The core concept within FaMe-Net is the Episode of Care (EoC): all data in FaMe-Net are ordered into Episodes of Care. It can be defined as ‘a health problem presented by an individual to a healthcare provider, from the first presentation until the last encounter’. EoCs have a title, the episode diagnosis, classified with ICPC-2. The episode diagnosis can be modified during the EoC. An example: an EoC is first labelled as fatigue, but the diagnosis (episode title) is changed to iron deficiency anaemia, and it later appears to be caused by colon cancer, which will be the final diagnostic label. All contact elements related to this health problem are comprised in this EoC, including specialist reports to the GP. 

Presented data from ‘Episodes of Care’ are abbreviated to ‘Episodes’ on this website.

Another essential concept used in FaMe-Net is the Reason for Encounter (RFE). 

Patients normally start the consultation with a spontaneous statement on why they visit the doctor: the Reason For Encounter. This reflects the initial presentation of the illness. This statement precedes the interaction between patient and GP, and the GP’s interpretation. RFEs are recorded regardless of the final diagnosis. FaMe-Net routinely and systematically registers all RFEs in all encounters during regular consultations, taking GPs less than a minute of time. 

The RFE(s) can be presented as a symptom (e.g. abdominal pain, a rash, cough), but also as a self-diagnosed disease (‘I’ve got the flu’; ‘I think I have migraine’; ‘I hope it’s not pneumonia again’) or a request for a particular intervention (‘I would like to have a blood test’). When multiple RFEs are presented, all are registered. The RFE(s) should be recognised by the patient as an acceptable description of the demand for care. RFE registration enables research studying associations between RFE and (final) diagnosis. RFEs in themselves have important prognostic value, for example in diagnosing cancer. (3, 4)

All presented symptoms, complaints, diseases, and problems in FaMe-Net are classified by the GP in accordance with the International Classification of Primary Care (ICPC-2) at the highest level of accuracy and understanding. In addition to ICPC-2, diagnoses are also coded with the International Classification of Diseases and Related Health Problems (ICD-10).

Transfer to ICPC version 3 is planned, now that it has been released in December 2020. This will allow for additional recording of functioning (activities and participation) and personal preferences linked to morbidity. 

All interventions and processes are also coded with ICPC-2. These include referral to primary or secondary care professionals, diagnostic imaging, laboratory testing, and therapeutic interventions such as medication, vaccination or surgical procedure.

Prescriptions are coded according to the Anatomical Therapeutic Chemical (ATC) coding system maintained by the World Health Organization.5 

Prescription data provide detail and are a particularisation of the intervention type ‘medication’ (ICPC-2 code *50). 

Prescription data are shown by the first five characters of the ATC code by default. If desired this may be changed to a less detailed level with the first four characters of the ATC code so that prescriptions are studied in larger groups of medication. This can be changed in the report showing Relations between a chosen episode (ICPC code) and its percentage with a prescription.

FaMe-Net distinguishes referrals to primary care professionals and to secondary (specialist) care, and the specialisms among these referral types (primary or secondary). 

Referral data are a particularisation of the intervention type ‘referral primary care’ (ICPC-2 code *66) and ‘referral secondary care’ (ICPC-2 code *67).

Synonym: contact, consultation. 

An encounter is the professional interchange between a patient and a GP. Healthcare provided to patients by other team members of the general practice (practice assistants, practice nurses (Dutch: POH’s), GPs and doctors (in training) are also recorded in encounters. 

We distinguish different types of encounters (encounter types). The majority concerns consultations during office hours. Other encounter types distinguished are home visits, telephone and email consultations (by the GP or the practice assistant), out-of-hours consultations, repeat prescriptions and administrative contacts (specialist letters). They all contribute to the registered morbidity, ordered in EoCs.
One or more Episodes of Care may be dealt with at an encounter. When more than one episode is dealt with during an encounter, there are two or more sub-encounters.Every (sub)encounter has at least one RFE. The only exemption are reports (letters) from other healthcare professionals, which do not have an RFE recorded.

Every encounter results in an (initial) diagnostic label, which is named Encounter diagnosis in FaMe-Net. This Encounter diagnosis may or may not be the final diagnosis (EoC). An Encounter diagnosis could be tiredness, changing later in the Episode to iron deficiency anaemia, and still later to colon cancer. In FaMe-Net’s Episode registration, all these encounters contribute to the Episode (EoC) colon cancer, but we are still able to review the (temporal/preliminary) Encounter diagnoses. In general practice, many Episodes of Care consist of only one encounter.

All presented symptoms, complaints, and diseases are classified in accordance with the International Classification of Primary Care (ICPC-2) at the highest level of accuracy and understanding. In addition to ICPC-2, diagnoses are also coded with the International Classification of Diseases and Related Health Problems (ICD-10).

Transfer to ICPC version 3 is planned, now that it has been released in December 2020. This will allow for additional recording of functioning (activities and participation) and personal preferences linked to morbidity.

In FaMe-Net, all morbidity is registered in episodes of care. An episode of care can be defined as ‘a health problem presented by an individual to a healthcare provider, from the first presentation until the last encounter’. The title of an episode of care is the episode diagnosis, classified with ICPC-2. The episode diagnosis can be modified during the episode of care. For example: an episode of care is first labelled as fatigue, but after laboratory testing, the diagnosis (episode title) is changed to iron deficiency anaemia, and it later appears to be caused by colon cancer, which will be the final diagnostic label. All contact elements related to this health problem are comprised in this episode of care, including specialist reports to the GP. We often abbreviate ‘episode of care to ‘episode’. 

In our infographic, we explain how the Episode of Care is built from one or multiple contacts between patient and general practitioner (GP).

Every encounter starts with coding the Reason for Encounter (RFE). This is the spontaneous statement of the patient on why they visit the care provider. This reflects the initial presentation of the illness. This statement precedes the interaction between patient and GP and precedes the GP’s interpretation. FaMe-Net routinely and systematically registers all RFEs in all encounters. 

The RFE(s) can be presented as a symptom (e.g. abdominal pain, a rash, cough), but also as a self-diagnosed or suspected disease (‘I’ve got the flu’; ‘I think I have migraine’; ‘I hope it’s not pneumonia again’) or a request for a particular intervention (‘I would like to have a blood test’). When multiple RFEs are presented, all are registered. The RFE(s) should be recognised by the patient as an acceptable description of the demand for care. RFE registration enables research studying associations between RFE and (final) diagnosis. RFEs have important prognostic value, for example in diagnosing cancer. RFEs are coded according to the ICPC-2. 

Since 2016, the duration of the RFE (the duration between the start of the complaint and the GP encounter) is also coded in every encounter.

Diagnoses are coded according to the International Classification of Primary Care (ICPC-2) at the highest level of accuracy and understanding. This means that diagnoses are coded as a symptom (e.g. fever of back complaints) when no disease can be diagnosed and are coded as a disease (e.g. infection or back syndrome) when the care provider is convinced of a disease as diagnosis. In addition to ICPC-2, diagnoses are also coded with the International Classification of Diseases and Related Health Problems (ICD-10). The episode diagnosis can be modified during the episode of care.

All diagnostic and therapeutic interventions are coded according to the ICPC-2. Examples of interventions are diagnostic imaging, laboratory testing, medication prescription, health advice, surgical procedure, and referral to primary or secondary care professionals. 

The intervention ‘medication prescription’ is followed by the type of medication that is prescribed. 

The intervention ‘referral’ and ‘consultation’ is followed by the specialism that is referred to (e.g. neurology of physical therapy).

All measurements made during an encounter are systematically registrated in the electronic medical record. This concerns measurements in the physical examination (e.g. temperature, blood pressure, oxygenation), variables resulting from the patient interview (e.g. smoking status) and results from laboratory testing. 

All medication prescriptions are coded according to the Anatomical Therapeutic Chemical (ATC) coding system maintained by the World Health Organization.

Click here to visit the ATC-Classification website.