Comput Methods Programs Biomed - Information quality measurement of medical encoding support based on usability.


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Medical encoding support systems for diagnoses and medical procedures are an emerging technology that begins to play a key role in billing, reimbursement, and health policies decisions. A significant problem to exploit these systems is how to measure the appropriateness of any automatically generated list of codes, in terms of fitness for use, i.e. their quality. Until now, only information retrieval performance measurements have been applied to estimate the accuracy of codes lists as quality indicator. Such measurements do not give the value of codes lists for practical medical encoding, and cannot be used to globally compare the quality of multiple codes lists. This paper defines and validates a new encoding information quality measure that addresses the problem of measuring medical codes lists quality. It is based on a usability study of how expert coders and physicians apply computer-assisted medical encoding. The proposed measure, named ADN, evaluates codes Accuracy, Dispersion and Noise, and is adapted to the variable length and content of generated codes lists, coping with limitations of previous measures. According to the ADN measure, the information quality of a codes list is fully represented by a single point, within a suitably constrained feature space. Using one scheme, our approach is reliable to measure and compare the information quality of hundreds of codes lists, showing their practical value for medical encoding. Its pertinence is demonstrated by simulation and application to real data corresponding to 502 inpatient stays in four clinic departments. Results are compared to the consensus of three expert coders who also coded this anonymized database of discharge summaries, and to five information retrieval measures. Information quality assessment applying the ADN measure showed the degree of encoding-support system variability from one clinic department to another, providing a global evaluation of quality measurement trends.

Resumo Limpo

medic encod support system diagnos medic procedur emerg technolog begin play key role bill reimburs health polici decis signific problem exploit system measur appropri automat generat list code term fit use ie qualiti now inform retriev perform measur appli estim accuraci code list qualiti indic measur give valu code list practic medic encod use global compar qualiti multipl code list paper defin valid new encod inform qualiti measur address problem measur medic code list qualiti base usabl studi expert coder physician appli computerassist medic encod propos measur name adn evalu code accuraci dispers nois adapt variabl length content generat code list cope limit previous measur accord adn measur inform qualiti code list fulli repres singl point within suitabl constrain featur space use one scheme approach reliabl measur compar inform qualiti hundr code list show practic valu medic encod pertin demonstr simul applic real data correspond inpati stay four clinic depart result compar consensus three expert coder also code anonym databas discharg summari five inform retriev measur inform qualiti assess appli adn measur show degre encodingsupport system variabl one clinic depart anoth provid global evalu qualiti measur trend

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