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

http://upload.wikimedia.org/wikipedia/commons/1/1a/Toyota_Model_AA.jpg

http://upload.wikimedia.org/wikipedia/commons/e/e3/TOYOTA_i-unit.jpg

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 (robinsonm@who.int) and copy the message to Bedirhan (ustunb@who.int) :– 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