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The WHO Family of International Classifications WHO-FIC

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1 The WHO Family of International Classifications WHO-FIC
UN Expert Group on International Economic and Social Classifications New York, 8-10 December 2003 The WHO Family of International Classifications WHO-FIC Bedirhan Üstün M.D. Andre L’hours Nenad Kostanjsek Classification, Assessment, Surveys & Terminology Group World Health Organization

2 Need for a Family of Health Classifications
lack of common language Death, disease, disability,… health need for health information systems monitoring MDGs, Life expectancy electronic health records identifying needs, uses, cost and outcome monitoring health care costs, major projects e.g. 3*5 If we look at the area of disability statistics we are facing a huge problem, which I think is best illustrated with the tower of bable picture in the background. So far we did not have a common language. Many surveys have a very limited focus and domains coverage looking mostly at few impairments. We see that often a priory definition of disability is used and there is no or very little linkage with health surveys.

3 WHO Family of International Classifications
ICD-10 International Statistical Classification of Diseases & Related Health Problems Interventions procedures Primary care adaptations Reasons for encounter ICF International Classification of Functioning, Disability and Health Speciality adaptations The ICF forms part of the WHO-FIC and together with ICD it constitutes the two building blocks of the family. With more than 150 years the oldest and most well known member of the family is the ICD which classifies health conditions. The ICF classifies health and health related states. Next to the ICD and ICF as the main classifications we have the Associated products and Adaptations. [READ SLIDE]. With regard to the ICF we are at the moment working on the development of a Children and youth version and we are also exploring the possibility of developing a ICF Primary Care version. Vobaularies, Terminologies. Nomenclature Associated Products Main Classifications Adaptations

4 classification of causes of death”.
150 years of the ICD 1853 International Statistical Congress William Farr (UK) and Marc d’Espine (Fr) prepared “an international classification of causes of death”. 1893 first ICD adopted by Intl Statistical Institute (ISI)

5 ICD-10 international standard diagnostic classification
for all general epidemiological and many health management purposes. Mortality Morbidity

6 Purpose of the ICD systematic recording analysis interpretation
comparison mortality data morbidity data within countries between countries at a certain point in time over time

7 Main uses of the ICD MORTALITY: Hospital discharge diagnostic data
Underlying and multiple cause Hospital discharge diagnostic data Primary care encounters Health surveys Disease registers Health insurance reimbursement Resource allocation in health services

8 Specialty-based adaptations
psychiatry neurology dentistry oncology paediatrics dermatology

9 The ICD-10 Browser Version 2003 Volumes I – III
Publication in 2004 as CD-ROM (PDF format) & web-based version Adobe Acrobat Reader Bookmarks Hyperlinks Text Search Simple Search Advanced Search (Boolean operators, proximity etc.)

10 WHO Statistical Information System
Links to Health Statistics External sources for health related statistical information Statistics by disease or condition Links to national health-related websites Regional and member state information Comparison of indicators All indicators for a member state

11 Periodic updating of ICD-10
Since 1996 a mechanism has been established for the periodic updating of ICD-10 minor updates each year major updates every three years

12 ICD Revisions

13 Policy for Revision Continuous life cycle systematic evaluation
Knowledge Management strategic vision - purpose - users - policy recognition of need & perspective: how & when Software release methodology Beyond Prejudgement: conservatism vs novelty undermining the ICD-10, ICF ? New = better ?; Old = better ? Marketing strategy Credibility management backward compatibility real response to need systematic evaluation impact, process serious planning for revision needs, resources, timeplan, customers, partners

14 ICF in Health & Disability Statistics
What difference does it make?

15 Universal Model vs. Minority Model
So when we say that ICF is based on a Universal Model we mean that that see disability: as a experience everybody may have in his/her life and NOT trademark of a minority group Lying on continuum with health and not a category multi-dimensional experience NOT Uni dimensional Everyone may have disability Continuum Multi-dimensional Certain impairment groups Categorical Uni-dimensional

16 Foundations of ICF Human Functioning - not merely disability
Universal Model not a minority model Integrative Model not merely medical or social Interactive Model not linear progressive Parity not etiological causality Context - inclusive not person alone Cultural applicability - not western concepts Operational not theory driven alone Life span coverage not adult driven In summary 1. ICF is focused on Human Func. and not only disability, this is e.g. reflected in the use of neutral language and the in build possibility of the taxonomy to capture also positive aspects of functiong. 2. ICF is based on a Universal model not a… [READ SLIDE] "Unless we measure health, we cannot manage and improve health systems. The ICF is the ruler with which we will take precise measurements of health and disability”.

17 Environmental Factors
Use of ICF framework Body Functions & Structures Activities & Participation Environmental Factors CAPACITY/ PERFORMANCE PROBLEM IMPAIRMENT of Functions & Structure Barriers Facilitators In a moment I will present you the components of the ICF framework in more detail. In this slide I would like to stress the two major advantages of this framework. The framework allows you to understand the full problem of functioning at body, person and societal level and captures also the impact of the environmental factors on the person's functioning. and secondly it allows you to identify and compare different types of interventions the focus of the intervention. Rehab, back to work programme, education Medical treatment Destigma. campaign Support informal care

18 Functioning and Disability
4 Components 1st level: 34 Chapters ICF Functioning and Disability Activities and Participation (d) Environmental Factors (e) Personal Factors Not classified yet b1– b8 Contextual Factors Body Functions (b) Body Structures (s) 2 Parts s1– s8 d1– d9 e1– e5 ICIDH categories are organized in a "nested" approach Broader Category  detailed subcategory The classification has two parts, each with two components. [An example may help to illustrate the point: The universe of health and disability is being classified (this is the forest). Within that forest we classify the dimensions of Impairments, Activities and Participation (the trees). In the Activities dimension we have several chapters or domains ranging from simple to complex activities - from sensing and recognizing to interpersonal behaviors (the trunks). Within, for example, the chapter on Interpersonal Behaviors are included activities such as general interactive skills (the branch) and included in that broad category are behaviors such as initiating social contact, responding to cues and so on (the leaves).] b110 - b899 s110 - s899 d110 - d899 e110 - e599 2nd level: 362 categories b1100 b7809 b11420 b54509 s1100 s7609 s11000 s76009 d1550 d9309 e1100 e5959 3rd level and 4th level: 1424 sub-categories

19 Common ‘language’ endorsed by 191 WHO Member States in the 54th WHA
Endorse and publish ICF Use the ICF in Member States in: research surveillance reporting Joint use with ICD Operational subsets: surveys clinical encounters Periodic revision The ICF was endorsed by the WHA in May 2001 for [READ SLIDE] Unlike its predecessor the ICIDH, which was endorsed for FT purposes only the ICF has been endorsed by the WHA for use in Member States. This creates a more binding force for the implementation of ICF

20 WHO ICF framework for defining health & disability
places disability as an issue of a threshold on a continuum of health clearly recognises the impact of the environment on levels of functioning destigmatises ‘ill-health’ and ‘disability’ by accepting it as a universal human experience In summary we believe that the current ICF framework reflects the state of the art thinking about disability and in many ways it is a paradigma shift in the understanding of disability by {READ SLIDE}.

21 The ICF Browser ICF Browser ICF Coding Tool (in development)
Multilingual ( languages) classification in its tree structure display two languages at the same time advanced search function cross references via hyperlinks selects and work on subsets internet based upgrading facilities ICF Coding Tool (in development) Case specific recording ICF Qualifier scale Customized Assessment scale Assessment Instrument Crosswalk ICD Code & socio-demo. Info.

22 The World Health Survey ICF domains used
1. Vision 2. Hearing 3. Digestion 4. Bodily Excretions/ Continence 5. Fertility 6. Skin and Disfiguration 7. Breathing Difficulty 8. Pain and Discomfort 9. Affect 10. Sleep 11. Energy and Vitality 12. Understanding and Interacting 13. Communication 14. Mobility and Physical Activity 15. Dexterity and Fine Motor Activity 16. Self Care 17. Interpersonal Relationships 18. Usual Activities and Roles 19. Social Functioning

23 ICF Implementation 1. Population level 2. Specific Applications
Census questions on health and disability Health and Disability Surveys Indicator development & reporting in Health Info. Systems Health and Social Policy Legislation (UN Disability Convention, Right for Health 2. Specific Applications Clinical Encounters Specific populations Elderly Administrative Records 3. Other uses Insurance Education

24 Information Paradox What is wrong with this picture

25 Drivers for change Clinical Currency
WHO as a Standards Development Organization recognizing WHO FIC as “Knowledge Assets” effectively “owning & managing” them Client needs & Information technology needs Electronic Patient Records - billing- outcome evaluation Clinical Terminology & Vocabulary SNOMED Int, NLM, HL7 … Clinical Currency HIV-AIDS, SARS, … Diabetes, Hypertension, Coronary disease… definitions, risk factors Oncogenes Single Gene Disorders Alzheimer’s; Narcolepsia, Huntington’s, Rye Syndrome... New and expected developments: Human Genome Project, treatments... Compatibility within the Family ICD - XM, updates of AM, CM, CA, DM. ICF ICHI ICECI

26 Further information: Visit the ICF website Contact us via e-mail:
Contact us via Contact WHO Collaborating Centers for the Family of International Classifications

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