How well does ICD9 represent phrases used in the medical record problem list?

Abstract

We are considering using the International Classification of Diseases with Clinical Modifications, Ninth Revision (ICD9) as the basis for an automated problem list for a clinical information system. To determine physician satisfaction with an ICD9 representation of phrases used in the medical record problem list, we asked 6 physicians to evaluate ICD9 representations of 332 phrases taken from medical record problem lists, using a scale of 1(extremely dissatisfied) to 5 (extremely satisfied). The mean score was 3.0; intraclass correlation for 25 phrases given to all 6 evaluators was 0.47. In 45% of the phrases the physicians were dissatisfied with the ICD9 representation. In developing an automated problem list it is desirable to improve the level of satisfaction of clinician users above this level. This could be done by modifying ICD9, using a different vocabulary to represent the problem list, or improving the method of assigning ICD9 codes.