ICD Revision 2014
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The document discusses the progress of the ICD-11 revision. It notes that the beta version is currently frozen for review and field trials, with over 75% of top-level categories defined and errors reduced. Field trials will assess the applicability, reliability and utility of ICD-11 for purposes like mortality and morbidity coding. The revision aims to create an electronic, multilingual classification to facilitate health information exchange.
![THE CONTENT MODEL
Any Category in ICD is represented by:
1. ICD Concept Title
1.1. Fully Specified Name
2. Classification Properties
2.1. Parents
2.2 Type
2.3. Use and Linearization(s)
3. Textual Definition(s)
4. Terms
4.1. Base Index Terms
4.2. Inclusion Terms
4.3. Exclusions
5. Body Structure Description
5.1. Body System(s)
5.2. Body Part(s) [Anatomical Site(s)]
5.3. Morphological Properties
6. Manifestation Properties
6.1. Signs & Symptoms
6.2. Investigation findings
7. Causal Properties
7.1. Etiology Type
7.2. Causal Properties - Agents
7.3. Causal Properties - Causal Mechanisms
7.4. Genomic Linkages
7.5. Risk Factors
8. Temporal Properties
8.1. Age of Occurrence & Occurrence Frequency
8.2. Development Course/Stage
9. Severity of Subtypes Properties
10. Functioning Properties
10.1. Impact on Activities and Participation
10.2. Contextual factors
10.3. Body functions
11. Specific Condition Properties
11.1 Biological Sex
11.2. Life-Cycle Properties
12. Treatment Properties
13. Diagnostic Criteria](https://image.slidesharecdn.com/icd2014darwinustunshow-141003075012-phpapp02/85/ICD-Revision-2014-11-320.jpg)
ICD Revision 2014
- 1. ICD Revision: Where Are We? Dr. T. Bedirhan Üstün World Health Organization Classifications, 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 YOU who 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
- 6. ICD-11 Revision Goals 1. 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
- 7. Genealogy of ICD 1664 350 years
- 8. ICD Revisions 139 161 179 189 205 214 200 954 965 1,040 1,164 8,173 1,967 14,473 1 10 100 1000 10000 100000 Farr/d'Espine Bertillon ICD 1 ICD 2 ICD 3 ICD 4 ICD 5 ICD 6 ICD 7 ICD 8 ICD 9 ICD-9-M ICD 10 ICD-10-M 1853 1893 1900 1909 1920 1929 1938 1948 1955 1968 1975 1979 1993 1993
- 9. How do we go from Here to 21st Century?
- 10. • Open and Collaborative Platform – Web based – Like WIKIPEDIA • But – by the Content Model • with – by the TAGs , and scientific peers
- 11. THE CONTENT MODEL Any Category in ICD is represented by: 1. ICD Concept Title 1.1. Fully Specified Name 2. Classification Properties 2.1. Parents 2.2 Type 2.3. Use and Linearization(s) 3. Textual Definition(s) 4. Terms 4.1. Base Index Terms 4.2. Inclusion Terms 4.3. Exclusions 5. Body Structure Description 5.1. Body System(s) 5.2. Body Part(s) [Anatomical Site(s)] 5.3. Morphological Properties 6. Manifestation Properties 6.1. Signs & Symptoms 6.2. Investigation findings 7. Causal Properties 7.1. Etiology Type 7.2. Causal Properties - Agents 7.3. Causal Properties - Causal Mechanisms 7.4. Genomic Linkages 7.5. Risk Factors 8. Temporal Properties 8.1. Age of Occurrence & Occurrence Frequency 8.2. Development Course/Stage 9. Severity of Subtypes Properties 10. Functioning Properties 10.1. Impact on Activities and Participation 10.2. Contextual factors 10.3. Body functions 11. Specific Condition Properties 11.1 Biological Sex 11.2. Life-Cycle Properties 12. Treatment Properties 13. Diagnostic Criteria
- 12. What is “NOntology” ? Ontology (philosophy) the Organization of Reality !!! Ontology (computer science) – the explicit – operational description of the 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 to allow interoperability among people
- 13. ICD11 βeta http://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
- 14. ICD-11 Features Internet Based Platform Content Model Multi Lingual Representations Input from all Stakeholders Definitions لعربية Arabic 官话Chinese English English Français French Русский язык Russian Español Spanish Deutsch German Português Portuguese Field Trials for Use Cases Electronic Health Record Ready
- 15. 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.
- 16. 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
- 17. Linerization requirements • Classical ICD – Mutually Exclusive – Jointly Exhaustive MEJEpriniciple No double counting All categories will be in Residuals: Other (*.8) Unspecified (*.9) should be generated for each linearization
- 18. 18 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 Morbidity Mortality Primary Care
- 19. Building Linearizations • Multiple Parenting Allowed – Pneumonia • Lung Disease • Sometimes Infectious Disease • Permanence of meaning across different linearizations – Telescopic principle • Zoom in – zoom out
- 24. Example of Telescope Title Primary C. Joint Lin. Ophthalm. Cataract code code code Age-related cataract code code code Cortical age-related cataract other other code Nuclear age-related cataract other other code Cataracta brunescens other other code Nuclear sclerosis cataract other other code Capsular and Subcapsular age-related cataract other other code Capsular age-related cataract other other code Anterior subcapsular polar age-related cataract other other code Posterior subcapsular polar age-related cataract other other code Incipient age-related cataract other other code Coronary age-related cataract other code code Punctate age-related cataract other code code Water clefts other other code Advanced or mature age-related cataract other other code Mature age-related cataract other code code Subtotal advanced or mature age-related cataract other other code Advanced or mature age-related cataract, total cataract other other code Morgagnian age-related cataract other other code Calcified age-related cataract other other code Combined forms of age-related cataract other other code
- 25. Current Status as 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)
- 27. 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
- 28. ICD Organization • Pre-coordination - fixed names 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 • Post- Coordination - extensions • Bicycle Accident • Hit • Role • Context • Activity
- 30. 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 Topology Specific Anatomic Location Provisional diagnosis Histopathology Diagnosis confirmed by Biological Indicators Rule out / Differential Consciousness External Causes (detail) Injury Specific (detail)
- 31. Multiple Coding Equivalent Expressions Cluster Style – Code1* – Code2* – Code3* – .. – * CLUSTERING IND. Chain / String Style – Code1/Code2/Code3
- 32. Multiple Coding Equivalent Expressions STEMI - posterior wall – confirmed by EKG Chain / String Style JH6.100/ XT0.???/ XD0.100 Cluster Style • JH6.1001 Myocardial Infarction with ST Elevation • XT0.???1 Posterior wall of heart • XD0.1001 Diagnosis Confirmed by EKG • 1 CLUSTERING indicator.
- 33. Stability Analysis Objectives • Ensure a seamless transition between ICD-10 and ICD-11 – national – international levels • CrossCutting TAGs review and confirm continuity between ICD-10 and ICD- 11 • Represent knowledge gained from national clinical modifications in the revised ICD.
- 34. • Mortality • Morbidity Stability Analysis Types & 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
- 35. Age-adjusted death rates for nephritis, nephrotic syndrome, and nephrosis: United States, 1968-2005
- 36. Proposal Mechanism • Add Entity • Delete Entity • Complex Hierarchical Changes • Content Proposal – ADD: Propose Adding any property value such as synonym, body site, etc. – EDIT: Propose changes in Title or Definition – DELETE: Propose deleting any property value such as synonym, body site, etc.
- 37. Browsing - Creating Proposals
- 38. 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
- 39. Linearization Review 1. Mortality Linearization Review 2. Morbidity Linearization Review 3. Primary Care Linearization Review 4. Mirror-Coding Review 5. Quality & Safety TAG review
- 40. 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
- 41. Contributor - Reviewer Acknowledgement • 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 be acknowledged: – RSG – RSG-SEG – TAG – TAG WGs – Managing Editors – NGOs – Other Contributors – WHO-FIC Collaborating Centres – WHO Staff
- 43. 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
- 44. 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?
- 45. 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
- 46. Core Studies • Study One: – Feasibility and Reliability for live Cases and Case Summaries coding with • ICD-10 an 11 • Study Two: – Basic Questions
- 47. Inter-rater reliability • The Case information • live • medical record • Coded using ICD11 by at least two different people • Agreement rates measured
- 48. Bridge Coding • The Case information • live • medical record • Coded using • ICD10 • ICD11 • Agreement rates measured
- 49. 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
- 50. ICD-11 • International Public Good – Openly Accessible – Free for WHO Member States • Available in multiple formats: – Printed Book editions – Internet-edition – Various computerized tools
- 51. Beta Phase • Comments • Proposals • Review Mechanism • Field Trials
- 52. … BUILDING BLOCKS OF HEALTH INFORMATION …
- 53. ICD-10 • Annual Revision Conferences • Focus on mortality statistics • Produced manually • Produced in English • NO field tests • Update mechanism built in later ICD-11 • Continuous web platform + meetings • Focus on ALL statistical use cases • Produced digitally – w/ information model • Multilingual development • Field tests done before • Continuous update – revision mechanism
- 54. Questions & Answers ustunb@who.int @ustunb bedirhan-ustun