ICD Revision OverviewInternal Medicine TAG 2012

Dr. T. Bedirhan Üstün

Coordinator, Classifications, Terminologies, Standards.

World Health Organization

Key Issues

• ICD revision is complex– Multiple: uses/purposes; histories; principles/styles…

• Dimensions: deaths, diseases, risk factors, disability, treatments, … • Science and Practice needs: genes, patient care, population health …

Fragmented Information integration is needed

• ICD has to be re-engineered as a digital system– IT sector, economics, governments, international regulations– Information Systems Formal representation of Biomedical Knowledge

Common Exchange platform for Health Information Systems

• Multiple stakeholders are involved: Policymakers; Providers; Clients;– a common language is needed

ICD needs to be built jointly

Construction of ICD-10: Revision Process in 20th Century

• 8 Annual Revision Conferences (1982 - 89)

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

• Manual curation– List exchange– Index was done later

• "Decibel" ? Method of discussion• Output: Paper Copy• Work in English only• Limited testing in the field

Construction of ICD-11: Revision Process in the 21st 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

How do we go from Here to 21st Century?

ICD-11 Timeline

• 2011 : Alpha version ( ICD 11 alpha draft) – +1 YR : Commentaries and consultations

• 2012 : Beta version & Field Trials Version – +2 YR : Field trials

• 2014 : Final version for public viewing–2015 : WHA Approval

• 2015+ implementation

http://who.int/classifications

ICD Revision

ICD11 αlpha http://www.who.int/classifications/icd/revision

• Alpha – Browser & Print 10 look & feel + descriptions – code structure !

• ICD-11 alpha draft is INCOMPLETE • updated on a daily basis• NOT TO BE USED for CODING at this stage• not yet been approved by the TAGs, RSG or

WHO

iCAT• Open and Collaborative Platform

– Web based

– Like WIKI – Trip Advisor• But structured

– by the Content Model

• Editorial Oversight– by the TAGs

iCATCollaborative Authoring Tool

for ICD Revision

THE CONTENT MODELRequired Parameters:

Any Category in ICD is represented by:

1. TITLE of ENTITY: Name of disease, disorder, syndrome…

2. Classification Properties

3. Textual definition

4. Terms: Synonyms - Inclusion – Exclusion - Index terms

5. Body System(s) / Part(s)

6. Temporal Properties

7. Severity Properties

THE CONTENT MODELOptional Parameters:

8. Manifestation Properties

9.   Causal Properties

10. Functioning Properties

11. Specific Condition Properties

12.    Treatment Properties

13.    Diagnostic Criteria

Browsing ICD Entities

Advanced Search

OpenID Logon

User Profile

Threaded Comments

Single Assessment Questions

Suggesting Definitions

Comments

Dashboard (Foundation)

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ICD-11 Features

Internet Based Platform

Content Model

Multi Lingual Representations

Definitions

Input from all Stakeholders

Arabic لعربية 官话 ChineseEnglish EnglishFrançais FrenchРусский язык Russian Español Spanish Deutsch German Português Portuguese

Field Trials for Use Cases

Electronic Health Record Ready

Information Notes: Yellow Sheets

1. Communication & Dissemination

2. Revision Timelines

3. TAG Allocations

4. Content Model

5. Foundation Component & Linearizations

6. Legacy Linearizations

7. Code Structure

8. Multidimensional Coding

9. Index

10. < …>

ICD11 Components

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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

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)

ICD11 Code Structure Information Note 7 – under SEG Consideration

• Default ICD Code format:

E1D213 .E4E5E: base 34 (0-9; A-Z caps – less I, O)

D: base 26 (A-Z caps caps – less I, O)

1: base 10 integers (0-9)

• Optimum expressive space– Block and chapters not included in design – but accommodated

• E1D213 = Same pre-coordinated set for mortality, morbidity– Russian Dolls – Telescopic expansion

ICD Multi-dimensional CodingInformation Note 8 – under SEG Consideration

• Representing qualifiers by post-coordination

• E1D213 .E4E5

• Agreed Multiple Dimensions will include:

• Anatomic detail, including Laterality

• Severity

• Temporality

• Causal agent/etiology

Issue of Pre-coordinated Categories:Coding cycling accident in ICD-10

• V12.24 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, non-traffic accident, while resting, sleeping, eating or engaging in other vital activities

The history of cycling codes

• 1972 ICD-9 (E826): 8 codes

• READ-2 (T30..): 81 codes

• READ-3: 87: 82 codes

• 1999 ICD-10: 587 codes

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

Conceptual Lego… it could be... Post-coordinated

Structured Data Entry

File Edit Help

What you hit

Your Role

Activity

Location

Cycling Accident

Managing Expectations

March 2012• vTAG input finished• SEG finalizes the key

linearizations

May 2012• Representation of

Mortality and Morbidity Linearizations

• Reference Guide ( vol II)• Index (vol III)• Field Trial protocols• Multilingual Prototype

Current Status as of end Jan.2012

• Some Chapters need further work– Infectious Disease A– Neoplasms B,C– Sign & Symptoms R– Z codes

• Other chapters’ structure reported to be complete

• Definitions > 50% – Top level > 70 %

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ICD-11 Features

Internet Based Platform

Content Model

Translations

Field Trials for Use Cases

Definitions

Input from all Stakeholders

Electronic Health Record Ready

Bridge Coding

• The information on a case (live or medical record) will be coded:

• ICD10• ICD11

to see whether both systems yield the same codes.

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Measles

Rubella

Rubella

Measles

BETA PHASE FIELD TESTS:How TWO different users code the same case ?

?

Stability Analysisof ICD-11 key linearizations

• Categories remain constant vs changed • Mortality • ICD Morbidity - DRGs

10constant

changed 11

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• Shows the change from ICD-10– Backwards compatible

ICD11 alpha - DIFF

“DIFF”Tracking incremental changes from ICD

The curious case of …

Transition Strategy

75 79 90 13 15 ??

ICD-9 ICD-10 ICD-11

4 23

2015

ICD

- 2016

ICD

- 2017

ICD

- 2018

ICD

- 2019

• Participation in the ICD Revision• Joint Authoring• Review Panels• Organizing Field testing

• Other BUSINESS Applications:

• Electronic Health Records • Education

Collaboration with IM TAGPost TOKYO:

ICD Revision OverviewInternal Medicine TAG 2012

Dr. T. Bedirhan Üstün

Coordinator, Classifications, Terminologies, Standards.

World Health Organization