Leveraging the Electronic Medical Record for Functional Neurological Disorder: A Scoping Review.

BACKGROUND

Functional neurological disorder (FND) is a neuropsychiatric condition that causes disabling neurological symptoms. Despite its frequent occurrence, FND has a long history of misclassification, and this is reflected in inconsistencies in how healthcare providers code for FND patients in the medical record.

OBJECTIVES

We aim to (1) assess if an electronic medical record (EMR) case definition(s) for FND or its subtypes has been created or validated, (2) explore what yet-to-be-validated definitions and codes have been used and (3) understand how the EMR is currently being used to study FND.

METHODS

We conducted a scoping review, searching EMBASE, MEDLINE and APA PsycInfo for peer-reviewed literature that identifies FND patients using the EMR. Included studies were published after 2000, written in English or French, and were original research.

RESULTS

Our search identified 31 articles. Thirty-two diagnostic codes have been used for FND, most commonly F44.x International Classification of Diseases (ICD)-10-CM codes in 21 of 31 studies (68%) and 300.x ICD-9 codes in 8 of 31 studies (26%). Additionally, nine distinct case definitions, which combined various data-driven identification methods, were used inconsistently, and validation was only attempted in five studies. Functional dissociative seizure was the most frequently studied subtype. Epidemiology and comorbidities were the topics explored most often.

CONCLUSIONS

The EMR holds great promise as a tool for FND research, although a validated case definition is needed. Of great concern are the inconsistent coding practices for FND. Future efforts should focus on tackling stigma to remove barriers to diagnosis and improve coding practices.