ICD Revision Overview
Tevfik Bedirhan Üstün
Classifications, Terminologies, Standards Team World Health Organization
Tokyo 2007 April 2013 February ICD - Revision Journey
Thanks to: • WHOFIC Network• Japanese MHLW• Japan Hospital Association• Japanese Medical Organizations
IM TAG Brazil PosterConclusions - Request
• Japanese government and academic societies have heavily involved
in the IM-TAG activities.
• As ICD is used in many countries with various ways it should be
supported financially by WHO and a number of governments.
• Also, it is essential to provide concrete and logical leadership by WHO
for conducting such a large international project effectively.
You can find the slides in…
Genealogy of ICD 1664
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Number of deaths reported to WHO with ICD codes 1950 - 2007
Reference year of data
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Source: WHO Mortality Data base as of 19 Oct 2012
ICD-7 ICD-8 ICD-9 ICD-10
Age-adjusted death rates for nephritis, nephrotic syndrome, and nephrosis:
United States, 1968-2005
ICD-11 Revision Goals1. Evolve a multi-purpose and coherent classification
– Mortality, morbidity, primary care, clinical care, research, public health…
– Consistency & interoperability across different uses
2. Serve as an international and multilingual reference standard for scientific comparability and communication purposes
3. 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
ICD-11 Timeline
• 2012 : Beta version & Field Trials Version – +2 YR : Field trials
• 2015 : Final version for WHA Approval– 2015+ implementation– Continuous Annual Cycles
• ICD 2015 • ICD 2016• ICD 2017
How do we go from Here to 21st Century?
iCAT• Open and Collaborative Platform
– Web based
– Like WIKIPEDIA• But
– by the Content Model • with
– by the TAGs , and scientific peers
iCATCollaborative Authoring Tool
for ICD Revision
structured
Editorial Oversight
ICD11 βetahttp://www.who.int/classifications/icd/revision
• Beta – Browser & Print 10 look & feel + descriptions – code structure !
• ICD-11 Beta draft is NOT FINAL
• updated on a daily basis
•NOT TO BE USED for CODING except for agreed FIELD TRIALS
βeta
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)
The ICD Linearizations
• A linearization is a subset of the foundation component, that is:
• Fit for a particular purpose: reporting mortality, morbidity, or other uses
• Jointly Exhaustive of ICD Universe (Foundation Component)
• Composed of entities that are Mutually Exclusive of each other
• Each entity is given a single parent
Skin
Neoplasms
ICD11 Components: Linearizations
23
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
Linerization requirements
• Classical ICD– Mutually Exclusive– Jointly Exhaustive
No double countingAll categories will be in
Residuals: Other (*.8) Unspecified (*.9)
should be generated for each linearization
MEJE priniciple
Building Linearizations
• Multiple Parenting Allowed– Pneumonia
• Lung Disease• Sometimes Infectious Disease
• Permanence of meaning across different linearizations– Telescopic principle
• Zoom in – zoom out
Morbidity111
Morbidity112
Morbidity121
Morbidity133
Morbidity131
Morbidity132
Morbidity221
Morbidity222
Morbidity211
Morbidity311
Morbidity312
Morbidity321
Morbidity341
Morbidity342
Morbidity351
MORBIDITYInternational
PC – Low 1
PC – Low 2
PC – Low 3
PRIMARY CARE Low Resource
(Verbal Autopsy ?)
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
PRIMARY CARE High Resource
PC – Low 1
PC – Low 2
PC – Low 3
PRIMARY CARE Low Resource
(Verbal Autopsy ?) MORTALITY
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 MORBIDITY
PC – Low 1
PC – Low 2
PC – Low 3
PRIMARY CARE Low Resource
(Verbal Autopsy ?) MORTALITY International
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 MORBIDITY
PC – Low 1
PC – Low 2
PC – Low 3
PRIMARY CARE Low Resource
(Verbal Autopsy ?) MORTALITY International National LinearizationsSpecialty - Research
Extensions
X – Chapter:
Extension Codes Type 1 Type 2 Type 3
Severity Main Condition (types) History of
Temporality (course of the condition)
Reason for encounter/admission
Family History of
Temporality (Time in Life)
Main Resource Condition Screening/Evaluation
Etiology Present on Admission
Anatomic detail TopologySpecific Anatomic Location
Provisional diagnosis
Histopathology Diagnosis confirmed by
Biological Indicators Rule out / Differential
Consciousness
External Causes (detail)
Injury Specific (detail)
Beta Phase
• Comments
• Proposals
• Review Mechanism
• Field Trials
Why a Review 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
Review Process
• The review process :– the content
• Definitions• Content model parameters
– The structure - of the linearization (s) • Mortality• Morbidity• Primary Care
• The reviewers: – scientific peers
Initial Review
• Initial Review of the current Beta draft:– Linearization Structure(s) (e.g. Mortality and Morbidity or Primary
Care)– Content
• Review Units: may include individual entities or groups of entities at any level, such as:
Structure Review Units– Entire Linearization– Chapter– Subchapter– Clusters– Use Cases– Other structure groupings, as selected
Content Review Units
– Chapter– Subchapter– Clusters– Individual entities– Other groups of entities, as selected
Reviewers
• Content Reviewers: Pool of specialist experts to review in their area of expertise, similar to quality assessment in peer-reviewed journals.
• Structure Reviewers: Morbidity TAG and Mortality TAG
• TAG and WG members :– will act as a scientific journal editorial board.– should NOT be nominated as reviewers.
Call for Reviewers
• WHO Requests all TAGs and WGs to provide nominations of reviewers for the next step in the Beta Phase.
• Please send the following information to WHO ([email protected]) and copy the message to Bedirhan ([email protected]) :– Name of the nominee– Email address– Area(s) of expertise (content they are qualified to review)– CV of the nominee (preferred)– Linked-In or other professional profile link (if available)
Content Review – Schedule
3rd Wave– Musculoskeletal– Mental Health– Neurology– Rare Diseases– Circulatory
4th Wave– Dermatology– Hematology– Respiratory– Neoplasms– Infectious Diseases– Pediatrics
1st Wave• GURM• TM (Disorders)• Gastroenterology• Nephrology• Hepato-pancreatobiliary
2nd Wave• External Causes and Injuries• Ophthalmology• Dentistry• Rheumatology• Endocrinology
Transition Strategy
75 79 90 13 15 ??
ICD-9 ICD-10 ICD-11
4 23
2015
ICD
- 2016
ICD
- 2017
ICD
- 2018
ICD
- 2019
• TAG serving as an Editorial Board• Reviews
• Organizing Field testing• Feasibility• Quality assurance• Reliability
Roadmap during Beta Phase
A caterpillar,
This deep in fall-
Still not a butterfly
Basho
ICD11 βeta