Terms Conversion

Together with your Implementation Consultant, when your site goes live with Communicare, a clinician with Administrator user privileges can use the Terms Converter tool to convert local terms into centrally maintained terms, for example, ICPC-2 PLUS terms.

Communicare reports return data based on clinical items and qualifiers. It cannot report on local terms that have not been converted to centrally maintained terms. Centrally maintained terms enable consistency in the reporting and recording of diagnosis. Chronic disease diagnoses which are reported heavily in nKPI reports are the first priority. Common conditions and immunisations are also important.

For example, the following multiple descriptions of local terms can be converted to a single ICPC-2 PLUS term.

Table 1. Example local terms that can be converted to a central term
Previous terms ICPC-2 PLUS term
Type Two Diabetes Diabetes; Type 2
NIDDM
Non-Insulin-dependant diabetes
Diabetes Mellitus Type II
Maturity onset diabetes mellitus
DM2
Note: Terms conversion is a delicate task and should only be undertaken under the guidance of a Communicare health informatics specialist.

Local terms are those which have not been distributed by the central data update program and have not been assigned an ICPC code. Migrated clinical items of conditions and procedures are local terms.

Some of the Term Converter functions may be used to convert between local terms.

Terms are only converted where the qualifiers match exactly. Consequently, most local terms with qualifiers are not converted.

Prerequisites

After conditions and procedures have been migrated to Communicare, run the term converter.

Terms Converter Functions

Run the following functions where required in the order listed:
  1. Auto Convert Local Qualifiers to Central Qualifiers by System Code - converts local qualifiers to central qualifiers based solely on SYS_CODE. The qualifiers should have equivalent units and be of the same type for the conversion to succeed. Unsuccessful conversions are reported. On completion of this function, patient qualifiers are linked to the central qualifier types.
  2. Auto Convert Local Qualifiers to Central Qualifiers by Description - scans all local qualifiers and attempts to match them to central qualifiers with identical descriptions and units. Strings of the form [n] at the end of local descriptions are ignored. Conversion success and any unit mismatches are reported. On completion of this function, patient qualifiers are linked to the central qualifier types.
  3. Convert Used Local Terms by Description and Class - scans local Condition, Procedure and Referral terms that have been used in patient clinical records and changes the patient record to use identical central terms. Matching is done on the basis of description (the actual terms) and subtype. Strings of the form [n] at the end of local descriptions are ignored.
  4. Disable Local Conditions, Procedures Referrals and Immunisations - disables all local Condition, Procedure, Referral and Immunisation terms. Terms in the Pathology topic and terms used in enabled automated recalls are bypassed by this process, that is, they remain enabled. When all conversion activity is complete, you may need to enable terms not represented by Central Terms again, particularly newly created terms that have not yet been used. Unused disabled local terms are deleted by a later process.
  5. Delete Unused Disabled Local Terms - deletes all disabled, unused, local terms. No statistics are reported. Ensure that any newly created clinical items, that may not have been used in a patient record yet, have have been enabled before you run this function.
  6. Delete Unused Local Qualifier Types - deletes all unused local qualifiers. No statistics are reported.
  7. Convert Local Conditions, Procedures and Referrals to Selected Conditions, Procedures, Referrals and Immunisations - lists local terms. Use the Terms browser to select local terms and match them to equivalent central terms. Patient clinical records are updated to use the central terms and the original terms are deleted. Conversion statistics and failures are reported. You can also use these functions to convert local terms to other local terms.
  8. Convert Other/Elsewhere Localities to Selected Localities - allows invalid locality names to be converted to valid locality names and address line 2 cleared. During data conversion from a legacy system, patient addresses recorded with invalid locality names are imported to the 'Other/Elsewhere' locality and the invalid locality name is placed in address line 2. Valid localities are those in Communicare's locality reference table, which contains over 17,000 Australia Post locality names, plus any others added by your Communicare Administrator. After the data conversion has been completed, run this function. This data cleaning is important, because address localities are used to group patients, for example, to identify those living within a health service area.
  9. Correct Terms Gender - alters ICPC terms to correlate to the patient's sex. For example, the term Mammography;F is changed to Mammography;M where recorded for male patients. This function works for any terms that end with ;F or ;M.
  10. Convert Topics - lists all local terms with local topics. Use this window to update local topics to central topics. Using central topics for local terms is preferred, but local special purpose topics are acceptable provided they do not cause ambiguity with central topics.

Converting terms

For sites using a Terminal Server, the site administrator must publish the TermsConverter.exe so that it is available for users to access.

To convert terms, you must belong to the System Administrators user group.

Follow these recommendations when converting terms:
  • 'Measures imported from source software' - do not convert local items with this description to ICPC-2 PLUS terms. This description is applied to any local clinical items that could not be uniquely identified during migration
  • Local items with qualifiers - local items containing qualifiers should not be converted, unless the ICPC-2 PLUS item has exactly the same qualifiers. Qualifiers are listed in the bottom table in the Terms Conversion window. If you try to convert a local item with qualifiers, a message is displayed stating that the data will be retained but the qualifier will not be available for ongoing data entry. If you click 'Yes':
    • If the qualifier is not a central qualifier, the process will complete as planned.
    • If the qualifier already exists as a central qualifier, the conversion cannot be completed and an error message is displayed stating that Centrally Maintained items cannot be edited.
  • Local terms that exist in Communicare only as a qualifier cannot be converted. For example, Pulse rate is a qualifier in Communicare but not a clinical item.
  • Local terms that are useful. For example, Assessment;Smoking;MD is a clinical item created to migrate a list of qualifiers which are mapped from the source to Communicare. These terms should not be converted.
  • Clinical items that can be converted to items with required fields should not be converted. Clinical items such as Aboriginal Health Checks could be converted to the matching ICPC-2 PLUS item and be counted for reporting purposes, however the required fields would remain incomplete. If these terms are converted, an additional process is required to adjust the effective date of the required qualifiers so that outstanding recalls or incomplete clinical items aren't created. Alternatively, add a system code or export code for reporting, but leave the items disabled and instead use the correct ICPC-2 PLUS items.
  • Clinical items that cannot be converted due to patient sex - some local terms cannot be converted in one step because the ICPC-2 PLUS items are sex-specific. For example, a Mammogram local term cannot be converted in one step because the ICPC-2 PLUS item is Mammogram:M or Mammogram:F and the local term will have been used for a mixture of both sex patients. To complete term conversion for sex-specific terms:
    1. Convert the local term to a central term. For example, MAMMOGRAM to Mammography;F.
    2. In the Terms Conversion window, click 'Correct Terms Gender'. This function checks the sex recorded for patients and for example, changes Mammography;F to Mammography;M when the patient is male.
To run the terms converter:
  1. Select Start > Communicare > Terms Converter or run TermsConverter.exe from the Microsoft Windows command line.
  2. To complete terms conversion for migrated data, in the Terms Conversion window, click Convert Local Conditions and Procedures to Selected Terms.
  3. The NON-ICPC Coded Clinical Items View lists all local non-ICPC-2 PLUS coded clinical items used at your site. Click Used to sort the terms by the number of times they are used.
  4. To open the Clinical Terms Browser with a list of suggested matching ICPC-2 PLUS central clinical terms for the local item, double-click the local item in the top list. The Clinical Terms Browser uses the first word of the local term to suggest possible central term equivalents. The clinician may need to search manually to find the correct clinical item to match to. For example, for the locally migrated term Metabolic Bone Disease, the browser returns a list based on the word Metabolic. In the Clinical Terms Browser, the clinician searches instead for the word bone, and selects Disease;bone.
  5. In the the Clinical Terms Browser, select the correct central term and click Select.
  6. In the confirmation window, check that the terms you are converting from and to are correct, and if so, click Yes.
    Note: After a term has been converted from a local term to a centrally maintained term, you cannot undo this process. The Information window displays how many records have been updated and of what type.
  7. Repeat steps 4-6 for all local terms that you want to convert to central terms.
  8. To finish the conversion process, close the NON-ICPC Coded Clinical Items View and in the Terms Conversion window, click Save to commit the changes to the database.

Results

The items that have been successfully converted are no longer listed in the Terms Conversion window.

Run Correct Terms Gender to fix sex-specific clinical items.

Validation

To check terms conversion and validate that the correct changes have occurred:
  1. Choose a local migrated clinical item from the list before you complete terms conversion, for example, Dressing Change.
  2. In File > Reference Tables > Clinical Item Types, look up Dressing change. The item is not enabled.
  3. If you try to delete the row for Dressing change, you will get an error message stating that the item is in use.
  4. Complete the terms conversion.
  5. In File > Reference Tables > Clinical Item Types, look up Dressing change and attempt to delete the item. The system will now delete the clinical item type as it is no longer is use.
To validate term conversion in a clinical record:
  1. Choose a local clinical item from the list before conversion. For example, CKD (Chronic Kidney Disease) Stage 5.
  2. To identify a patient with that clinical item, run Report > Patients > With Selected Clinical Item.
  3. Open the patient record and find the selected clinical item and then close the record.
  4. In the Terms Conversion window, open the local term and convert it to a central term. For example, CKD (Chronic Kidney Disease) Stage 5 to Disease;kidney;chronic;stage 5.
  5. Open the same patient record. The clinical record will now display the new ICPC-2 PLUS clinical item. The Detail tab displays the local term in the Converted from field.

Notes Qualifier Conversion Errors

Local qualifiers may exist on central items because of prior conversion work. When a local term is converted to a central term, local qualifiers are copied to the central term and disabled. This process allows the conversion to proceed without data loss. You will be able to view the old qualifier data, though no new data can be added using the disabled local qualifiers.

Auto Convert Local Qualifiers to Central Qualifiers by System Code and Auto Convert Local Qualifiers to Central Qualifiers by Description may fail as a result of these local qualifiers on central items. The message displayed is Unable to delete local Qualifier nn. May be used on a CENTRAL item.

This failure occurs because the terms converter does not have the ability to put a central qualifier on a central item. In other words, this is a necessary failure. It is not a problem provided that reporting is done using system codes. Reports should always use system_code rather than a primary key or description when it is available.

This scenario can only occur when the terms are converted before the qualifiers are converted, which is not the usual sequence. However it has occurred where terms were converted, then in a later central update, new central qualifiers were introduced, for example Height and Weight, which then conflicted with local qualifiers.