1. ICD Revision: Where Are We?Dr. T. Bedirhan stnWorld Health OrganizationClassifications, Terminologies, Standards

2. Overview ICD Revision progress Current status Stability: how similar to ICD10 ICD10AM Novelty : Collaborative Authoring Peer Review Field Trials Digital Products How can we enable YOUR participation ? 3. It is YOUwho is going to build the ICD 4. Overall Evaluation+ Engagement of Partners TAGs, agencies Solid Digitalization iCAT Browser Proposal Mechanism Linkage to SNOMED URIs Quality Assurance Review Mechanism Field Trials- / ? Project Management International Consensus Funding Communication 5. ICD-11 Revision Goals1. Evolve a multi-purpose and coherent classification Mortality, morbidity, primary care, clinical care, research, publichealth Consistency & interoperability across different uses2. Serve as an international and multilingual reference standardfor scientific comparability and communication purposes3. Ensure that ICD-11 will function in an electronic environment. ICD-11 will be a digital product Support 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 6. Genealogy of ICD 1664350years 7. ICD Revisions1391611791892052142009549651,0401,1648,1731,96714,473110100100010000100000Farr/d'EspineBertillonICD 1ICD 2ICD 3ICD 4ICD 5ICD 6ICD 7ICD 8ICD 9ICD-9-MICD 10ICD-10-M1853 1893 1900 1909 1920 1929 1938 1948 1955 1968 1975 1979 1993 1993 8. How do we gofrom Here to 21st Century? 9. Open and Collaborative Platform Web based Like WIKIPEDIA But by the Content Model with by the TAGs , and scientific peers 10. THE CONTENT MODELAny Category in ICD is represented by:1. ICD Concept Title1.1. Fully Specified Name2. Classification Properties2.1. Parents2.2 Type2.3. Use and Linearization(s)3. Textual Definition(s)4. Terms4.1. Base Index Terms4.2. Inclusion Terms4.3. Exclusions5. Body Structure Description5.1. Body System(s)5.2. Body Part(s) [Anatomical Site(s)]5.3. Morphological Properties6. Manifestation Properties6.1. Signs & Symptoms6.2. Investigation findings7. Causal Properties7.1. Etiology Type7.2. Causal Properties - Agents7.3. Causal Properties - Causal Mechanisms7.4. Genomic Linkages7.5. Risk Factors8. Temporal Properties8.1. Age of Occurrence & Occurrence Frequency8.2. Development Course/Stage9. Severity of Subtypes Properties10. Functioning Properties10.1. Impact on Activities and Participation10.2. Contextual factors10.3. Body functions11. Specific Condition Properties11.1 Biological Sex11.2. Life-Cycle Properties12. Treatment Properties13. Diagnostic Criteria 11. What is NOntology ?Ontology (philosophy)the Organization of Reality !!! Ontology (computer science) the explicit operational description ofthe conceptualization of a domain Entities Atributes Values An ontology defines: a common vocabulary a shared understanding / exchange: among software agents between people and software to reuse data - information to introduce standards toallow interoperability among people 12. ICD11 etahttp://www.who.int/classifications/icd/revisionBeta Browser & Print10 look & feel+ descriptions code structure ! ICD-11 Beta draft is NOT FINAL updated on a daily basisNOT TO BE USED for CODINGexcept for agreed FIELD TRIALSeta 13. ICD-11 FeaturesInternet BasedPlatformContent ModelMulti Lingual RepresentationsInput fromall StakeholdersDefinitions ArabicChineseEnglish EnglishFranais French RussianEspaol SpanishDeutsch GermanPortugus PortugueseField Trials forUse CasesElectronic Health RecordReady 14. The ICD Foundation Component is a collection of ALLICD entities likediseases, disorders... It represents the wholeICD universe. In a simple way, the foundationcomponent is similar to a store ofbooks or songs. 15. The ICD Linearizations A linearization is a subset of thefoundation component, that is: Fit for a particular purpose: reporting mortality,morbidity, or other uses Jointly Exhaustive of ICD Universe (FoundationComponent) Composed of entities that are Mutually Exclusiveof each other Each entity is given a single parent 16. Linerization requirements Classical ICD Mutually Exclusive Jointly ExhaustiveMEJEprinicipleNo double countingAll categories will be inResiduals:Other (*.8)Unspecified (*.9)should be generated for each linearization 17. 18Foundation: ICDcategories with- Definitions, synonyms- Clinical descriptions- Diagnostic criteria- Causal mechanism- Functional PropertiesFind TermSNOMED-CT,International Classification of Functioning,Disability and Health (ICF)LinearizationsMorbidityMortalityPrimary Care 18. Building Linearizations Multiple Parenting Allowed Pneumonia Lung Disease Sometimes Infectious Disease Permanence of meaning across differentlinearizations Telescopic principle Zoom in zoom out 19. Linearizations:Zoom-in Zoom-Out 20. Example of TelescopeTitle Primary C. Joint Lin. Ophthalm.Cataract code code codeAge-related cataract code code codeCortical age-related cataract other other codeNuclear age-related cataract other other codeCataracta brunescens other other codeNuclear sclerosis cataract other other codeCapsular and Subcapsular age-related cataract other other codeCapsular age-related cataract other other codeAnterior subcapsular polar age-related cataract other other codePosterior subcapsular polar age-related cataract other other codeIncipient age-related cataract other other codeCoronary age-related cataract other code codePunctate age-related cataract other code codeWater clefts other other codeAdvanced or mature age-related cataract other other codeMature age-related cataract other code codeSubtotal advanced or mature age-related cataract other other codeAdvanced or mature age-related cataract, total cataract other other codeMorgagnian age-related cataract other other codeCalcified age-related cataract other other codeCombined forms of age-related cataract other other code 21. Current Statusas of 30 September 2014 Frozen September 30 iCAT continues real time JLMMS is frozen for review & field trials A new freeze is expected in Dec 14. Definitions Top level > 75 % > 10,000 definitions Linearization errors < 600 (from 10K) Duplicates < 105 (from 3K) 22. Defusing the exploding bicycle:500 codes in pieces 10 things to hit Pedestrian / cycle / motorbike / car / HGV / train / unpowered vehicle /a tree / other 5 roles for the injured Driving / passenger / cyclist / getting in / other 5 activities when injured resting / at work / sporting / at leisure / other 2 contexts In traffic / not in trafficV12.24 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedalcyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities 23. ICD Organization Pre-coordination - fixed namesV12.24 Pedal cyclist injured in collision with two- or three-wheeledmotor vehicle, unspecified pedal cyclist, nontraffic accident, whileresting, sleeping, eating or engaging in other vital activities Post- Coordination - extensions Bicycle Accident Hit Role Context Activity 24. X Chapter:Extension CodesType 1 Type 2 Type 3Severity Main Condition (types) History ofTemporality(course of the condition)Reason forencounter/admissionFamily History ofTemporality(Time in Life)Main Resource Condition Screening/EvaluationEtiology Present on AdmissionAnatomic detailTopologySpecific AnatomicLocationProvisional diagnosisHistopathology Diagnosis confirmed byBiological Indicators Rule out / DifferentialConsciousnessExternal Causes (detail)Injury Specific (detail) 25. Multiple CodingEquivalent ExpressionsCluster Style Code1* Code2* Code3* .. * CLUSTERING IND.Chain / String Style Code1/Code2/Code3 26. Multiple CodingEquivalent ExpressionsSTEMI - posterior wall confirmed by EKGChain / String StyleJH6.100/ XT0.???/ XD0.100Cluster Style JH6.1001 Myocardial Infarctionwith ST Elevation XT0.???1 Posterior wall of heart XD0.1001 Diagnosis Confirmedby EKG 1 CLUSTERING indicator. 27. Stability AnalysisObjectives Ensure a seamless transitionbetween ICD-10 and ICD-11 national international levels CrossCutting TAGs review and confirmcontinuity between ICD-10 and ICD-11 Represent knowledge gained fromnational clinical modifications in therevised ICD. 28. Mortality MorbidityStability AnalysisTypes & Methodology ICD-10-WHO with ICD-11-WHO ICD-10&11-WHO with ICD-10-GM ICD-10&11-WHO with ICD-10-CA ICD-10&11-WHO with ICD-10-AM ICD-10&11-WHO with ICD-10-CM 29. Age-adjusted death rates fornephritis, nephrotic syndrome, and nephrosis:United States, 1968-2005 30. Proposal Mechanism Add Entity Delete Entity Complex Hierarchical Changes Content Proposal ADD: Propose Adding any property valuesuch as synonym, body site, etc. EDIT: Propose changes in Title or Definition DELETE: Propose deleting any propertyvalue such as synonym, body site, etc. 31. Browsing - Creating Proposals 32. Why a Review Process The review process will help WHO assurethe quality of the Beta Content Review focus: Scientific accuracy Completeness of each unit Internal consistency Utility / Relevance of each unit 33. Linearization Review1. Mortality Linearization Review2. Morbidity Linearization Review3. Primary Care Linearization Review4. Mirror-Coding Review5. Quality & Safety TAG review 34. Content Review Proposal Generation Phase When proposals are mature (decide how) Submit to 5 reviewers Obtain 3 complete reviews Generate combined statement Submit to TAG in a combined list Implement results Submit conflicts to RSG 35. Contributor - ReviewerAcknowledgement WHO is currently creating a list to acknowledge all participants: ICD website Print version of the ICD-11. Please include all with participant contact information. The following individuals will beacknowledged: RSG RSG-SEG TAG TAG WGs Managing Editors NGOs Other Contributors WHO-FIC Collaborating Centres WHO Staff 36. Incentives for Reviewers 37. ICD11 Field Trials Basic aims To test the fitness of ICD-11 for multiple purposes Mortality coding Morbidity coding Quality & Safety Other use cases To ensure the comparability between ICD-10 and ICD-11 To increase consistency, identify improvement paths, and reduce errors. Key Assessments: Applicability feasibility easy to use Reliability - consistency gives same results in the hands of all Utility - added value renders useful information 38. ICD11 Field Trials Applicability (Feasibility) Is the classification easy to implement in the hands of the real life users (coders,doctors etc.) ? Reliability Is the classification used in the same manner by different users? Do two different users code the same case with the same code? What are the sources of discrepancy? What are the factors to improve comparability and consistency? Utility What is the value of the classification to enhancing data capture and its uses? Does it improve recognition? Does it serve for better documentation? Does it enable re-use? Does it guide better diagnosis? Does it allow better resource allocation? 39. Field Trials KEY USES: Mortality: cause of death coding, verbal autopsy Morbidity: various morbidity codings hospital discharge, DRG etc. Quality Safety Other uses DIFFERENT SETTINGS: Primary Care High-resource settings Low-resource settings General Health Care Specialty settings Research settings Use in population studies - epidemiology Use in clinical research 40. Core Studies Study One: Feasibility and Reliability for live Cases and CaseSummaries coding with ICD-10 an 11 Study Two: Basic Questions 41. Inter-rater reliability The Case information live medical record Coded using ICD11 byat least two differentpeople Agreement ratesmeasured 42. Bridge Coding The Case information live medical record Coded using ICD10 ICD11 Agreement ratesmeasured 43. ICD-11 Timeline 2014 : Beta version & Field Trials Version +2 YR : Field trials 2017 : Final version for WHA Approval 2018+ implementation Continuous Annual Cycles ICD 2018 ICD 2019 ICD 2020 44. ICD-11 International Public Good Openly Accessible Free for WHO Member States Available in multiple formats: Printed Book editions Internet-edition Various computerized tools 45. Beta Phase Comments Proposals Review Mechanism Field Trials 46. BUILDING BLOCKS OF HEALTH INFORMATION 47. ICD-10 Annual RevisionConferences Focus on mortalitystatistics Produced manually Produced inEnglish NO field tests Update mechanismbuilt in laterICD-11 Continuous webplatform + meetings Focus on ALLstatistical use cases Produced digitally w/ information model Multilingualdevelopment Field tests done before Continuous update revision mechanism 48. Questions & Answersustunb@who.int@ustunbbedirhan-ustun