1. WHO Agenda: Classifications – Terminologies - Standards
Digital Health and Electronic Medical Records:
Aligning the EU and UK Agendas
15th July 2010, RCP London, UK
WHO Agenda: Classifications – Terminologies - Standards
Nenad Kostanjsek World Health Organization

2. Placing WHO Classifications in HIS & IT of the 21st Century
KRs
Mappings
Terminologies
e-Health Record
Systems
ICD
ICPS
ICF
ICTM
ICHI
Population Health
Births
Deaths
Diseases
Disability
Risk factors
Clinical
Decision Support
Integration of care
Outcome
Administration
Scheduling
Resources
Billing
Reporting
Cost
Needs
Classifications 2

3. The desiderata for a WHO FIC in 21st Century
Evolve a multi-purpose and coherent WHO classification which are
consistent yet adaptable and interoperable across
different uses (public health, service management, research)
the spectrum of health care (Primary, Secondary, Tertiary)
in developing and developed countries
compatible with other WHO classifications
Serve as an international and multilingual reference standard for scientific comparability and communication purposes
Ensure that WHO classification will function in an electronic health records environment.
Link WHO FIC logically to underpinning terminologies and ontologies (e.g. SNOMED, GO, …)
WHO FIC categories “defined” by "logical operational rules" on their associations and details

4. Key workstreams & elements for developing WHO FIC
Use cases
Content model (parameter & value set)
Population & peer review of content model
Web based collaborative authoring tool (iCAT)
Ontology development

5. ICD 11 is no longer just lists…it is based on a content model5

6. THE CONTENT MODEL Any Category in ICD is represented by:
ICD Concept Title: Name of disease, disorder, or syndrome
Classification Properties: Parents, Type, Use
Textual Definition(s): Fully Specified Name
Terms: synonyms, Index, inclusion, exclusion
Clinical Description: Body System(s), Body Part(s), [Anatomical Site(s), Histopathology
Manifestation Properties: Signs & Symptoms, Findings
Causal Properties: etiology type, agents, mechanisms, genomic characteristics; risk factors
Temporal Properties: age of occurrence & occurrence Frequency, development course
Severity Properties
Functioning Properties
Specific Condition Properties
Treatment Properties
Diagnostic Criteria
External Causes
Maintenance attributes
Unique identifier
Mapping relationships
Linkages to other systems like SNOMED etc.
Other rules 6 6

7. ICD 11 Foundation Component and Linearizations
ICD-11 content model parameters
- Definitions, synonyms
- Clinical descriptions
- Manifestation properties
- Causal properties
- Functional properties
Specialty
Adaptation
Primary Care
Linearizations
Morbidity
Mortality
Value Set
SNOMED-CT, International Classification of Functioning, Disability and Health (ICF), International Classification of External Causes of Injury (ICECI)…

8. Web based collaborative authoring tool (iCAT)
display & browse taxonomy with its content model rubrics
allow user to comment on the content
allow users editing the content and facilitate the use of value sets derived from other classifications and terminologies
allow user restructuring the classification
Incorporates multiple level of user access
supports multilingual representation
ontology tooling interface with description logic technology

9. Making WHO FIC ontology based Example: ICPS ontology development
has cause
Hazard
Incident type
Incident
has type
has circumstances
Contextual Factors
has impact
has consequence
Harm
Action
is a
is a
Patient outcome
Managing action
Preven. action
Org. outcome
Injury
Adverse Reaction
Disease
Disability
is a

10. WHO classification development in the 20th Century Construction of ICD-10 & ICF:
ICD: 8 Annual Revision Conferences ( ) ICF: 7 int. & 38 nat. Revision Conferences ( )
ICD: 17 – 58 Countries participated
1- 5 person delegations
mainly Health Statisticians
ICF: 61 Countries participated
Multi-disciplinary
Manual curation
List exchange
Index was done later
"Decibel" ? Method of discussion
ICF: Concept driven
Output: Paper Copy
Work in English only
ICD: Limited testing in the field ICF: drafts translated into / tested in 27 languages
post-coordinated development of linkages to related classification, terminologies and assessment instruments

11. WHO classification development in the 21th Century
Internet-based permanent platform
All year round
Open to all people in a structured way
Linkages to related classification, terminologies and assessment instruments
Content experts & users are empowered
Digital curation
Wiki enabled collaboration
Ontology
Enhanced discussion & peer review
Electronic copy  print version
Work in multiple languages
field tests
based on Use Cases

12. What is the answer? ... what is the question?
Computers are useless. They can only give you answers.
Pablo Picasso ( )