World Health Organization Classifications, Terminologies, Standards ICD Revision: Where Are We?

Overview ICD Revision progress –Current status –Stability: how similar to ICD10 – ICD10AM –Next Steps: Collaborative Authoring Tool improvements Proposals Peer Review Field Trials Other Products …

ICD-11 Revision Goals multi-purpose 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 environment. a digital productICD-11 will be a digital product electronic health records and information systemsSupport electronic health records and information systems Link ICD logically to underpinning terminologies and ontologies (e.g. SNOMED, GO, …) ICD Categories “defined” by "logical operational rules" on their associations and details

Current Status Frozen September 30 – iCAT continues real time – JLMMS is frozen for review – A new freeze is expected in Dec Definitions – Top level > 75 %> 10,000 definitions Linearization errors < 465 (from 10K) Duplicates< 105 (from 3K)

The ICD Foundation Component is a collection of ALL ICD entities like diseases, disorders... It represents the whole ICD universe. In a simple way, the foundation component is similar to a “store” of books or songs.

The ICD Linearizations A linearization is a subset of the foundation component, that is: Fit for a particular purpose: reporting mortality, morbidity, or other uses Jointly Exhaustive of ICD Universe (Foundation Component) Composed of entities that are Mutually Exclusive of each other Each entity is given a single parent

Foundation 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

Linearizations: Zoom-in Zoom-Out

Title Primary C.Joint Lin.Ophthalm. Cataractcode Age-related cataractcode Cortical age-related cataract other code Nuclear age-related cataract other code Cataracta brunescens other code Nuclear sclerosis cataract other code Capsular and Subcapsular age-related cataract other code Capsular age-related cataract other code Anterior subcapsular polar age-related cataract other code Posterior subcapsular polar age-related cataract other code Incipient age-related cataract other code Coronary age-related cataract other code Punctate age-related cataract other code Water clefts other code Advanced or mature age-related cataract other code Mature age-related cataract other code Subtotal advanced or mature age-related cataract other code Advanced or mature age-related cataract, total cataract other code Morgagnian age-related cataract other code Calcified age-related cataract other code Combined forms of age-related cataract other code Example of Telescope

Pre-coordination - fixed names V12.24 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities ICD Organization Post- Coordination - extensions Bicycle Accident Hit Role Context Activity

X – Chapter: Extension Codes Type 1 Type 2 Type 3 SeverityMain Condition (types)History of Temporality (course of the condition) Reason for encounter/admission Family History of Temporality (Time in Life) Main Resource ConditionScreening/Evaluation EtiologyPresent on Admission Anatomic detail Topology Specific Anatomic Location Provisional diagnosis Histopathology Diagnosis confirmed by Biological IndicatorsRule out / Differential Consciousness External Causes (detail) Injury Specific (detail)

POST COORDINATION MECHANISM Extension codes are implemented in iCAT Sanctioning tables are being generated – REQUIRED – ALLOWED – DISALLOWED First target group is the REQUIRED a.ICD-10 categories which have equivalence with ICD11 STEM + X codes (around 1000 codes) b.other

2014 : Beta version & Field Trials Version – +2 YR : Field trials 2017 : Final version for WHA Approval – implementation – Continuous Annual Cycles ICD 2018 ICD 2019 ICD 2020 ICD-11 Timeline

ICD11 βeta ICD11 βeta Browser Beta – Browser & Print 10 look & feel + descriptions – code structure ! ICD-11 Beta draft is NOT FINAL updated on a daily basis NOT TO BE USED for CODING except for agreed FIELD TRIALS βeta

ICD-11 Browser

Visualization

Print Versions

ICD 2014 September release Print version release includes: Frozen “Joint Linearization for Mortality and Morbidity Statistics” ( Vol. 1 Equivalent). The ongoing work on iCAT will go ahead in further completing the ICD definitions and improvements. A future release is also planned in December. Thereafter the releases will be made whenever necessary. Incremental changes from August Release are given in a separate document to enable tracking which parts remained stable – which parts changed.

Taxonomic Check Taxonomic check includes the aggregation equivalence: with the Primary Care versions – PC Intermediate Resource version  renamed: Intermediate Version – PC Low Resource version  renamed: Short Version With Specialty Versions – see whether the specialty extensions roll up to JLMMS ( if this was the chosen option)

Annotation Document & Reviews An updated Annotation Document identifies the architecture, principles and known issues. Reviews by Mortality and Morbidity TAGs included for common reference and guiding future work

STABILITY ANALYSIS A Foundation based equivalence programme identifies equivalences between ICD-10 and ICD-11. a TRANSCODING table between ICD-10 and ICD-11 in excel format A CROSSWALK gives the detailed output in excel format The ICD11 Beta Browser will display the ICD-10 equivalents accordingly.

Mapping Tool

Transcoding tables ICD-10 to ICD-11 in excel

ICD-10ICD-11 ICD-10 ICD-11 correspondence 3 character – 1183 (w/o ECI & Residuals) – 951 Equivalent – 191 mapped to a larger entity in 11 with post coordination many have equivalent maps – 41 not mapped 4 character – 4343 Equivalent – 2207 mapped to a larger entity in 11 with post coordination many have equivalent maps – 85 not mapped

ICD Index Print Index is about 1900 pages with some lead terms running several pages. About 3000 ICD10 Index terms are “missing”. A human judgement is being made as to whether they are necessary and once included they point to the right code. Sublead terms missing Improvements planned

Translation Platform