Presentation at the 2nd International Symposium: ICF Education. 30 June 2017 (Cape Town). http://www.icfeducation.org

1. Using ICF in the Insurance Medicine Decision Support
(IMDS) and in electronic medical certificates to assess
workability
2017-06-30
Ann-Helene Almborg 1,2,3
Claudia Ehrentraut 4
Regina Ylvén1
1 National Board of Health and Welfare, Stockholm, Sweden
2 Nordic WHO-FIC CC, Oslo, Norway
3 The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden.
4 Consultant at Inera AB, Stockholm, Sweden

2. Insurance Medicine Decision Support (IMDS)
• Published in 2007 on the website of the National Board of Health and
Welfare
• Consists of:
– General principles
– Recommendations for about 120 different diagnoses
• Covers about 80% of all reported sick leave
• Is highly utilized and well established in healthcare
– has been implemented in some of the counties electronic health record and certification
systems
www.socialstyrelsen.se

3. IMDS and in electronic medical certificates
•In 2016, the National Board of Health and Welfare had the
commission of the Swedish government to update IMDS for 17
psychiatric diagnoses.
• In Sweden, a national application for issuing medical certificates
electronically is in use.

4. Purpose
• to highlight how the ICF can be
used to describe impairment and
activity limitations in the IMDS
• to investigate how ICF can be
used when issuing medical
certificates electronically in the
national application

5. Methods
ICF-subsets for 17 psychiatric diagnosis within the insurance process for
IMDS were developed by means of:
– Medical experts
– ICF coresets
– Other materials in the field
It was then investigated and tested how these ICF-subsets with qualifiers
could be presented to physicians in Sweden’s national application, in order
to be used when issuing medical certificates electronically.

6. Adapting IMDS to digital format by …
• Developing concept- and information-models
• Structuring and coding the information
– ICD-10 (for diagnosis and comorbidity)
– ICF (for impairments and activity limitations)
– Snomed CT och the National Board of Health’s own codesets (for factors having an
impact on the sickness duration e.g. work load)

7. Results
• The information about impairments and activity limitations was improved for
all 17 diagnoses by using ICF as framework and as a terminology
– Several of the 17 psychiatric diagnoses had no information and some had inadequate
information
• Furthermore, the work yielded a prototype illustrating how ICF with qualifiers
can be used when entering information about impairments and activity
limitations in Sweden’s national application for medical certifications for sick
leave.

8. Activity limitations - information in IMDS

10. Conclusions
Insurance Medicine Decision Support (IMDS) supports
• the physician in assessment of work ability and sick leave
ICF supports
• mindset regarding health, functioning and assessment of work ability
• using a common terminology
• using structured documentation in electronic patient health records
• saving time
ICF may improve data quality and facilitate the communication between
physicians and administrators at the Swedish Social Insurance Agency

11. More information at: www.socialstyrelsen.se
Thank you for attention
Ann-Helene Almborg
Ann-helene.almborg@socialstyrelsen.ae