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ICD Revision Process:ICD Revision Process:towards ICD -11towards ICD -11
Classification, Assessment, Terminology TeamClassification, Assessment, Terminology Team
WHOWHO
CLASSIFICATIONS … … BUILDING BLOCKS OF HEALTH INFORMATION …BUILDING BLOCKS OF HEALTH INFORMATION …
WHO Family of ClassificationsWHO Family of ClassificationsREFERENCE
Classifications
I I nternationalnternationalCC lassification of lassification of DD iseases iseases
II nternational nternationalCC lassification of lassification of FF unctioning, unctioning, Disability & HealthDisability & Health
II nternational nternational CC lassification of lassification of HH ealth ealth I I nterventions 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)
CLASSIFICATIONS … … BUILDING BLOCKS OF HEALTH INFORMATION …BUILDING BLOCKS OF HEALTH INFORMATION …
ICD RevisionsICD Revisions
7
910 10
910
7
10 10
14
22
0
5
10
15
20
25
ICD-1 ICD-2 ICD-3 ICD-4 ICD-5 ICD-6 ICD-7 ICD-8 ICD-9 ICD-10 ICD-11
1900 1909 1919 1929 1938 1948 1955 1965 1975 1989 2011
Inte
rval
(ye
ars)
CLASSIFICATIONS … … BUILDING BLOCKS OF HEALTH INFORMATION …BUILDING BLOCKS OF HEALTH INFORMATION …
Key DriversKey Drivers
• Mandated by WHA and EBWHA and EB
• Respond to consumer-needsconsumer-needs– Prevention, Primary Care, Secondary Care, Administration, Patients, Families;
Data-users
• Keep up with new scientific knowledge– New DiseasesNew Diseases, Measures, Treatments, Terminology…– Corrections: pruning and grafting, deletions
– Change in rules, guidelines, conventions…
• Compatibility within the WHO-FIC membersthe WHO-FIC members– ICPC, ICFICPC, ICF,, ICHI, ICECIICHI, ICECI, ICD-OICD-O…
• Creation of an improved network and dissemination
• Better implementation within Health Information Systems– Electronic Health Record, Clinical Terminologies, Mortality Database
CLASSIFICATIONS … … BUILDING BLOCKS OF HEALTH INFORMATION …BUILDING BLOCKS OF HEALTH INFORMATION …
Placing WHO Classifications in HIS Placing WHO Classifications in HIS & & ITIT
Population Health• Births • Deaths • Diseases• Disability • Risk factors
e-Health RecordSystems
ICD ICD
ICFICF
ICHIICHI
Classifications
Mappings
Terminologies
Clinical• Decision Support• Integration of care• Outcome
Administration• Scheduling• Resources • Billing
Reporting• Cost• Needs• Outcome
CLASSIFICATIONS … … BUILDING BLOCKS OF HEALTH INFORMATION …BUILDING BLOCKS OF HEALTH INFORMATION …
Linking Classifications to eHealth Records
ICD ICD
ICFICF
ICHIICHI
e-Health RecordSystems
Mappings
ClassificationsTerminologies
Diagnosis / Assessment• Diseases• Disability
Management / Interventions
Modifications to External Causes Blocks of ICD
No
Yes
Yes
Yes
V01
- V09
V10
- V19
V20
- V29
V30
- V39
V40
- V49
V50
- V59
V60
- V69
V70
- V79
V80
- V89
V90
- V94
V95
- V97
V98
- V99
W00
- W
19
W20
- W
49
W50
- W
64
W65
- W
74
W75
- W
84
W85
- W
99
X00
- X09
X10
- X19
X20
- X29
X30
- X39
X40
- X49
X50
- X57
X58
- X59
X60
- X84
X85
- Y09
Y10
- Y34
Y35
- Y36
Y40
- Y84
Y40
- Y59
Y60
- Y69
Y70
- Y82
Y83
- Y84
Y85
- Y89
Y90
- Y98
Clinical modifications
ICE Survey
Sources for Revision of Chapter XXSources for Revision of Chapter XX
CLASSIFICATIONS … … BUILDING BLOCKS OF HEALTH INFORMATION …BUILDING BLOCKS OF HEALTH INFORMATION …
Modifications to Injuries Blocks of ICD
No
Yes
Yes
Yes
S00
- S09
S10
- S19
S20
- S29
S30
- S39
S40
- S49
S50
- S59
S60
- S69
S70
- S79
S80
- S89
S90
- S99
T00
- T07
T08
- T14
T15
- 19
T20
- T25
T26
- T28
T29
- T32
T33
- T35
T36
- T50
T51
- T65
T66
- T78 T7
9
T80
- T88
T90
- T98
ICE Survey
Clinical Modifications
Sources for Revision of Chapter XXSources for Revision of Chapter XX
3 Ch. Categories
ICD Chapter XXICD Chapter XX- International Statistical Use -- International Statistical Use -
Chapters
Blocks
4 Ch. Categories
ICD
Child Mortality
ICD Morbidity
ISHMTHospital Morbidity
General Mortality
Verb. Autopsy
Use (Epidemiology)
Accidental poisoning
Intentional self harm
Medical devices associated with adverse incidents
Traffic accidents
Revision Chapter XXRevision Chapter XXMortalityMortality
• Use of Chapter XX (Doris Ma Fat, Dejan Loncar, WHO)
• 1/3 of all deaths reported to WHO
• ~ 7 % Chapter XX
• Transport: 45 % “unspecified”
• 13/~70 countries do not use 4th character
• ~ 400 codes never used
– “Bitten or struck by crocodile or alligator, residential
institution”
CLASSIFICATIONS … … BUILDING BLOCKS OF HEALTH INFORMATION …BUILDING BLOCKS OF HEALTH INFORMATION …
ICD Revision ProcessICD Revision Process
• Drafting Rules– Taxonomic Guidelines– Definition, Diagnosis and Indexing / mapping guidelines
• Drafting Overall Structure• Drafting Individual Chapters
• Overseeing the TOTAL ICD– ALPHA Draft – structured comments– BETA Draft – field testing
• Final Draft WHA Approval
CLASSIFICATIONS … … BUILDING BLOCKS OF HEALTH INFORMATION …BUILDING BLOCKS OF HEALTH INFORMATION …
ICD Revision Work StreamsICD Revision Work Streams1. Scientific Stream
• Evidence Based Reviews• Surveys • Validation Studies • Add-on protocols for existing studies• Meta analyses
2. Clinical Stream• Primary care utility• Secondary care utility• Linkage to patient reports• Treatment Response• Phenotypes: gene to behaviour specs
3. Public Health Stream• Impact on Health Systems –society –service delivery• Impact on statistics• Resource management -reimbursement - accounting• IT applications - terminology
CLASSIFICATIONS … … BUILDING BLOCKS OF HEALTH INFORMATION …BUILDING BLOCKS OF HEALTH INFORMATION …
Knowledge PortalKnowledge PortalWeb of ICD RevisionWeb of ICD Revision
• Evidence based systematic reviews– Clinical Use: Primary Care, Secondary Care – Epidemiology, demography and public health
• Knowledge Sharing– All ICD Chapters:
• Disease Definitions and Criteria • comment threads
– Structured Discussion Forums
– Field Trials: Global Practice Networks to test the proposed codes, definitions…
Personalized selections in an interconnected electronic environment Actionable information – alerting, planning, query, reporting & analysis Collaboration (Executive, Knowledge worker, User)
CLASSIFICATIONS … … BUILDING BLOCKS OF HEALTH INFORMATION …BUILDING BLOCKS OF HEALTH INFORMATION …
CLASSIFICATIONS … … BUILDING BLOCKS OF HEALTH INFORMATION …BUILDING BLOCKS OF HEALTH INFORMATION …
CLASSIFICATIONS … … BUILDING BLOCKS OF HEALTH INFORMATION …BUILDING BLOCKS OF HEALTH INFORMATION …
Tentative TimelineTentative Timeline
• ICD-11 by …– 2006 : International Consultations for blueprint– 2007 : Start of multiple streams of workplan – 2008 : Alpha version– 2008 : Commentaries and consultations– 2009 : Beta version & Field Version – 2010 : Field trials– 2011 : Final version for public viewing– 2012 : WHA Approval– 2014+ implementation
CLASSIFICATIONS … … BUILDING BLOCKS OF HEALTH INFORMATION …BUILDING BLOCKS OF HEALTH INFORMATION …
Involvement StrategyInvolvement Strategy
• International: – Multiple countries– Multiple languages– Multiple health care systems
• Multiple Parties & Professionals– Different clinical specialties, nursing & midwifery; other professionals– Different health care aspects:
• Prevention• Primary care • Secondary care• Home care • Rehabilitation • Long term care
– Consumers from different sectors
CLASSIFICATIONS … … BUILDING BLOCKS OF HEALTH INFORMATION …BUILDING BLOCKS OF HEALTH INFORMATION …
Structure of Revision ProcessStructure of Revision Process
WHOClassifications Team
WHO FICUpdate & Revision
Committee
Coordinating Group
Scientific StreamClinical Stream
Public Health Stream
Treatment Response
Phenotypes Terminology Payment Groups
Topical Groups
DisorderGroups
FIE
LD
T
RIA
LS
KMS
PORTAL
CLASSIFICATIONS … … BUILDING BLOCKS OF HEALTH INFORMATION …BUILDING BLOCKS OF HEALTH INFORMATION …
One Classification – One Classification – Multiple Projections Multiple Projections (samples)
II
CC
DD
ICDICDhead
thorax
abdom.cavity
foot
ICDICDinfectious
immune
work
iatrogen
ICDICDmortality
Primarycare
billing
VerbalAutopsy
The OneThe One AnatomyAnatomy EthiologyEthiology UseUse
CLASSIFICATIONS … … BUILDING BLOCKS OF HEALTH INFORMATION …BUILDING BLOCKS OF HEALTH INFORMATION …
ICD-11ICD-11
• Easy to use and implement
• To reflect spectrum of needs of multiple– cultures – levels of development– health sectors
• Compatibility with existing Classifications
• Statistical comparability and continuity
CLASSIFICATIONS … … BUILDING BLOCKS OF HEALTH INFORMATION …BUILDING BLOCKS OF HEALTH INFORMATION …
WHOClassifications Team
WHO FICUpdate & Revision
Committee
Coordinating Group
Scientific StreamClinical Stream
Public Health Stream
Treatment Response
Phenotypes Terminology Payment Groups
Topical Groups
DisorderGroups
FIE
LD
T
RIA
LS
KMS
PORTAL
Structure of Revision ProcessStructure of Revision Process
External causes and injuries
Accidents
Drugs
Patient safety
Work
Factors