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Dr. T. Bedirhan ÜstünDr. T. Bedirhan ÜstünCoordinator, Coordinator, Classifications, Terminologies, Standards. Classifications, Terminologies, Standards.
World Health OrganizationWorld Health Organization
ICDICD
BackgroundBackground
• WHO +International Standards ICD
• Classification – Common language for definitions:
• Applications:• Mortality: Counting the dead• Morbidity: Monitoring & Evaluation • Primary Care: Diagnosis Management• Research: Epi, Genetics, Pharma…
1666 2011
ICD Revisions139
161
179
189
205
200
954
965
1,0
40
1,1
64
8,1
73
1,9
67
14,4
73
214
1
10
100
1000
10000
100000
Farr
/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 1993 1993
ICD-10 Medical Devices associated with adverse incidents in diagnostic
and therapeutic use• Y70 Anaesthesiology devices associated with adverse incidents
• Y71 Cardiovascular devices associated with adverse incidents
• Y72 Otorhinolaryngological devices associated with adverse incidents
• Y73 Gastroenterology and urology devices associated with adverse incidents
• Y74 General hospital and personal-use devices associated with adverse incidents
• Y75 Neurological devices associated with adverse incidents
• Y76 Obstetric and gynaecological devices associated with adverse incidents
• Y77 Ophthalmic devices associated with adverse incidents
• Y78 Radiological devices associated with adverse incidents
• Y79 Orthopaedic devices associated with adverse incidents
• Y80 Physical medicine devices associated with adverse incidents
• Y81 General- and plastic-surgery devices associated with adverse incidents
• Y82 Other and unspecified medical devices associated with adverse incidents
WHO Family of ClassificationsREFERENCE
Classifications
I nternationalI nternationalC C lassificationlassification of of D iseases D iseases
I nternationalI nternationalC lassification of C lassification of F unctioning, F unctioning, Disability & HealthDisability & Health
I nternational I nternational C lassification of C lassification of H ealth H ealth I nterventions I nterventions (under development)(under development)
RELATED Classifications
International Classification of Primary Care (ICPC)
International Classification of External Causes of
Injury (ICECI)
The Anatomical, Therapeutic, Chemical
(ATC) classification system with Defined Daily Doses
(DDD)
ISO 9999 Technical aids for persons with disabilities
– Classification and Terminology
DERIVED Classifications
International Classification of Diseases for Oncology, Third
Edition (ICD-O-3)
The ICD-10 Classification of Mental and Behavioural
Disorders
Application of the International Classification of Diseases to
Dentistry and Stomatology, Third Edition
(ICD-DA)
Application of the International Classification of Diseases to
Neurology(ICD-10-NA)
ICF, Children & Youth Version (ICF -CY)
WHO Classifications in HISWHO Classifications in HIS
Population Health• Births • Deaths • Diseases• Disability • Risk factors
ICD ICD
ICFICF
ICHIICHI
Classifications
Clinical• Decision Support• Integration of care• Outcome
Administration• Scheduling• Resources • Billing
Reporting• Cost• Needs• Outcome
Placing WHO Classifications in HIS Placing WHO Classifications in HIS & & ITIT
Population Health• Births • Deaths • Diseases• Disability • Risk factors
e-Health RecordSystems
ICD ICD
ICFICF
ICHIICHI
Classifications
LinkagesKRs
Terminologies
Clinical• Decision Support• Integration of care• Outcome
Administration• Scheduling• Resources • Billing
Reporting• Cost• Needs• Outcome
How do we optimize
our health services
Health Information Systems:Analog to Digital
ICD-11 Revision Goals1. Evolve a multi-purpose and coherent classification
– Mortality, morbidity, primary care, clinical care, research, public health…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 health records environment.
• Link ICD logically to underpinning terminologies and ontologies (e.g. SNOMED, GO, …)
• ICD Categories “defined” by "logical operational rules" on their associations and details
Construction of ICD-10: Revision Process in the 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
Definition of Diseasea set of dysfunction(s) in any of the body systems
including:• with a known pattern of signs, symptoms & findings
» symptomatology - manifestationssymptomatology - manifestations
• probably with an underlying explanatory mechanism» etiologyetiology
• a distinct pattern of development over time» course and outcomecourse and outcome
• a known pattern of response to interventions » treatment responsetreatment response
• with linkage to underlying genetic factors » genotypes, phenotypes and endophenotypesgenotypes, phenotypes and endophenotypes
• with linkage to interacting environmental factors
• Ontology (philosophy)– the Organization of Reality !!!
• Ontology (computer science) – the explicit – operational description of
the conceptualization of a domain:• Concepts: entity and quality
(properties and attributes)
• 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 Ontology?
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. Terms
4.1. Base Index Terms4.2. Base Inclusion Terms4.3. Base Exclusion Terms
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
TITLE of ENTITY: Name of disease, disorder, or syndrome…7. Causal Properties7.1. Etiology Type7.2. Causal Properties - Agents7.3. Causal Properties - Causal Mechanisms 7.4. Genomic Linkages7.5. Risk Factors8. Temporal Properties
8.1. Age of Occurrence & Occurrence Frequency
8.2. Development Course/Stage9. Severity of Subtypes Properties10. Functioning Properties
10.1. Impact on Activities and Participation10.2. Contextual factors10.3. Body functions
11. Specific Condition Properties11.1 Biological Sex11.2. Life-Cycle Properties
12. Treatment Properties13. Diagnostic Criteria
iCAT• Open and collaborative process
– Users are empowered– Web based– Like WIKI – Trip Advisor
• But structured • Editorial Oversight
iCAT
ICD11 Components
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
Mortality
Morbidity
Primary 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 synergisticsynergistic and not antagonistic
ICD & WHO FICICD & WHO FIC
• International Public Good– Openly Accessible– Free for WHO Member States
• Available in multiple formats:– Printed Book editions– Internet-edition – Various computerized tools
ICD & WHO FICICD & WHO FIC– Simultaneous development in Multiple Languages
– لألمراض الدولي التصنيف
– 國際疾病與相關健康問題統計分類
– International Classification of Diseases
– Classification internationale des maladies
– Международная классификация болезней
– Clasificación internacional de enfermedades
ICD & WHOFIC• Multiple Settings:
– Primary Care– Clinical Services– Research
• Specialty Adaptations:– Children and Youth– Oncology– Mental Health– Neurology– Musculoskeletal– Dermatology– Dentistry
e.g. ICD-10 Diagnostic Guidelines for Mental Health in Primary Care
Desiderata for a global terminology (1)1. Comprehensiveness:
– Coverage for all aspects of health care
2. Adequacy: – Is it fit or purpose – multiple purposes?– Does it have a good information model and ontological basis?
3. Multilingual applicability– language independent formal concept representation– Representation in multiple languages – more than translation
4. Utility:– Is it beneficial for:
• Care providers : decision making, outcome evaluation• Consumers : participation – ownership – evaluation – risk
reduction• Policy/Decision Makers : informed decision making on costs, benefits,
efficiency
5. Reliability: – does it give the same results in different users
Desiderata for a global terminology (2)
6. Validity:– Does it indicate the right things – and does the indication make sense
7. Comparability• Does the data in different context have same properties to be compared?
8. Interoperability– Technical: Can information systems exchange information and use it? – Semantic: Can information systems interpret the data with the same meaning?
9. Quality Assurance– Product: Annotation and Content– Process: Use and Usability
10.Sustainability– Secured maintenance: commitment to stability with earlier versions – Openness to address emerging technical issues