title: External validation of EPICON: a grouping system for estimating morbidity rates using electronic medical records.
abstract: OBJECTIVE
  To externally validate EPICON, a computerized system for grouping diagnoses from EMRs in general practice into episodes of care. These episodes can be used for estimating morbidity rates.
  
  
  METHODS
  Comparative observational study.
  
  
  METHODS
  Morbidity rates from an independent dataset, based on episode-oriented EMRs, were used as the gold standard. The EMRs in this dataset contained diagnoses which were manually grouped by GPs. The authors ungrouped these diagnoses and regrouped them automatically into episodes using EPICON. The authors then used these episodes to estimate morbidity rates that were compared to the gold standard. The differences between the two sets of morbidity rates were calculated and the authors analyzed large as well as structural differences to establish possible causes.
  
  
  RESULTS
  In general, the morbidity rates based on EPICON deviate only slightly from the gold standard. Out of 675 diagnoses, 36 (5%) were considered to be deviating diagnoses. The deviating diagnoses showed differences for two main reasons: "differences in rules between the two methods of episode construction" and "inadequate performance of EPICON."
  
  
  CONCLUSIONS
  The EPICON system performs well for the large majority of the morbidity rates. We can therefore conclude that EPICON is useful for grouping episodes to estimate morbidity rates using EMRs from general practices. Morbidity rates of diseases with a broad range of symptoms should, however, be interpreted cautiously.
authors.affiliation: Department of Medical Informatics, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. m.biermans@mi.umcn.nl
authors.forename: Marion C J
authors.initials: MC
authors.lastname: Biermans
authors.forename: Geert H
authors.initials: GH
authors.lastname: Elbers
authors.forename: Robert A
authors.initials: RA
authors.lastname: Verheij
authors.forename: Willem
authors.initials: W
authors.lastname: Jan van der Veen
authors.forename: Gerhard A
authors.initials: GA
authors.lastname: Zielhuis
authors.forename: Pieter F de Vries
authors.initials: PF
authors.lastname: Robbé