Dr Robert Jakob, Medical Officer ICD Dr Bedirhan Ustun, Coordinator Classifications, Terminologies, Standards World Health Organization ICD Revision: A

Dr Robert Jakob, Medical Officer ICD

Dr Bedirhan Ustun, Coordinator Classifications, Terminologies, Standards

World Health Organization

ICD Revision: A new way to build the ICD Revision: A new way to build the ICDICD

2 | ICD-11 UN Classification Experts 14 May 2013

Death registration-causes of death reported to Death registration-causes of death reported to WHOWHO

Of the reporting countries, half are developed providing 75% of the deaths included, but only 33% of estimated global deaths

WHO region Number of MemberStates

Data reported for at least one of the years

2004-2008

Percentage of Member

States reporting

AFR 46 4 9

AMR 35 32 91

EMR 21 6 29

EUR 53 46 87

SEAR 11 3 27

WPR 27 8 30

Global 193 99 51


Reporting 2009Reporting 2009

3


ICD use in Morbidity ICD use in Morbidity

DRAFT – To be edited DRAFT – To be edited

DRAFT Green=ICD-10 useLight blue= ICD-9 useYellow= some useGrey=some known usersDark blue=unknown

Morbidity use follows pattern similar to mortality use


WHO International Drug Monitoring ProgrammeWHO International Drug Monitoring Programme - - MembershipMembershipAugust 2005August 2005

Full members of the WHO programmeAssociated members of the WHO programmeNon members of the WHO programme

Membership in programme


Cancer registration (ICD / ICD-O)Cancer registration (ICD / ICD-O)


The International Classification of The International Classification of Diseases 11Diseases 11thth Revision is due by 2015 Revision is due by 2015

ICD is the international standard to measure health & health services

Mortality Statistics

Morbidity Statistics

Health Care Costs

Progress towards MDGs

βeta

Placing WHO Classifications in HIS & ITPlacing WHO Classifications in HIS & IT

Population Health• Births • Deaths • Diseases• Disability • Risk factors

e-Health RecordSystems

ICD ICD

ICFICF

ICHIICHI

Classifications

LinkagesKRs

Terminologies

Clinical• Decision Support• Integration of care• Outcome

Administration• Scheduling• Resources • Billing

Reporting• Cost• Needs• Outcome


Construction of ICD-11: Construction of ICD-11: Revision Process in the 21Revision Process in the 21stst Century Century

• Internet-based permanent platform – All year round – Open to all people in a structured way– Content experts focus

• Digital curation– Wiki enabled collaboration– Ontology based

• Enhanced discussion & peer review – TAGs serve as the editorial group

• Electronic copy print version • Work in multiple languages• Planned field tests

– Based on Use Cases


ICD-11ICD-11

• International Classification =

• Global Participation

ICD-11 Revision Platform

is OPEN to ALL people

in a structured way


ICD Revision Organizational StructureICD Revision Organizational Structure

Gastroenterology WG

Cardiovascular WG

Hepatology & Pancreatobiliary WG

Nephrology WG

Endocrinology WG

Rheumatology WG

Cross-Sectional TAGs

Content-Specific TAGs

Working Groups

Haematology WG

Respiratory WG

Dentistry TAG

Musculoskeletal TAG

Mental Health TAG

Maternal, Neonatal and Urogenital TAG

External Causes and Injuries TAG

Dermatology TAG

Internal Medicine TAG

Neurology TAG

Ophthalmology TAG

Paediatrics TAG

Rare Diseases TAG

Health Informatics and Modelling TAG (HIM TAG)

iCAT Software Team

Traditional Medicine TAG

Neoplasms TAG

WHO

Revision Steering Group


iCATiCAT


ICD-11ICD-11

• Integrates standard definitions– Diseases– Disorders, syndromes– …

• Ready for electronic health records

• Links with standard terminologies– SNOMED-CT– Gene Ontology


THE CONTENT MODELTHE CONTENT MODELAny Category in ICD is represented by:Any Category in ICD is represented by:

1. ICD Concept Title1.1. Fully Specified Name

2. Classification Properties2.1. Parents2.2 Type2.3. Use and Linearization(s)

3. Textual Definition(s)4. Terms

4.1. Base Index Terms4.2. Inclusion Terms4.3. Exclusions

5. Body Structure Description 5.1. Body System(s) 5.2. Body Part(s) [Anatomical Site(s)]5.3. Morphological Properties

6. Manifestation Properties6.1. Signs & Symptoms 6.2. Investigation findings

TITLE of ENTITY: Name of disease, disorder, or syndrome…7. Causal Properties7.1. Etiology Type7.2. Causal Properties - Agents7.3. Causal Properties - Causal Mechanisms 7.4. Genomic Linkages7.5. Risk Factors8. Temporal Properties

8.1. Age of Occurrence & Occurrence Frequency

8.2. Development Course/Stage9. Severity of Subtypes Properties10. Functioning Properties

10.1. Impact on Activities and Participation10.2. Contextual factors10.3. Body functions

11. Specific Condition Properties11.1 Biological Sex11.2. Life-Cycle Properties

12. Treatment Properties13. Diagnostic Criteria


ICD ~ SNOMED-CT ICD ~ SNOMED-CT Common OntologyCommon Ontology

Core subset of ICD ICD Foundation ComponentFoundation Component

& SNOMED CT SNOMED CT

•Shared concepts: –fully specified names; definitions; synonyms

•Same parent-child relationships–Similar polyhierarchies–Similar grouping logic–Same content model parameters

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Smooth transiton to ICD-11Smooth transiton to ICD-11

• Seamless evolution from ICD-10– Backwards compatible

βet

a


• Mortality

• Morbidity– ICD-10-WHO with ICD-11-WHO– ICD-10&11-WHO with ICD-10-GM– ICD-10&11-WHO with ICD-10-CA– ICD-10&11-WHO with ICD-10-AM– ICD-10&11-WHO with ICD-10-CM

Stability AnalysisStability Analysis

Types & MethodologyTypes & Methodology

17

Mort/PCHigh 11

Mort/PCHigh 12

Mort/PCHigh 13

Mort/PCHigh 21

Mort/PCHigh 22

Mort/PCHigh 31

Mort/PCHigh 33

Mort/PCHigh 34

Mort/PCHigh 32

Mort/PCHigh 35

Morbidity111

Morbidity112

Morbidity121

Morbidity133

Morbidity131

Morbidity132

Morbidity221

Morbidity222

Morbidity211

Morbidity311

Morbidity312

Morbidity321

Morbidity341

Morbidity342

Morbidity351

PRIMARY CARE High Resource MORBIDITYMORBIDITY

PC – Low 1

PC – Low 2

PC – Low 3

PRIMARY CARE Low Resource

(Verbal Autopsy ?) MORTALITYMORTALITY International National LinearizationsSpecialty - Research

Extensions 18


ICD-11ICD-11

– Simultaneous development in Multiple Languages

– التصنيف الدولي لألمراض

– 國際疾病與相關健康問題統計分類

– International Classification of Diseases

– Classification internationale des maladies

– Международная классификация болезней

– Clasificación internacional de enfermedades


Translation platformTranslation platform

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Information NotesInformation Notes

1. ICD Revision Communication

2. ICD Revision Timelines

3. TAG Allocation

4. Content Model

5. Foundation Component and Linearizations

6. Legacy Linearizations

7. Code Structure

8. Multidimensional Coding

9. Index

10.Diagnosis Type

11. Main Condition

12.Review Process

13.Mirror Coding

14.Modifiers and Qualifiers

15.Field Trials

16.Stability Analysis

17.Multilingual ICD Platform

18.Dagger and Asterisk resolution

19.Multisystem Chapter

21


OverviewOverview

• ICD-11 progress– Volume I: Current status of Content

• Stability Analysis: ICD10 in 11• Review Process• Field Trials

– Volume II: ICD knowledge base– Volume III: Index

• Issues and Solution Plans

22


Current Status Current Status as of 30 April 2013as of 30 April 2013

• Some Chapters need further work– Signs & Symptoms – Factors influencing health status and contact with health

services

• Other chapters’ structure reported to be complete– Mental Health, Sexual Health, GURM sections…

• Definitions – Top level > 50 %– Overall > 35 %

23


Proposal mechanismProposal mechanism

24


Review ProcessReview Process

• The review process will help WHO assure the quality of the Beta Content

• Review focus: – Scientific accuracy– Completeness of each unit– Internal consistency– Utility / Relevance of each unit


ICD-11 Field TrialsICD-11 Field Trials

– To test the “fitness of ICD-11 for multiple purposes”

• Mortality coding

• Morbidity coding

• Other use cases

– To ensure the comparability between ICD-10 and ICD-11


Field Trial StudiesField Trial Studies

1. Core Studies– Study One:

• Basic Questions – consistency, errors– Study Two:

• Reliability & Feasibility– Study Three:

• Bridge Coding

2. Additional Studies


• Collaborative Authoring Tools

• Review Mechanisms

• Field testing

• Multilingual Production

• USE CASES

• Linking Classifications

RoadmapRoadmap


ICD-11ICD-11

• International Public Good– Openly Accessible– Free for WHO Member States

• Available in multiple formats:– Printed Book editions– Internet-edition – Various computerized tools

• e.g. Mobile phones…


ICD-11 TimelineICD-11 Timeline

• 2013 : Beta version: Field Trials Version –+2 YR : Field trials

• 2015 : Final version for WHA Approval–2015+ implementation

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Documents

Dr Robert Jakob, Medical Officer ICD Dr Bedirhan Ustun, Coordinator Classifications, Terminologies, Standards World Health Organization ICD Revision: A