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WHO is revising the ICD to be completed by 2015. It is going to enter into a Beta phase by 2012 May during which all stakeholders could see and comment on the ICD as well as propose changes, test in practice.
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ICD Revision OverviewInternal Medicine TAG 2012
Dr. T. Bedirhan Üstün
Coordinator, Classifications, Terminologies, Standards.
World Health Organization
Key Issues
• ICD revision is complex– Multiple: uses/purposes; histories; principles/styles…
• Dimensions: deaths, diseases, risk factors, disability, treatments, … • Science and Practice needs: genes, patient care, population health …
Fragmented Information integration is needed
• ICD has to be re-engineered as a digital system– IT sector, economics, governments, international regulations– Information Systems Formal representation of Biomedical Knowledge
Common Exchange platform for Health Information Systems
• Multiple stakeholders are involved: Policymakers; Providers; Clients;– a common language is needed
ICD needs to be built jointly
Construction of ICD-10: Revision Process in 20th Century
• 8 Annual Revision Conferences (1982 - 89)
• 17 – 58 Countries participated– 1- 5 person delegations– mainly Health Statisticians
• Manual curation– List exchange– Index was done later
• "Decibel" ? Method of discussion• Output: Paper Copy• Work in English only• Limited testing in the field
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
How do we go from Here to 21st Century?
ICD-11 Timeline
• 2011 : Alpha version ( ICD 11 alpha draft) – +1 YR : Commentaries and consultations
• 2012 : Beta version & Field Trials Version – +2 YR : Field trials
• 2014 : Final version for public viewing–2015 : WHA Approval
• 2015+ implementation
http://who.int/classifications
ICD Revision
ICD11 αlpha http://www.who.int/classifications/icd/revision
• Alpha – Browser & Print 10 look & feel + descriptions – code structure !
• ICD-11 alpha 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
iCAT• Open and Collaborative Platform
– Web based
– Like WIKI – Trip Advisor• But structured
– by the Content Model
• Editorial Oversight– by the TAGs
iCATCollaborative Authoring Tool
for ICD Revision
THE CONTENT MODELRequired Parameters:
Any Category in ICD is represented by:
1. TITLE of ENTITY: Name of disease, disorder, syndrome…
2. Classification Properties
3. Textual definition
4. Terms: Synonyms - Inclusion – Exclusion - Index terms
5. Body System(s) / Part(s)
6. Temporal Properties
7. Severity Properties
THE CONTENT MODELOptional Parameters:
8. Manifestation Properties
9. Causal Properties
10. Functioning Properties
11. Specific Condition Properties
12. Treatment Properties
13. Diagnostic Criteria
Browsing ICD Entities
Advanced Search
OpenID Logon
User Profile
Threaded Comments
Single Assessment Questions
Suggesting Definitions
Comments
Dashboard (Foundation)
24
ICD-11 Features
Internet Based Platform
Content Model
Multi Lingual Representations
Definitions
Input from all Stakeholders
Arabic لعربية 官话 ChineseEnglish EnglishFrançais FrenchРусский язык Russian Español Spanish Deutsch German Português Portuguese
Field Trials for Use Cases
Electronic Health Record Ready
Information Notes: Yellow Sheets
1. Communication & Dissemination
2. Revision Timelines
3. TAG Allocations
4. Content Model
5. Foundation Component & Linearizations
6. Legacy Linearizations
7. Code Structure
8. Multidimensional Coding
9. Index
10. < …>
ICD11 Components
26
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
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.
• From these elements we build a selection as a linearization.
• This analogy may however be misleading because there are many links between the ICD entities (like parent-child relations and other).
• The ICD entities in the Foundation Component:
• are not necessarily mutually exclusive• allow multiple parenting ( i. e. an entity may be
in more than one branch, for example tuberculosis meningitis is both an infection and a brain disease)
ICD11 Code Structure Information Note 7 – under SEG Consideration
• Default ICD Code format:
E1D213 .E4E5E: base 34 (0-9; A-Z caps – less I, O)
D: base 26 (A-Z caps caps – less I, O)
1: base 10 integers (0-9)
• Optimum expressive space– Block and chapters not included in design – but accommodated
• E1D213 = Same pre-coordinated set for mortality, morbidity– Russian Dolls – Telescopic expansion
ICD Multi-dimensional CodingInformation Note 8 – under SEG Consideration
• Representing qualifiers by post-coordination
• E1D213 .E4E5
• Agreed Multiple Dimensions will include:
• Anatomic detail, including Laterality
• Severity
• Temporality
• Causal agent/etiology
Issue of Pre-coordinated Categories:Coding cycling accident in ICD-10
• V12.24 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, non-traffic accident, while resting, sleeping, eating or engaging in other vital activities
The history of cycling codes
• 1972 ICD-9 (E826): 8 codes
• READ-2 (T30..): 81 codes
• READ-3: 87: 82 codes
• 1999 ICD-10: 587 codes
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 traffic
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
Conceptual Lego… it could be... Post-coordinated
Structured Data Entry
File Edit Help
What you hit
Your Role
Activity
Location
Cycling Accident
Managing Expectations
March 2012• vTAG input finished• SEG finalizes the key
linearizations
May 2012• Representation of
Mortality and Morbidity Linearizations
• Reference Guide ( vol II)• Index (vol III)• Field Trial protocols• Multilingual Prototype
Current Status as of end Jan.2012
• Some Chapters need further work– Infectious Disease A– Neoplasms B,C– Sign & Symptoms R– Z codes
• Other chapters’ structure reported to be complete
• Definitions > 50% – Top level > 70 %
37
ICD-11 Features
Internet Based Platform
Content Model
Translations
Field Trials for Use Cases
Definitions
Input from all Stakeholders
Electronic Health Record Ready
Bridge Coding
• The information on a case (live or medical record) will be coded:
• ICD10• ICD11
to see whether both systems yield the same codes.
39
Measles
Rubella
Rubella
Measles
BETA PHASE FIELD TESTS:How TWO different users code the same case ?
?
Stability Analysisof ICD-11 key linearizations
• Categories remain constant vs changed • Mortality • ICD Morbidity - DRGs
10constant
changed 11
41
• Shows the change from ICD-10– Backwards compatible
ICD11 alpha - DIFF
“DIFF”Tracking incremental changes from ICD
The curious case of …
Transition Strategy
75 79 90 13 15 ??
ICD-9 ICD-10 ICD-11
4 23
2015
ICD
- 2016
ICD
- 2017
ICD
- 2018
ICD
- 2019
• Participation in the ICD Revision• Joint Authoring• Review Panels• Organizing Field testing
• Other BUSINESS Applications:
• Electronic Health Records • Education
Collaboration with IM TAGPost TOKYO:
ICD Revision OverviewInternal Medicine TAG 2012
Dr. T. Bedirhan Üstün
Coordinator, Classifications, Terminologies, Standards.
World Health Organization