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Dr Robert Jakob, Medical Officer ICD
Dr Bedirhan Ustun, Coordinator Classifications, Terminologies, Standards
World Health Organization
ICD Revision: A new way to build the ICD Revision: A new way to build the ICDICD
2 | ICD-11 UN Classification Experts 14 May 2013
Death registration-causes of death reported to Death registration-causes of death reported to WHOWHO
Of the reporting countries, half are developed providing 75% of the deaths included, but only 33% of estimated global deaths
WHO region Number of MemberStates
Data reported for at least one of the years
2004-2008
Percentage of Member
States reporting
AFR 46 4 9
AMR 35 32 91
EMR 21 6 29
EUR 53 46 87
SEAR 11 3 27
WPR 27 8 30
Global 193 99 51
3 | ICD-11 UN Classification Experts 14 May 2013
Reporting 2009Reporting 2009
3
4 | ICD-11 UN Classification Experts 14 May 2013
ICD use in Morbidity ICD use in Morbidity
DRAFT – To be edited DRAFT – To be edited
DRAFT Green=ICD-10 useLight blue= ICD-9 useYellow= some useGrey=some known usersDark blue=unknown
Morbidity use follows pattern similar to mortality use
5 | ICD-11 UN Classification Experts 14 May 2013
WHO International Drug Monitoring ProgrammeWHO International Drug Monitoring Programme - - MembershipMembershipAugust 2005August 2005
Full members of the WHO programmeAssociated members of the WHO programmeNon members of the WHO programme
Membership in programme
6 | ICD-11 UN Classification Experts 14 May 2013
Cancer registration (ICD / ICD-O)Cancer registration (ICD / ICD-O)
7 | ICD-11 UN Classification Experts 14 May 2013
The International Classification of The International Classification of Diseases 11Diseases 11thth Revision is due by 2015 Revision is due by 2015
ICD is the international standard to measure health & health services
Mortality Statistics
Morbidity Statistics
Health Care Costs
Progress towards MDGs
βeta
Placing WHO Classifications in HIS & ITPlacing WHO Classifications in HIS & IT
Population Health• Births • Deaths • Diseases• Disability • Risk factors
e-Health RecordSystems
ICD ICD
ICFICF
ICHIICHI
Classifications
LinkagesKRs
Terminologies
Clinical• Decision Support• Integration of care• Outcome
Administration• Scheduling• Resources • Billing
Reporting• Cost• Needs• Outcome
9 | ICD-11 UN Classification Experts 14 May 2013
Construction of ICD-11: Construction of ICD-11: Revision Process in the 21Revision Process in the 21stst Century 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
10 | ICD-11 UN Classification Experts 14 May 2013
ICD-11ICD-11
• International Classification =
• Global Participation
ICD-11 Revision Platform
is OPEN to ALL people
in a structured way
11 | ICD-11 UN Classification Experts 14 May 2013
ICD Revision Organizational StructureICD Revision Organizational Structure
Gastroenterology WG
Cardiovascular WG
Hepatology & Pancreatobiliary WG
Nephrology WG
Endocrinology WG
Rheumatology WG
Cross-Sectional TAGs
Content-Specific TAGs
Working Groups
Haematology WG
Respiratory WG
Dentistry TAG
Musculoskeletal TAG
Mental Health TAG
Maternal, Neonatal and Urogenital TAG
External Causes and Injuries TAG
Dermatology TAG
Internal Medicine TAG
Neurology TAG
Ophthalmology TAG
Paediatrics TAG
Rare Diseases TAG
Health Informatics and Modelling TAG (HIM TAG)
iCAT Software Team
Traditional Medicine TAG
Neoplasms TAG
WHO
Revision Steering Group
12 | ICD-11 UN Classification Experts 14 May 2013
iCATiCAT
13 | ICD-11 UN Classification Experts 14 May 2013
ICD-11ICD-11
• Integrates standard definitions– Diseases– Disorders, syndromes– …
• Ready for electronic health records
• Links with standard terminologies– SNOMED-CT– Gene Ontology
14 | ICD-11 UN Classification Experts 14 May 2013
THE CONTENT MODELTHE CONTENT MODELAny Category in ICD is represented by:Any Category in ICD is represented by:
1. ICD Concept Title1.1. Fully Specified Name
2. Classification Properties2.1. Parents2.2 Type2.3. Use and Linearization(s)
3. Textual Definition(s)4. Terms
4.1. Base Index Terms4.2. Inclusion Terms4.3. Exclusions
5. Body Structure Description 5.1. Body System(s) 5.2. Body Part(s) [Anatomical Site(s)]5.3. Morphological Properties
6. Manifestation Properties6.1. Signs & Symptoms 6.2. Investigation findings
TITLE of ENTITY: Name of disease, disorder, or syndrome…7. Causal Properties7.1. Etiology Type7.2. Causal Properties - Agents7.3. Causal Properties - Causal Mechanisms 7.4. Genomic Linkages7.5. Risk Factors8. Temporal Properties
8.1. Age of Occurrence & Occurrence Frequency
8.2. Development Course/Stage9. Severity of Subtypes Properties10. Functioning Properties
10.1. Impact on Activities and Participation10.2. Contextual factors10.3. Body functions
11. Specific Condition Properties11.1 Biological Sex11.2. Life-Cycle Properties
12. Treatment Properties13. Diagnostic Criteria
15 | ICD-11 UN Classification Experts 14 May 2013
ICD ~ SNOMED-CT ICD ~ SNOMED-CT Common OntologyCommon Ontology
Core subset of ICD ICD Foundation ComponentFoundation Component
& SNOMED CT SNOMED CT
•Shared concepts: –fully specified names; definitions; synonyms
•Same parent-child relationships–Similar polyhierarchies–Similar grouping logic–Same content model parameters
15
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Smooth transiton to ICD-11Smooth transiton to ICD-11
• Seamless evolution from ICD-10– Backwards compatible
βet
a
17 | ICD-11 UN Classification Experts 14 May 2013
• Mortality
• Morbidity– 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
Stability AnalysisStability Analysis
Types & MethodologyTypes & Methodology
17
Mort/PCHigh 11
Mort/PCHigh 12
Mort/PCHigh 13
Mort/PCHigh 21
Mort/PCHigh 22
Mort/PCHigh 31
Mort/PCHigh 33
Mort/PCHigh 34
Mort/PCHigh 32
Mort/PCHigh 35
Morbidity111
Morbidity112
Morbidity121
Morbidity133
Morbidity131
Morbidity132
Morbidity221
Morbidity222
Morbidity211
Morbidity311
Morbidity312
Morbidity321
Morbidity341
Morbidity342
Morbidity351
PRIMARY CARE High Resource MORBIDITYMORBIDITY
PC – Low 1
PC – Low 2
PC – Low 3
PRIMARY CARE Low Resource
(Verbal Autopsy ?) MORTALITYMORTALITY International National LinearizationsSpecialty - Research
Extensions 18
19 | ICD-11 UN Classification Experts 14 May 2013
ICD-11ICD-11
– Simultaneous development in Multiple Languages
– التصنيف الدولي لألمراض
– 國際疾病與相關健康問題統計分類
– International Classification of Diseases
– Classification internationale des maladies
– Международная классификация болезней
– Clasificación internacional de enfermedades
20 | ICD-11 UN Classification Experts 14 May 2013
Translation platformTranslation platform
20
21 | ICD-11 UN Classification Experts 14 May 2013
Information NotesInformation Notes
1. ICD Revision Communication
2. ICD Revision Timelines
3. TAG Allocation
4. Content Model
5. Foundation Component and Linearizations
6. Legacy Linearizations
7. Code Structure
8. Multidimensional Coding
9. Index
10.Diagnosis Type
11. Main Condition
12.Review Process
13.Mirror Coding
14.Modifiers and Qualifiers
15.Field Trials
16.Stability Analysis
17.Multilingual ICD Platform
18.Dagger and Asterisk resolution
19.Multisystem Chapter
21
22 | ICD-11 UN Classification Experts 14 May 2013
OverviewOverview
• ICD-11 progress– Volume I: Current status of Content
• Stability Analysis: ICD10 in 11• Review Process• Field Trials
– Volume II: ICD knowledge base– Volume III: Index
• Issues and Solution Plans
22
23 | ICD-11 UN Classification Experts 14 May 2013
Current Status Current Status as of 30 April 2013as of 30 April 2013
• Some Chapters need further work– Signs & Symptoms – Factors influencing health status and contact with health
services
• Other chapters’ structure reported to be complete– Mental Health, Sexual Health, GURM sections…
• Definitions – Top level > 50 %– Overall > 35 %
23
24 | ICD-11 UN Classification Experts 14 May 2013
Proposal mechanismProposal mechanism
24
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Review ProcessReview Process
• The review process will help WHO assure the quality of the Beta Content
• Review focus: – Scientific accuracy– Completeness of each unit– Internal consistency– Utility / Relevance of each unit
26 | ICD-11 UN Classification Experts 14 May 2013
ICD-11 Field TrialsICD-11 Field Trials
– To test the “fitness of ICD-11 for multiple purposes”
• Mortality coding
• Morbidity coding
• Other use cases
– To ensure the comparability between ICD-10 and ICD-11
27 | ICD-11 UN Classification Experts 14 May 2013
Field Trial StudiesField Trial Studies
1. Core Studies– Study One:
• Basic Questions – consistency, errors– Study Two:
• Reliability & Feasibility– Study Three:
• Bridge Coding
2. Additional Studies
28 | ICD-11 UN Classification Experts 14 May 2013
• Collaborative Authoring Tools
• Review Mechanisms
• Field testing
• Multilingual Production
• USE CASES
• Linking Classifications
RoadmapRoadmap
29 | ICD-11 UN Classification Experts 14 May 2013
ICD-11ICD-11
• International Public Good– Openly Accessible– Free for WHO Member States
• Available in multiple formats:– Printed Book editions– Internet-edition – Various computerized tools
• e.g. Mobile phones…
30 | ICD-11 UN Classification Experts 14 May 2013
ICD-11 TimelineICD-11 Timeline
• 2013 : Beta version: Field Trials Version –+2 YR : Field trials
• 2015 : Final version for WHA Approval–2015+ implementation
30