Dr. T. Bedirhan ÜstünDr. T. Bedirhan ÜstünCoordinator, Coordinator, Classifications, Terminologies, Standards. Classifications, Terminologies, Standards.

World Health OrganizationWorld Health Organization

ICDICD

BackgroundBackground

• WHO +International Standards ICD

• Classification – Common language for definitions:

• Applications:• Mortality: Counting the dead• Morbidity: Monitoring & Evaluation • Primary Care: Diagnosis Management• Research: Epi, Genetics, Pharma…

1666 2011

ICD Revisions139

161

179

189

205

200

954

965

1,0

40

1,1

64

8,1

73

1,9

67

14,4

73

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ICD

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ICD

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ICD

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ICD

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ICD

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ICD

-9-M

ICD

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ICD

-10-M

1853 1893 1900 1909 1920 1929 1938 1948 1955 1968 1975 1979 1993 1993

ICD-10 Medical Devices associated with adverse incidents in diagnostic

and therapeutic use• Y70 Anaesthesiology devices associated with adverse incidents

• Y71 Cardiovascular devices associated with adverse incidents

• Y72 Otorhinolaryngological devices associated with adverse incidents

• Y73 Gastroenterology and urology devices associated with adverse incidents

• Y74 General hospital and personal-use devices associated with adverse incidents

• Y75 Neurological devices associated with adverse incidents

• Y76 Obstetric and gynaecological devices associated with adverse incidents

• Y77 Ophthalmic devices associated with adverse incidents

• Y78 Radiological devices associated with adverse incidents

• Y79 Orthopaedic devices associated with adverse incidents

• Y80 Physical medicine devices associated with adverse incidents

• Y81 General- and plastic-surgery devices associated with adverse incidents

• Y82 Other and unspecified medical devices associated with adverse incidents

WHO Family of ClassificationsREFERENCE

Classifications

I nternationalI nternationalC C lassificationlassification of of D iseases D iseases

I nternationalI nternationalC lassification of C lassification of F unctioning, F unctioning, Disability & HealthDisability & Health

I nternational I nternational C lassification of C lassification of H ealth H ealth I nterventions I nterventions (under development)(under development)

RELATED Classifications

International Classification of Primary Care (ICPC)

International Classification of External Causes of

Injury (ICECI)

The Anatomical, Therapeutic, Chemical

(ATC) classification system with Defined Daily Doses

(DDD)

ISO 9999 Technical aids for persons with disabilities

– Classification and Terminology

DERIVED Classifications

International Classification of Diseases for Oncology, Third

Edition (ICD-O-3)

The ICD-10 Classification of Mental and Behavioural

Disorders

Application of the International Classification of Diseases to

Dentistry and Stomatology, Third Edition

(ICD-DA)

Application of the International Classification of Diseases to

Neurology(ICD-10-NA)

ICF, Children & Youth Version (ICF -CY)

WHO Classifications in HISWHO Classifications in HIS

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

ICD ICD

ICFICF

ICHIICHI

Classifications

Clinical• Decision Support• Integration of care• Outcome

Administration• Scheduling• Resources • Billing

Reporting• Cost• Needs• Outcome

Placing WHO Classifications in HIS Placing WHO Classifications in HIS & & ITIT

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

How do we optimize

our health services

Health Information Systems:Analog to Digital

ICD-11 Revision Goals1. Evolve a multi-purpose and coherent classification

– Mortality, morbidity, primary care, clinical care, research, public health…public health…– Consistency & interoperability across different uses

2. Serve as an international and multilingual reference standard for scientific comparability and communication purposes

3. Ensure that ICD-11 will function in an electronic health records environment.

• Link ICD logically to underpinning terminologies and ontologies (e.g. SNOMED, GO, …)

• ICD Categories “defined” by "logical operational rules" on their associations and details

Construction of ICD-10: Revision Process in the 20th Century

• 8 Annual Revision Conferences (1982 - 89)

• 17 – 58 Countries participated– 1- 5 person delegations

– mainly Health Statisticians

• Manual curation– List exchange

– Index was done later

• "Decibel" Method of discussion

• Output: Paper Copy

• Work in English only

• Limited testing in the field

Construction of ICD-11: Revision Process in the 21st 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

Definition of Diseasea set of dysfunction(s) in any of the body systems

including:• with a known pattern of signs, symptoms & findings

» symptomatology - manifestationssymptomatology - manifestations

• probably with an underlying explanatory mechanism» etiologyetiology

• a distinct pattern of development over time» course and outcomecourse and outcome

• a known pattern of response to interventions » treatment responsetreatment response

• with linkage to underlying genetic factors » genotypes, phenotypes and endophenotypesgenotypes, phenotypes and endophenotypes

• with linkage to interacting environmental factors

• Ontology (philosophy)– the Organization of Reality !!!

• Ontology (computer science) – the explicit – operational description of

the conceptualization of a domain:• Concepts: entity and quality

(properties and attributes)

• An ontology defines:– a common vocabulary a shared

understanding/exchange:• among people• among software agents• between people and software

– to reuse data - information– to introduce standards to allow

interoperability

What is Ontology?

THE CONTENT MODELAny 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. Base Inclusion Terms4.3. Base Exclusion Terms

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

iCAT• Open and collaborative process

– Users are empowered– Web based– Like WIKI – Trip Advisor

• But structured • Editorial Oversight

iCAT

ICD11 Components

18

Foundation: ICD categories with

- Definitions, synonyms- Clinical descriptions- Diagnostic criteria- Causal mechanism- Functional Properties

Find Term

SNOMED-CT, International Classification of Functioning, Disability and Health (ICF)…

Linearizations

Mortality

Morbidity

Primary Care

Why work together?– WHO & IHTSDO

– Coverage & Adequacy– Quality – Reliability - Utility– MultiLingual Applicability– Interoperability– Sustainability

– Member States: Enable health care delivery

and compile health information

SNOMED & WHO Classifications are synergisticsynergistic and not antagonistic

ICD & WHO FICICD & WHO FIC

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

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

ICD & WHO FICICD & WHO FIC– Simultaneous development in Multiple Languages

– لألمراض الدولي التصنيف

– 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

ICD & WHOFIC• Multiple Settings:

– Primary Care– Clinical Services– Research

• Specialty Adaptations:– Children and Youth– Oncology– Mental Health– Neurology– Musculoskeletal– Dermatology– Dentistry

e.g. ICD-10 Diagnostic Guidelines for Mental Health in Primary Care

Desiderata for a global terminology (1)1. Comprehensiveness:

– Coverage for all aspects of health care

2. Adequacy: – Is it fit or purpose – multiple purposes?– Does it have a good information model and ontological basis?

3. Multilingual applicability– language independent formal concept representation– Representation in multiple languages – more than translation

4. Utility:– Is it beneficial for:

• Care providers : decision making, outcome evaluation• Consumers : participation – ownership – evaluation – risk

reduction• Policy/Decision Makers : informed decision making on costs, benefits,

efficiency

5. Reliability: – does it give the same results in different users

Desiderata for a global terminology (2)

6. Validity:– Does it indicate the right things – and does the indication make sense

7. Comparability• Does the data in different context have same properties to be compared?

8. Interoperability– Technical: Can information systems exchange information and use it? – Semantic: Can information systems interpret the data with the same meaning?

9. Quality Assurance– Product: Annotation and Content– Process: Use and Usability

10.Sustainability– Secured maintenance: commitment to stability with earlier versions – Openness to address emerging technical issues