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ICD Revision: A new way to build the ICD

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Presentation on theme: "ICD Revision: A new way to build the ICD"— Presentation transcript:

1 ICD Revision: A new way to build the ICD
Dr Robert Jakob, Medical Officer ICD Dr Bedirhan Ustun, Coordinator Classifications, Terminologies, Standards World Health Organization

2 Death registration-causes of death reported to WHO
Of the reporting countries, half are developed providing 75% of the deaths included, but only 33% of estimated global deaths WHO region Number of Member States Data reported for at least one of the years Percentage of Member States reporting AFR 46 4 9 AMR 35 32 91 EMR 21 6 29 EUR 53 87 SEAR 11 3 27 WPR 8 30 Global 193 99 51

3 Reporting 2009

4 ICD use in Morbidity DRAFT – To be edited
Morbidity use follows pattern similar to mortality use Green=ICD-10 use Light blue= ICD-9 use Yellow= some use Grey=some known users Dark blue=unknown DRAFT

5 WHO International Drug Monitoring Programme - Membership August 2005
Full members of the WHO programme Associated members of the WHO programme Non members of the WHO programme Membership in programme

6 Cancer registration (ICD / ICD-O)

7 The International Classification of Diseases 11th 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

8 Placing WHO Classifications in HIS & IT
Linkages KRs Terminologies e-Health Record Systems ICD ICF ICHI Classifications Population Health Births Deaths Diseases Disability Risk factors Reporting Cost Needs Outcome Clinical Decision Support Integration of care Outcome Administration Scheduling Resources Billing

9 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

10 ICD-11 International Classification = Global Participation
ICD-11 Revision Platform is OPEN to ALL people in a structured way

11 ICD Revision Organizational Structure
WHO Revision Steering Group Gastroenterology WG Cardiovascular WG Hepatology & Pancreatobiliary WG Nephrology WG Endocrinology WG Rheumatology WG Health Informatics and Modelling TAG (HIM TAG) iCAT Software Team 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 Haematology WG Functioning TAG Mortality TAG Morbidity TAG Quality & Safety TAG Respiratory WG Working Groups Neoplasms TAG Cross-Sectional TAGs Traditional Medicine TAG Content-Specific TAGs

12 iCAT

13 ICD-11 Integrates standard definitions
Diseases Disorders, syndromes Ready for electronic health records Links with standard terminologies SNOMED-CT Gene Ontology

14 THE CONTENT MODEL Any Category in ICD is represented by:
TITLE of ENTITY: Name of disease, disorder, or syndrome… Causal Properties Etiology Type Causal Properties - Agents Causal Properties - Causal Mechanisms Genomic Linkages Risk Factors Temporal Properties Age of Occurrence & Occurrence Frequency Development Course/Stage Severity of Subtypes Properties 10. Functioning Properties Impact on Activities and Participation Contextual factors Body functions 11. Specific Condition Properties Biological Sex Life-Cycle Properties 12. Treatment Properties 13. Diagnostic Criteria ICD Concept Title Fully Specified Name Classification Properties Parents Type Use and Linearization(s) Textual Definition(s) Terms Base Index Terms Inclusion Terms Exclusions Body Structure Description Body System(s) Body Part(s) [Anatomical Site(s)] Morphological Properties Manifestation Properties Signs & Symptoms Investigation findings Green already exists in ICD-10 either explicitly or implicitly – Content model specifies them in a more systematic way Orange rubrics are new – they exist in some specialty adaptations already such as oncology, mental health, neurology, dermatology, Functioning Properties is also new – to allow joint use of ICD and ICF 14 14

15 ICD ~ SNOMED-CT Common Ontology
Core subset of ICD Foundation Component & SNOMED CT Shared concepts: fully specified names; definitions; synonyms Same parent-child relationships Similar polyhierarchies Similar grouping logic Same content model parameters ICD revision process is to have a “common ontology” shared (or at least coherent with) SNOMED CT. The “common ontology” has two functions: To provide an “ontological” – i.e. formal logically sound – framework for the Foundation Component of ICD-11. To provide a common structure for interoperability with SNOMED CT. What’s in the “Common Ontology” Logical core The logic-based definitions of concepts and additional universal logic assertions about those concepts – i.e. assertions to which any exception would be a “contradiction in terms”. Usefulness criteria determine whether assertions are included or not. (e.g. assertions about “things that are necessarily red” may be excluded if not useful) The scope of concepts in the common ontology remains to be specified. It will include at least the “core subset” of concepts already in ICD (roughly 15,000). Issues outstanding include: Section headings from ICD Terms from the ICD index. In addition, it may be that a much smaller “mid level” subset needs to be defined in some sub-hierarchies. (The first intended experiment is to develop a small “slice” of the Common Ontology around Cardiovascular Diseases.) Hierarchies Typically, the common ontology is displayed in a polyhierarchy. The polyhierarchy is inferred logically from the definitions and universal assertions (some of which may state simply that one concept is a kind of another). Text definitions The common ontology is to be annotated with “Text Definitions” which explain the meaning and intent. As text, they play no part in the logical structure of the ontology, but should be kept aligned with it. Curation of the text definitions is a major challenge. The goal is to assure that they are: a) Correct b) Understandable c) Coherent with the logical definitions. There are several different sub-elements of text definitions, and agreement is needed on the desired element(s) to be developed. These elements might include: (1) statements of genus-differentia (appendicitis is an inflammatory disorder that is located in the vermiform appendix), (2) statements of archetypal examples or lists of instances (instances of body organ include heart, lung, liver, and kidney), (3) statements explaining how to recognize/identify archetypal instances (myocardial infarction is typically accompanied by chest pain and ST segment elevation on EKG), (4) other clarifying statements such as exclusions, literature references, etc. Names / labels / terms Each concept in the “Common Ontology” should have: A fully defined name in English (need to decide spelling/dialect: en-US or en-GB, or both) In each language and dialect: A preferred term that is unique within the “Common Ontology” (not necessarily unique across all of SNOMED CT. For example “immunosuppression” might be a disorder or a procedure.) Any number of synonyms that need not be unique (but implementers must provide means of disambiguation where terms are not unique.) Any number of “hidden” synonyms that can be used for search but are not normally displayed. (Acronyms, Eponyms, abbreviations, etc.) Except for English, a  fully defined name (unless the national coordinating centre prefers to use the English.) Identifiers Each concept in the “Common Ontology” will be identified by an IRI. Details of the IRI scheme to be discussed separately. Note: SNOMED CT has a draft IRI scheme that makes use of SNOMED CT Identifiers. We should take advantage of opportunities for re-use and coordination. Also need to discuss whether there is value in using SCTIDs in the “common ontology” IRI. The WHO-IHTSDO agreement intended to allow this, as one way to implement linkages.

16 Smooth transiton to ICD-11
Seamless evolution from ICD-10 Backwards compatible βeta

17 Stability Analysis Types & Methodology
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

18 PC – Low 1 PC – Low 2 PC – Low 3 MORBIDITY MORTALITY Extensions
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 Extensions PC – Low 1 PC – Low 2 PC – Low 3 PRIMARY CARE Low Resource (Verbal Autopsy ?) PRIMARY CARE High Resource MORBIDITY MORTALITY International National Linearizations Specialty - Research

19 ICD-11 Simultaneous development in Multiple Languages 國際疾病與相關健康問題統計分類
التصنيف الدولي للأمراض 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

20 Translation platform

21 Information Notes ICD Revision Communication ICD Revision Timelines
TAG Allocation Content Model Foundation Component and Linearizations Legacy Linearizations Code Structure Multidimensional Coding Index Diagnosis Type Main Condition Review Process Mirror Coding Modifiers and Qualifiers Field Trials Stability Analysis Multilingual ICD Platform Dagger and Asterisk resolution Multisystem Chapter

22 Overview ICD-11 progress Issues and Solution Plans
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

23 Current Status as 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 %

24 Proposal mechanism Browser functionality the same including searching
List of existing proposals visible with a summary Proposals attached to descendant entities can be viewed Creation of proposals

25 Review 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 There is currently great diversity in the level of work completed in the Beta draft

26 ICD-11 Field Trials Mortality coding Morbidity coding Other use cases
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

27 Field Trial Studies Additional Studies Core Studies Study One:
Basic Questions – consistency, errors Study Two: Reliability & Feasibility Study Three: Bridge Coding Additional Studies

28 Roadmap Collaborative Authoring Tools Review Mechanisms Field testing
Multilingual Production USE CASES Linking Classifications

29 ICD-11 International Public Good Available in multiple formats:
Openly Accessible Free for WHO Member States Available in multiple formats: Printed Book editions Internet-edition Various computerized tools e.g. Mobile phones…

30 ICD-11 Timeline 2013 : Beta version: Field Trials Version
+2 YR : Field trials : Final version for WHA Approval implementation BETA: is not same as computer usage. 30

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