Overview of the WHO ICD Revision Process (ICD-11) Donna Pickett, RHIA, MPH Medical Systems Administrator AHRQ Annual Conference September 10, 2012 National Center for Health Statistics Classifications and Public Health Data Standards

ICD Revision History ICD Revision No. Year of Conference When Adopted Year in Use in the U.S. ICD, Clinical Modification Year in Use in the U.S. First 1900 1900-1909 Second 1909 1910-1920 Third 1920 1921-1929 Fourth 1929 1930-1938 Fifth 1938 1939-1948 Sixth 1948 1949-1957 Seventh 1955 1958-1967 Eighth 1965 1968-1978 ICDA-8 H-ICDA-1 H-ICDA-2 1968-1972 1973-1978 Ninth 1975 1979-1998 ICD-9-CM 1979 Tenth 1989 1999- ICD-10-CM Oct. 1, 2014

Single implementation date for all users HIPAA Administrative Simplification: Modifications to Medical Data Code Set Standards Published August 2012 Adopts ICD-10-CM and ICD10-PCS as replacements for ICD-9-CM October 1, 2014 – Compliance date for implementation of ICD-10-CM and ICD-10-PCS Single implementation date for all users Date of service for ambulatory and physician reporting Date of discharge for inpatient and other settings

The ICD Revision Process Background Alpha Beta Timeline Participation

ICD-11 Revision Goals Multi-purpose and coherent classification Dr. T. Ustun ICD-11 Revision Goals 4/11/2017 Multi-purpose and coherent classification Mortality, morbidity, primary care, clinical care, research, public health… Consistency & interoperability across different uses International multilingual reference standard for scientific comparability and communication purposes Fit for electronic health record environments Link terminologies and ontologies (e.g. SNOMED, GO, …) ICD Categories “defined” by "logical operational rules" on their associations and details ustunb@who.int 6

Definitions All ICD entities will have definitions: key descriptions of the meaning of the category in human readable terms – to guide users Limited definition in Print Version – 100 words Detailed definitions ONLINE Definitions will be compatible with: the Content Model Diagnostic Criteria across the whole classification and the versions

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

ICD Revision Organizational Structure WHO Revision Steering Group Gastroenterology WG Health Informatics and Modelling TAG (HIM TAG) iCAT Software Team Cardiovascular WG Internal Medicine TAG Paediatrics TAG Hepatology & Pancreatobiliary WG Dentistry TAG Nephrology WG Dermatology TAG Endocrinology WG Rare Diseases TAG Rheumatology WG External Causes and Injuries TAG Haematology WG Functioning TAG Mortality TAG Morbidity TAG Quality & Safety TAG GURM Respiratory WG Mental Health TAG Working Groups Musculoskeletal TAG Neoplasms TAG Neurology TAG Genito-Urinary, Reproductive and Maternal TAG Ophthalmology TAG Cross-Sectional TAGs Traditional Medicine TAG

ICD11 beta Beta – Browser & Print http://www.who.int/classifications/icd/revision Beta – Browser & Print 10 look & feel + descriptions – code structure ! ICD-11 beta draft is INCOMPLETE updated on a daily basis NOT TO BE USED for CODING at this stage not yet been approved by the TAGs, RSG or WHO

The ICD-11 Beta Phase New beta platform: ICD-11 Browser WHO Web story Twitter announcement Facebook announcement WHO website FAQs and Fact Sheet about the revision to post on WHO website ADG Video Message calling on experts to get involved http://www.who.int/classifications/icd/revision/en/index.html

The ICD-11 Beta Phase Draft ICD-11 Content presented in web portal: www.who.int/classifications/icd11 Daily Updates Participants can: Make comments Make proposals to change ICD Categories Propose structured definitions of diseases Participate in field testing Assist in translating ICD into other languages Answer Single Assessment Questions (e.g. Is this category in the right place? Is this scientifically accurate?)

Work Program during Beta Phase Completion of chapters by end August 2012 Standardized structured reviews by experts Suggested by TAG and others Inter rater reliability Bridge coding WHO will draw a framework to ensure standardization of beta testing

ICD-11 Timeline 2015 : WHA Approval 2011 : Alpha version ( ICD 11 alpha draft) +1 YR : Commentaries and consultations 2012 : Beta version & Field Trials Version 14 May 2012 +2 YR : Field trials 2014 : Final version for public viewing 2015 : WHA Approval 2015+ implementation

Donna Pickett - dfp4@cdc.gov Questions? Donna Pickett - dfp4@cdc.gov