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Dr. T. Bedirhan Üstün Coordinator, Classifications, Terminologies, Standards. World Health Organization ICD.

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Presentation on theme: "Dr. T. Bedirhan Üstün Coordinator, Classifications, Terminologies, Standards. World Health Organization ICD."— Presentation transcript:

1 Dr. T. Bedirhan Üstün Coordinator, Classifications, Terminologies, Standards. World Health Organization ICD

2 Background 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…

3

4 ICD Revisions

5 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

6 WHO Family of Classifications REFERENCE Classifications I nternational C lassification of D iseases I nternational C lassification of F unctioning, Disability & Health I nternational C lassification of H ealth 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)

7 WHO Classifications in HIS Population Health Births Deaths Diseases Disability Risk factors ICD ICF ICHI Classifications Clinical Decision Support Integration of care Outcome Administration Scheduling Resources Billing Reporting Cost Needs Outcome

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

9 How do we optimize our health services Health Information Systems: Analog to Digital

10 ICD-11 Revision Goals 1.Evolve a multi-purpose and coherent classification public health… –Mortality, morbidity, primary care, clinical care, research, 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

11 Construction of ICD-10: Revision Process in the 20 th Century 8 Annual Revision Conferences ( ) 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

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

13 Definition of Disease a set of dysfunction(s) in any of the body systems including: with a known pattern of signs, symptoms & findings »symptomatology - manifestations probably with an underlying explanatory mechanism »etiology a distinct pattern of development over time »course and outcome a known pattern of response to interventions »treatment response with linkage to underlying genetic factors »genotypes, phenotypes and endophenotypes with linkage to interacting environmental factors

14 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?

15 THE CONTENT MODEL Any Category in ICD is represented by: 1. ICD Concept Title 1.1. Fully Specified Name 2. Classification Properties 2.1. Parents 2.2 Type 2.3. Use and Linearization(s) 3. Textual Definition(s) 4. Terms 4.1. Base Index Terms 4.2. Base Inclusion Terms 4.3. 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 Properties 6.1. Signs & Symptoms 6.2. Investigation findings TITLE of ENTITY: Name of disease, disorder, or syndrome… 7. Causal Properties 7.1. Etiology Type 7.2. Causal Properties - Agents 7.3. Causal Properties - Causal Mechanisms 7.4. Genomic Linkages 7.5. Risk Factors 8. Temporal Properties 8.1. Age of Occurrence & Occurrence Frequency 8.2. Development Course/Stage 9. Severity of Subtypes Properties 10. Functioning Properties Impact on Activities and Participation Contextual factors Body functions 11. Specific Condition Properties 11.1 Biological Sex Life-Cycle Properties 12. Treatment Properties 13. Diagnostic Criteria

16 iCAT Open and collaborative process –Users are empowered –Web based –Like WIKI – Trip Advisor But structured Editorial Oversight

17 iCAT

18 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

19 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 synergistic are synergistic and not antagonistic

20 ICD & WHO FIC International Public Good –Openly Accessible –Free for WHO Member States Available in multiple formats: –Printed Book editions –Internet-edition –Various computerized tools

21 ICD & WHO FIC –Simultaneous development in Multiple Languages –التصنيف الدولي للأمراض – –International Classification of Diseases –Classification internationale des maladies –Международная классификация болезней –Clasificación internacional de enfermedades

22 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

23 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

24 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


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