WHO agenda: Classifications, Terminologies, Standards | RCP Conference on Digital Health & EMR, 15 July 2010, London, UK 1 |1 | WHO Agenda: Classifications

WHO agenda: Classifications, Terminologies, Standards |

RCP Conference on Digital Health & EMR, 15 July 2010, London, UK

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WHO Agenda: Classifications – Terminologies - Standards

WHO Agenda: Classifications – Terminologies - Standards

Nenad Kostanjsek World Health Organization

Digital Health and Electronic Medical Records: Digital Health and Electronic Medical Records: Aligning the EU and UK AgendasAligning the EU and UK Agendas

15th July 2010, RCP London, UK15th July 2010, RCP London, UK



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Placing WHO Classifications in HIS & IT of the Placing WHO Classifications in HIS & IT of the 2121stst Century Century

e-Health RecordSystems

ICD ICD

ICFICF

ICHIICHI

Classifications

KRsMappings

Terminologies

Population Health• Births • Deaths • Diseases• Disability • Risk factors

Clinical• Decision Support• Integration of care• Outcome

Administration• Scheduling• Resources • Billing

Reporting• Cost• Needs• Outcome

ICPS ICPS

ICTMICTM



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The desiderata for a WHO FIC in The desiderata for a WHO FIC in 21st Century21st CenturyThe desiderata for a WHO FIC in The desiderata for a WHO FIC in 21st Century21st 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



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Key workstreams & elements for developing WHO FIC

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



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ICD 11 is no longer just lists…it is based on a content model

ICD 11 is no longer just lists…it is based on a content model



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THE CONTENT MODELAny Category in ICD is represented by:

THE CONTENT MODELAny Category in ICD is represented by:

Maintenance attributes

A. Unique identifier

B. Mapping relationshipsLinkages to other systems like SNOMED etc.

C. Other rules

1. ICD Concept Title: Name of disease, disorder, or syndrome

2. Classification Properties: Parents, Type, Use

3. Textual Definition(s): Fully Specified Name

4. Terms: synonyms, Index, inclusion, exclusion

5. Clinical Description: Body System(s), Body Part(s), [Anatomical Site(s), Histopathology

6. Manifestation Properties: Signs & Symptoms, Findings

7. Causal Properties: etiology type, agents, mechanisms, genomic characteristics; risk factors

8. Temporal Properties: age of occurrence & occurrence Frequency, development course

9. Severity Properties

10. Functioning Properties

11. Specific Condition Properties

12. Treatment Properties

13. Diagnostic Criteria

14. External Causes



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ICD 11 Foundation Component and Linearizations

ICD 11 Foundation Component and Linearizations

ICD-11 content model parameters

- Definitions, synonyms- Clinical descriptions- Manifestation properties- Causal properties- Functional properties

Value Set

SNOMED-CT, International Classification of Functioning, Disability and Health (ICF), International Classification of External Causes of Injury (ICECI)…

Linearizations

Morbidity

Primary Care

Mortality

SpecialtyAdaptation



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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



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Making WHO FICMaking WHO FIC ontology ontology based based Example: ICPS ontology development

Making WHO FICMaking WHO FIC ontology ontology based based Example: ICPS ontology development

Incident

Harm Action

Patient outcome Org. outcome

InjuryAdverse Reaction

Disease

Disability

Incident type

has consequence

is a

is a

Managing action Preven. action

is a

Contextual Factors

has circumstances

has impact

has type

Hazardhas cause



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WHO classification development in the 20th Century Construction of ICD-10 & ICF:

WHO classification development in the 20th Century Construction of ICD-10 & ICF:

ICD: 8 Annual Revision Conferences (1982 - 89) ICF: 7 int. & 38 nat. Revision Conferences (1994 - 2001)

ICD: 17 – 58 Countries participated– 1- 5 person delegations– mainly Health Statisticians

ICF: 61 Countries participated– 1- 5 person delegations – 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



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WHO classification development in the 21th Century 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



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What is the answer? ... what is the question?

What is the answer? ... what is the question?

Computers are useless. They can only give you answers.

Pablo Picasso (1881-1973)

Documents

WHO agenda: Classifications, Terminologies, Standards | RCP Conference on Digital Health & EMR, 15 July 2010, London, UK 1 |1 | WHO Agenda: Classifications