The International Classification of Functioning, Disability and Health (ICF) in Electronic Health Records

 

 Permissions and Reprints

Summary

Background: The International Classification of Functioning, Disability and Health (ICF) is the World Health Organization’s standard for describing health and health-related states. Examples of how the ICF has been used in Electronic Health Records (EHRs) have not been systematically summarized and described yet.

Objectives: To provide a systematic review of peer-reviewed literature about the ICF’s use in EHRs, including related challenges and benefits.

Methods: Peer-reviewed literature, published between January 2001 and July 2015 was retrieved from Medline^®, CINAHL^®, Scopus^®, and ProQuest^® Social Sciences using search terms related to ICF and EHR concepts. Publications were categorized according to three groups: Requirement specification, development and implementation. Information extraction was conducted according to a qualitative content analysis method, deductively informed by the evaluation framework for Health Information Systems: Human, Organization and Technology-fit (HOT-fit).

Results: Of 325 retrieved articles, 17 publications were included; 4 were categorized as requirement specification, 7 as development, and 6 as implementation publications. Information regarding the HOT-fit evaluation framework was summarized. Main benefits of using the ICF in EHRs were its unique comprehensive perspective on health and its interdisciplinary focus. Main challenges included the fact that the ICF is not structured as a formal terminology as well as the need for a reduced number of ICF codes for more feasible and practical use.

Conclusion: Different approaches and technical solutions exist for integrating the ICF in EHRs, such as combining the ICF with other existing standards for EHR or selecting ICF codes with natural language processing. Though the use of the ICF in EHRs is beneficial as this review revealed, the ICF could profit from further improvements such as formalizing the knowledge representation in the ICF to support and enhance interoperability.

Citation: Maritz R, Aronsky D, Prodinger B. The International Classification of Functioning, Disability and Health (ICF) in Electronic Health Records. Appl Clin Inform 2017; 8: 964–980 https://doi.org/10.4338/ACI-2017050078

Protection of Human an Animal subjects

This project did not involve human and/or animal subjects.

• References

• 1 Holmström I, Röing M. The relation between patient-centeredness and patient empowerment: a discussion on concepts. Patient Education and Counseling 2010; 79 (02) 167-72.
  CrossrefPubMedGoogle Scholar
• 2 Joseph-Williams N, Elwyn G, Edwards A. Knowledge is not power for patients: a systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient education and counseling 2014; 94 (03) 291-309.
  CrossrefPubMedGoogle Scholar
• 3 Wiljer D, Urowitz S, Apatu E, DeLenardo C, Eysenbach G, Harth T, Pai H, Leonard K. Patient accessible electronic health records: exploring recommendations for successful implementation strategies. Journal of Medical Internet Research 2008; 10 (04) e34.
  CrossrefPubMedGoogle Scholar
• 4 Kalra D. Electronic health record standards. IMIA Yearbook of Medical Informatics 2006; 45: 136-44.
  PubMedGoogle Scholar
• 5 Westra BL, Delaney CW, Konicek D, Keenan G. Nursing standards to support the electronic health record. Nursing outlook 2008; 56 (05) 258-66. e1.
  CrossrefPubMedGoogle Scholar
• 6 Kalra D, Fernando B, Morrison Z, Sheikh A. A review of the empirical evidence of the value of structuring and coding of clinical information within electronic health records for direct patient care. Journal of Innovation in Health Informatics 2013; 20 (03) 171-80.
  CrossrefPubMedGoogle Scholar
• 7 Wiegand NM, Belting J, Fekete C, Gutenbrunner C, Reinhardt JD. All talk, no action?: the global diffusion and clinical implementation of the international classification of functioning, disability, and health. American Journal of Physical Medicine & Rehabilitation 2012; 91 (07) 550-60.
  CrossrefPubMedGoogle Scholar
• 8 Grol R, Wensing M, Eccles M, Davis D. Improving Patient Care: The Implementation of Change in Health Care. Chichester, UK: John Wiley & Sons; 2013
  PubMedGoogle Scholar
• 9 Kostanjsek N, Rubinelli S, Escorpizo R, Cieza A, Kennedy C, Selb M, Stucki G. Üstün TB. Assessing the impact of health conditions using the ICF. Disability And Rehabilitation 2011; 33 15–16 1475-82.
  CrossrefPubMedGoogle Scholar
• 10 Cerniauskaite M, Quintas R, Boldt C, Raggi A, Cieza A, Bickenbach JE, Leonardi M. Systematic literature review on ICF from 2001 to 2009: its use, implementation and operationalisation. Disabil Rehabil 2011; 33 (04) 281-309.
  CrossrefPubMedGoogle Scholar
• 11 Maribo T, Petersen KS, Handberg C, Melchiorsen H, Momsen AM, Nielsen CV, Leonardi M, Labriola M. Systematic Literature Review on ICF From 2001 to 2013 in the Nordic Countries Focusing on Clinical and Rehabilitation Context. Journal of clinical medicine research 2016; 8 (01) 1-9.
  CrossrefPubMedGoogle Scholar
• 12 Stucki G, Bickenbach J. Functioning: the third health indicator in the health system and the key indicator for rehabilitation. European journal of physical and rehabilitation medicine 2017; 53 (01) 134-8.
  CrossrefPubMedGoogle Scholar
• 13 World Health Organization. International Classification of Functioning, Disability and Health. Geneva: World Health Organization (WHO) 2001.
  PubMed
• 14 ISO.. ISO/TR 14639–2:2014(E) Health informatics — Capacity-based eHealth architecture roadmap — Part 2: Architectural components and maturity model. Geneva: ISO; 2014
  PubMedGoogle Scholar
• 15 ISO.. BS EN 15224:2012 Health care services — Quality management systems — Requirements based on EN ISO 9001:2008. Geneva: ISO; 2012
  PubMedGoogle Scholar
• 16 Coenen M, Cieza A, Stamm TA, Amann E, Kollerits B, Stucki G. Validation of the International Classification of Functioning, Disability and Health (ICF) Core Set for rheumatoid arthritis from the patient perspective using focus groups. Arthritis Research and Therapy 2006; 8 (04) R84.
  CrossrefPubMedGoogle Scholar
• 17 Kirchberger I, Coenen M, Hierl F, Dieterle C, Seissler J, Stucki G, Cieza A. Validation of the International Classification of Functioning, Disability and Health (ICF) core set for diabetes mellitus from the patient perspective using focus groups. Diabetic Medicine 2009; 26 (07) 700-7.
  CrossrefPubMedGoogle Scholar
• 18 Mayo NE, Poissant L, Ahmed S, Finch L, Higgins J, Salbach NM, Soicher J, Jaglal S. Incorporating the International Classification of Functioning, Disability, and Health (ICF) into an electronic health record to create indicators of function: proof of concept using the SF-12. Journal of the American Medical Informatics Association 2004; 11 (06) 514-22.
  CrossrefPubMedGoogle Scholar
• 19 Rastall P, Wooldridge D, Carpenter I, Hoogewerf J, Prodinger B. Perspectives of patients with long term health conditions. 2015 Available from: http://www.semantichealthnet.eu/SemanticHealthNet/assets/File/SHN%20288408%20D3_3%20rev2%20Annex%2010_Rastall_SHN_D3_3_final.pdf
  PubMedGoogle Scholar
• 20 Stallinga HA, Roodbol PF, Annema C, Jansen GJ, Wynia K. Functioning assessment vs. conventional medical assessment: a comparative study on health professionals’ clinical decision-making and the fit with patient‘s own perspective of health. Journal of clinical nursing 2014; 23 7–8 1044-54.
  PubMedGoogle Scholar
• 21 Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Journal of clinical epidemiology 2009; 62 (10) 1006-12.
  CrossrefPubMedGoogle Scholar
• 22 World Health Organization. How to use the ICF: A practical manual for using the International Classification of Functioning, Disability and Health (ICF). Exposure draft dor Comment. Geneva: WHO 2013
  PubMed
• 23 Kaufman D, Roberts WD, Merrill J, Lai TY, Bakken S. Applying an evaluation framework for health information system design, development, and implementation. Nursing research 2006; 55 (Suppl. 02) S37-42.
  CrossrefPubMedGoogle Scholar
• 24 Krippendorff K. Content analysis. In: Papazafeiropoulou A, Stergioulas LK. editors. International encyclopedia of communication. New York: Oxford University Press; 1989: 403-7.
  Google Scholar
• 25 Elo S, Kyngäs H. The qualitative content analysis process. Journal of advanced nursing 2008; 62 (01) 107-15.
  CrossrefPubMedGoogle Scholar
• 26 Yusof MM, Kuljis J, Papazafeiropoulou A, Stergioulas LK. An evaluation framework for Health Information Systems: human, organization and technology-fit factors (HOT-fit). International Journal of Medical Informatics 2008; 77 (06) 386-98.
  CrossrefPubMedGoogle Scholar
• 27 Yusof MM, Papazafeiropoulou A, Paul RJ, Stergioulas LK. Investigating evaluation frameworks for health information systems. Int J Med Inform 2008; 77 (06) 377-85.
  CrossrefPubMedGoogle Scholar
• 28 Gray K, Sockolow P. Conceptual Models in Health Informatics Research: A Literature Review and Suggestions for Development. JMIR medical informatics 2016; 4 (01) e7.
  CrossrefPubMedGoogle Scholar
• 29 Eivazzadeh S, Anderberg P, Larsson TC, Fricker SA, Berglund J. Evaluating Health Information Systems Using Ontologies. JMIR medical informatics 2016; 4 (02) e20.
  CrossrefPubMedGoogle Scholar
• 30 Kihuba E, Gheorghe A, Bozzani F, English M, Griffiths UK. Opportunities and challenges for implementing cost accounting systems in the Kenyan health system. Global health action 2016; 9: 30621.
  CrossrefPubMedGoogle Scholar
• 31 Shachak A, Montgomery C, Dow R, Barnsley J, Tu K, Jadad AR, Lemieux-Charles L. End-user support for primary care electronic medical records: a qualitative case study of users’ needs, expectations and realities. Health systems (Basingstoke, England) 2013; 2 (03) 198-212.
  CrossrefPubMedGoogle Scholar
• 32 Talboom-Kamp EP, Verdijk NA, Blom CM, Harmans LM, Talboom IJ, Numans ME, Chavannes NH. e-Vita: design of an innovative approach to COPD disease management in primary care through eHealth application. BMC pulmonary medicine 2016; 16 (01) 122.
  CrossrefPubMedGoogle Scholar
• 33 ICF Research Branch. Homepage ICF Reasearch Branch. 2017 [04.05.2017]; Available from: https://www.icf-research-branch.org
  PubMed
• 34 Vreeman DJ, Richoz C. Possibilities and Implications of Using the ICF and Other Vocabulary Standards in Electronic Health Records. Physiotherapy Research International:: The Journal For Researchers And Clinicians In Physical Therapy; 2013
  PubMedGoogle Scholar
• 35 Tanaka H, Matsumoto Y. Towards reorganization of international classification of functioning, disability and health for design of assistive robots. IEEE Workshop on Advanced Robotics and its Social Impacts, ARSO 2013: 100-5.
  PubMedGoogle Scholar
• 36 Subirats L, Ceccaroni L, Lopez-Blazquez R, Miralles F, Garcia-Rudolph A, Tormos JM. Circles of Health: towards an advanced social network about disabilities of neurological origin. Journal of Biomedical Informatics 2013; 46 (06) 1006-29.
  CrossrefPubMedGoogle Scholar
• 37 Frattura L, Simoncello A, Bassi G, Soranzio A, Terreni S, Sbroiavacca F. editors. The FBE development project: Toward flexible electronic standards-based biopsycho-social individual records. Studies in Health Technology and Informatics 2012
  PubMedGoogle Scholar
• 38 Della Mea V, Fioresi V. ICF machine: a web-based system for collection of ICF data. Studies In Health Technology And Informatics 2012; 180: 1188-90.
  PubMedGoogle Scholar
• 39 Spreyermann R, Lüthi H, Michel F, Baumberger M, Wirz M, Mäder M. Long-term follow-up of patients with spinal cord injury with a new ICF-based tool. Spinal cord 2011; 49 (02) 230-5.
  CrossrefPubMedGoogle Scholar
• 40 Manabe S, Miura Y, Takemura T, Ashida N, Nakagawa R, Mineno T, Matsumura Y. Development of ICF code selection tools for mental health care. Methods Of Information In Medicine 2011; 50 (02) 150-7.
  Article in Thieme ConnectPubMedGoogle Scholar
• 41 Martínez NO, Sánchez SP. SIDUR: Development of an information system, using controlled vocabulary designed to the characterization and sample of population with and without disability, attended by Rehabilitation programs, University of Rosar. Revista Ciencias de la Salud 2010; 8 (01) 55-67.
  PubMedGoogle Scholar
• 42 Kalwa M, Greitemann B. Technical implementation of an EDP based process documentation system for routine use in inpatient medical rehabilitation (RehaProDok) [German]. Rehabilitation 2009; 48 (03) 154-9.
  Article in Thieme ConnectPubMedGoogle Scholar
• 43 Lehnguth R, Leidag T. OT-ASSESS [German]. Ergotherapie & Rehabilitation 2007; 46 (09) 10-4.
  PubMedGoogle Scholar
• 44 van Grunsven A, Bindels R, Coenen C, de Bel E. Developing an integrated electronic nursing record based on standards. Studies In Health Technology And Informatics 2006; 122: 294-7.
  PubMedGoogle Scholar
• 45 Kukafka R, Bales ME, Burkhardt A, Friedman C. Human and automated coding of rehabilitation discharge summaries according to the International Classification of Functioning, Disability, and Health. Journal of the American Medical Informatics Association 2006; 13 (05) 508-15.
  CrossrefPubMedGoogle Scholar
• 46 Giannangelo K, Bowman S, Dougherty M, Fenton S. ICF: representing the patient beyond a medical classification of diagnoses. Perspectives in Health Information Management 2005; 2: 9p.
  PubMedGoogle Scholar
• 47 Üstün TB, Chatterji S, Kostansjek N, Bickenbach J. WHO’s ICF and functional status information in health records. Health Care Financing Review 2003; 24 (03) 77-88.
  PubMedGoogle Scholar
• 48 Rentsch HP, Bucher P, Dommen Nyffeler I, Wolf C, Hefti H, Fluri E, Wenger U, Wälti C, Boyer I. The implementation of the 舘International Classification of Functioning, Disability and Health‘ (ICF) in daily practice of neurorehabilitation: an interdisciplinary project at the Kantonsspital of Lucerne, Switzerland. Disability And Rehabilitation 2003; 25 (Suppl. 08) 411-21.
  CrossrefPubMedGoogle Scholar
• 49 Harris MR, Ruggieri AP, Chute CG. From clinical records to regulatory reporting: formal terminologies as foundation. Health Care Financing Review 2003; 24 (03) 103-20.
  PubMedGoogle Scholar
• 50 Rentsch HP, Bucher P, Dommen-Nyffeler I, Wolf C, Hefti H, Fluri E, Bucher Koller ML, Deerpaul Krummenacher A, Lenherr M, Zumsteg I, Fischer M. The implementation of the ICF in daily practice of neurorehabilitation. Neurologie und Rehabilitation 2001; 7 (04) 171-8.
  PubMedGoogle Scholar
• 51 Meyer T, Gutenbrunner C, Bickenbach J, Cieza A, Melvin J, Stucki G. Towards a conceptual description of rehabilitation as a health strategy. Journal of rehabilitation medicine 2011; 43 (09) 765-9.
  CrossrefPubMedGoogle Scholar
• 52 Timmermans S, Epstein S. A world of standards but not a standard world: toward a sociology of standards and standardization. Annual review of Sociology 2010; 36: 69-89.
  CrossrefPubMedGoogle Scholar
• 53 Bales M, Kukafka R, Burkhardt A, Friedman C. Extending a medical language processing system to the functional status domain. AMIA Annual Symposium Proceedings / AMIA Symposium AMIA Symposium 2005: 888.
  PubMedGoogle Scholar
• 54 Organization WH. How to use the ICF: A Practical Manual for using the International Classification of Functioning, Disability and Health (ICF). Geneva: WHO; 2013
  PubMedGoogle Scholar
• 55 World Health Organization. WHO ICF eLearning Tool. 2015; Available from: http://icf.ideaday.de
  PubMed
• 56 Swiss Paraplegic Research. ICF Case Studies. Translating Interventions into Real-Life Gains –a Rehab-Cycle Approach. 2016; Available from: https://www.icf-casestudies.org
  PubMed
• 57 Selb M, Escorpizo R, Kostanjsek N, Stucki G, Ustun B, Cieza A. A guide on how to develop an International Classification of Functioning, Disability and Health Core Set. European journal of physical and rehabilitation medicine 2015; 51 (01) 105-17.
  PubMedGoogle Scholar
• 58 Hopfe M, Prodinger B, Bickenbach JE, Stucki G. Optimizing health system response to patient‘s needs: an argument for the importance of functioning information. Disabil Rehabil 2017: 1-6.
  PubMedGoogle Scholar

• Supplementary Material