Utility & Added-value of Classifications

in Health Information SystemsTevfik Bedirhan Üstün

Classifications, Terminologies, Standards Team World Health Organization

A Web of Collaborators

ICD11ICFICHI

“Key” in the keynote

CLASSIFICATIONS TERMINOLOGIES & standards

… BUILDING BLOCKS OF HEALTH INFORMATION …

Sharing Meaning

YOU• Think• wish to express• think you have just

expressed• you expressed• …

OTHER ONE• wants to hear• Actually hears• wishes to understand• understands• …

Genealogy of ICD 1664

350years

ICD Revisions139

161

179

189

205

214

200

954

965

1,0

40

1,1

64

8,1

73

1,9

67

14,4

73

1

10

100

1000

10000

100000F

arr

/d'E

spin

e

Bert

illo

n

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 1990 1993

Placing WHO Classifications in HIS & IT

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

ICD

ICF

ICHI

Classifications

Clinical• Decision Support• Integration of care• Outcome

Administration• Scheduling• Resources • Billing

Reporting• Cost• Needs• Outcome

Current Analog situation

Current Analog situation

Placing WHO Classifications in HIS & IT

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

e-Health RecordSystems

ICD

ICF

ICHI

Classifications

LinkagesKRs

Terminologies

Clinical• Decision Support• Integration of care• Outcome

Administration• Scheduling• Resources • Billing

Reporting• Cost• Needs• Outcome

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

WHY ?

• Essential for EHR

• Enhance Care

• Decision Support

• Safety & Quality

• Better Collaboration

• Monitoring & Evaluation

• Better Health Information

• Less Administration

Why is this Sooooo important ?

How do we optimize

our health services

Health Information Systems:Analog to Digital

Digital Models

New business models

Existing business models

New products

Existing products

e-bay e-trade

e-banking e-media (music/video)

e-health

Computers are S T U P I D

? They cannot ask questions

¿ They may –if you

enable them - only give you answers.

Pablo Picasso

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 people• among software agents• between people and software

– to reuse data - information– to introduce standards to allow

interoperability

What is “NOntology” ?

THE CONTENT MODELAny Category in ICD is represented by:

1. ICD Concept Title1.1. Fully Specified Name

2. Classification Properties2.1. Parents2.2 Type2.3. Use and Linearization(s)

3. Textual Definition(s)

4. Terms4.1. Base Index Terms4.2. Inclusion Terms4.3. Exclusions

5. Body Structure Description 5.1. Body System(s) 5.2. Body Part(s) [Anatomical Site(s)]5.3. Morphological Properties

6. Manifestation Properties6.1. Signs & Symptoms 6.2. Investigation findings

7. Causal Properties7.1. Etiology Type7.2. Causal Properties - Agents7.3. Causal Properties - Causal Mechanisms 7.4. Genomic Linkages7.5. Risk Factors

8. Temporal Properties8.1. Age of Occurrence & Occurrence Frequency8.2. Development Course/Stage

9. Severity of Subtypes Properties

10. Functioning Properties10.1. Impact on Activities and Participation10.2. Contextual factors10.3. Body functions

11. Specific Condition Properties11.1 Biological Sex11.2. Life-Cycle Properties

12.Treatment Properties

13. Diagnostic Criteria 20

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

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

26

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

Beta

• Comments• Proposals• Field Trials• Review Mechanism

Incentives for Participants

ICD-11 Timeline

• 2014 : Beta : Field Trials Version – Systematic/scientific reviews– Vigorous crowdsourcing– Field Trials

• 2017 : Final version for WHA Approval– 2018+ implementation Perpetual DIGITAL editing – review cycles

SNOMED : Old and Current

FormerSNOMED

Enterprise

College

American

PathologistsGlobal

Network

Overall Health Care

Why work together?– WHO & IHTSDO

– Coverage & Adequacy– Quality – Reliability - Utility– MultiLingual Applicability– Interoperability– Sustainability

– Member States: Enable health care delivery

and compile health information

SNOMED & WHO Classifications are synergistic and not antagonistic

The «Common Ontology» Purpose

• To provide a common formal knowledge representation structure to enable interoperability between:– ICD-11 and SNOMED CT. – a shared semantics

Ultimate “Turing-like” Test

?≡

If common ontology achieved

Cerebrovascular diseasehttp://mitel.dimi.uniud.it/whotools/mappingTools/mappet/

Humpty Dumpty Theory

• "When I use a word," Humpty Dumpty said, in rather a scornful tone, "it means just what I choose it to mean- neither more nor less."

Grade 3 hypertension

Grade 2 hypertension

Grade 1 hypertension

High normal

normal

optimal

120 130 140 150 160 170 180

Systolic pressure

Dia

stol

ic p

ress

ure

172

102

110

105

100

95

90

85

80

Knowledge Representation

37

Rewriting ICD Using SNOMEDexample of Depressive Disorder F32.0

A. Low mood {41006004}

Loss of interest {417523004 }

Low energy {248274002}

1. Appetite (decrease, increase) {64379006, 72405004}

2. Body weight (decrease, increase) {89362005, 8943002}

3. Sleep (decrease, increase) {59050008, 77692006}

4. Psychomotor (decrease, increase) {398991009, 47295007}

5. Libido loss {8357008}

6. Low self esteem {286647002, 162220005}

7. Guilt, self blame {7571003}

8. Thoughts of death …

9. Suicide Ideation {102911000, 6471006}

B.

Beyond GoogleTM

Semantic Interoperability for HIS

• Search using Concepts above Words– How many patients do have diabetes mellitus type II?

• Extraction of Concepts from Health Records– Automated extraction of Hb1Ac results of selected patients with DM type II

from lab reports within last year

• Statistical Index on Community Collections– Calculation of coverage gap for treatment need for diabetes mellitus

• Concept Navigation across Collections– Comparison of region A with region B etc

39

Negation - disjunction

Real Time Public HealthRule-based Aggregation @ Individual, Facility, Population levels

Public Health, Epi & Surveillance

Findings InterventionsEvents

Clinical Information

ReimbursementResource Management

Clinical Use Case: Exploration of Cough

Fever

386661006

COUGH

49727002

WET COUGHsputum

28743005

Hemoptisia

Blood in Sputum

207069003

• X-ray : Tbc? • Culture

399208008

104184002

• Diagnosis: Tuberculosis 154283005A 15.0

• Treatment: DOTs { 324453004 }

Interoperability

Questions & Answers

ustunb@who.int

@ustunb