Web-Based Information Infrastructure Increases the Interrater Reliability of Medical Coders: Quasi-Experimental Study

BACKGROUND: Medical coding is essential for standardized communication and integration of clinical data. The Unified Medical Language System by the National Library of Medicine is the largest clinical terminology system for medical coders and Natural Language Processing tools. However, the abundance of ambiguous codes leads to low rates of uniform coding among different coders. OBJECTIVE: The objective of our study was to measure uniform coding among different medical experts in terms of interrater reliability and analyze the effect on interrater reliability using an expert- and Web-based code suggestion system. METHODS: We conducted a quasi-experimental study in which 6 medical experts coded 602 medical items from structured quality assurance forms or free-text eligibility criteria of 20 different clinical trials. The medical item content was selected on the basis of mortality-leading diseases according to World Health Organization data. The intervention comprised using a semiautomatic code suggestion tool that is linked to a European information infrastructure providing a large medical text corpus of >300,000 medical form items with expert-assigned semantic codes. Krippendorff alpha (K(alpha)) with bootstrap analysis was used for the interrater reliability analysis, and coding times were measured before and after the intervention. RESULTS: The intervention improved interrater reliability in structured quality assurance form items (from K(alpha)=0.50, 95% CI 0.43-0.57 to K(alpha)=0.62 95% CI 0.55-0.69) and free-text eligibility criteria (from K(alpha)=0.19, 95% CI 0.14-0.24 to K(alpha)=0.43, 95% CI 0.37-0.50) while preserving or slightly reducing the mean coding time per item for all 6 coders. Regardless of the intervention, precoordination and structured items were associated with significantly high interrater reliability, but the proportion of items that were precoordinated significantly increased after intervention (eligibility criteria: OR 4.92, 95% CI 2.78-8.72; quality assurance: OR 1.96, 95% CI 1.19-3.25). CONCLUSIONS: The Web-based code suggestion mechanism improved interrater reliability toward moderate or even substantial intercoder agreement. Precoordination and the use of structured versus free-text data elements are key drivers of higher interrater reliability.