M.D.
Hoofdwal 23-25
4207 EA Gorinchem
The Netherlands

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Page last reviewed November 1995
Internet Citation: Conference Information: Moving Toward International Standards in Primary Care Information: Clinical Vocabulary. November 1995. Agency for Healthcare Research and Quality, Rockville, MD.