ICD Revision Process: towards ICD -11 Classification, Assessment, Terminology Team WHO.

ICD Revision Process:ICD Revision Process:towards ICD -11towards ICD -11

Classification, Assessment, Terminology TeamClassification, Assessment, Terminology Team

WHOWHO

CLASSIFICATIONS … … BUILDING BLOCKS OF HEALTH INFORMATION …BUILDING BLOCKS OF HEALTH INFORMATION …

WHO Family of ClassificationsWHO Family of ClassificationsREFERENCE

Classifications

I I nternationalnternationalCC lassification of lassification of DD iseases iseases

II nternational nternationalCC lassification of lassification of FF unctioning, unctioning, Disability & HealthDisability & Health

II nternational nternational CC lassification of lassification of HH ealth ealth I I nterventions 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)


ICD RevisionsICD Revisions

7

910 10

910

7

10 10

14

22

0

5

10

15

20

25

ICD-1 ICD-2 ICD-3 ICD-4 ICD-5 ICD-6 ICD-7 ICD-8 ICD-9 ICD-10 ICD-11

1900 1909 1919 1929 1938 1948 1955 1965 1975 1989 2011

Inte

rval

(ye

ars)


Key DriversKey Drivers

• Mandated by WHA and EBWHA and EB

• Respond to consumer-needsconsumer-needs– Prevention, Primary Care, Secondary Care, Administration, Patients, Families;

Data-users

• Keep up with new scientific knowledge– New DiseasesNew Diseases, Measures, Treatments, Terminology…– Corrections: pruning and grafting, deletions

– Change in rules, guidelines, conventions…

• Compatibility within the WHO-FIC membersthe WHO-FIC members– ICPC, ICFICPC, ICF,, ICHI, ICECIICHI, ICECI, ICD-OICD-O…

• Creation of an improved network and dissemination

• Better implementation within Health Information Systems– Electronic Health Record, Clinical Terminologies, Mortality Database


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

Mappings

Terminologies

Clinical• Decision Support• Integration of care• Outcome

Administration• Scheduling• Resources • Billing

Reporting• Cost• Needs• Outcome


Linking Classifications to eHealth Records

ICD ICD

ICFICF

ICHIICHI

e-Health RecordSystems

Mappings

ClassificationsTerminologies

Diagnosis / Assessment• Diseases• Disability

Management / Interventions

Modifications to External Causes Blocks of ICD

No

Yes

Yes

Yes

V01

- V09

V10

- V19

V20

- V29

V30

- V39

V40

- V49

V50

- V59

V60

- V69

V70

- V79

V80

- V89

V90

- V94

V95

- V97

V98

- V99

W00

- W

19

W20

- W

49

W50

- W

64

W65

- W

74

W75

- W

84

W85

- W

99

X00

- X09

X10

- X19

X20

- X29

X30

- X39

X40

- X49

X50

- X57

X58

- X59

X60

- X84

X85

- Y09

Y10

- Y34

Y35

- Y36

Y40

- Y84

Y40

- Y59

Y60

- Y69

Y70

- Y82

Y83

- Y84

Y85

- Y89

Y90

- Y98

Clinical modifications

ICE Survey

Sources for Revision of Chapter XXSources for Revision of Chapter XX


Modifications to Injuries Blocks of ICD

No

Yes

Yes

Yes

S00

- S09

S10

- S19

S20

- S29

S30

- S39

S40

- S49

S50

- S59

S60

- S69

S70

- S79

S80

- S89

S90

- S99

T00

- T07

T08

- T14

T15

- 19

T20

- T25

T26

- T28

T29

- T32

T33

- T35

T36

- T50

T51

- T65

T66

- T78 T7

9

T80

- T88

T90

- T98

ICE Survey

Clinical Modifications

Sources for Revision of Chapter XXSources for Revision of Chapter XX

3 Ch. Categories

ICD Chapter XXICD Chapter XX- International Statistical Use -- International Statistical Use -

Chapters

Blocks

4 Ch. Categories

ICD

Child Mortality

ICD Morbidity

ISHMTHospital Morbidity

General Mortality

Verb. Autopsy

Use (Epidemiology)

Accidental poisoning

Intentional self harm

Medical devices associated with adverse incidents

Traffic accidents

Revision Chapter XXRevision Chapter XXMortalityMortality

• Use of Chapter XX (Doris Ma Fat, Dejan Loncar, WHO)

• 1/3 of all deaths reported to WHO

• ~ 7 % Chapter XX

• Transport: 45 % “unspecified”

• 13/~70 countries do not use 4th character

• ~ 400 codes never used

– “Bitten or struck by crocodile or alligator, residential

institution”


ICD Revision ProcessICD Revision Process

• Drafting Rules– Taxonomic Guidelines– Definition, Diagnosis and Indexing / mapping guidelines

• Drafting Overall Structure• Drafting Individual Chapters

• Overseeing the TOTAL ICD– ALPHA Draft – structured comments– BETA Draft – field testing

• Final Draft WHA Approval


ICD Revision Work StreamsICD Revision Work Streams1. Scientific Stream

• Evidence Based Reviews• Surveys • Validation Studies • Add-on protocols for existing studies• Meta analyses

2. Clinical Stream• Primary care utility• Secondary care utility• Linkage to patient reports• Treatment Response• Phenotypes: gene to behaviour specs

3. Public Health Stream• Impact on Health Systems –society –service delivery• Impact on statistics• Resource management -reimbursement - accounting• IT applications - terminology


Knowledge PortalKnowledge PortalWeb of ICD RevisionWeb of ICD Revision

• Evidence based systematic reviews– Clinical Use: Primary Care, Secondary Care – Epidemiology, demography and public health

• Knowledge Sharing– All ICD Chapters:

• Disease Definitions and Criteria • comment threads

– Structured Discussion Forums

– Field Trials: Global Practice Networks to test the proposed codes, definitions…

Personalized selections in an interconnected electronic environment Actionable information – alerting, planning, query, reporting & analysis Collaboration (Executive, Knowledge worker, User)




Tentative TimelineTentative Timeline

• ICD-11 by …– 2006 : International Consultations for blueprint– 2007 : Start of multiple streams of workplan – 2008 : Alpha version– 2008 : Commentaries and consultations– 2009 : Beta version & Field Version – 2010 : Field trials– 2011 : Final version for public viewing– 2012 : WHA Approval– 2014+ implementation


Involvement StrategyInvolvement Strategy

• International: – Multiple countries– Multiple languages– Multiple health care systems

• Multiple Parties & Professionals– Different clinical specialties, nursing & midwifery; other professionals– Different health care aspects:

• Prevention• Primary care • Secondary care• Home care • Rehabilitation • Long term care

– Consumers from different sectors


Structure of Revision ProcessStructure of Revision Process

WHOClassifications Team

WHO FICUpdate & Revision

Committee

Coordinating Group

Scientific StreamClinical Stream

Public Health Stream

Treatment Response

Phenotypes Terminology Payment Groups

Topical Groups

DisorderGroups

FIE

LD

T

RIA

LS

KMS

PORTAL


One Classification – One Classification – Multiple Projections Multiple Projections (samples)

II

CC

DD

ICDICDhead

thorax

abdom.cavity

foot

ICDICDinfectious

immune

work

iatrogen

ICDICDmortality

Primarycare

billing

VerbalAutopsy

The OneThe One AnatomyAnatomy EthiologyEthiology UseUse


ICD-11ICD-11

• Easy to use and implement

• To reflect spectrum of needs of multiple– cultures – levels of development– health sectors

• Compatibility with existing Classifications

• Statistical comparability and continuity


WHOClassifications Team

WHO FICUpdate & Revision

Committee

Coordinating Group

Scientific StreamClinical Stream

Public Health Stream

Treatment Response

Phenotypes Terminology Payment Groups

Topical Groups

DisorderGroups

FIE

LD

T

RIA

LS

KMS

PORTAL

Structure of Revision ProcessStructure of Revision Process

External causes and injuries

Accidents

Drugs

Patient safety

Work

Factors

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ICD Revision Process: towards ICD -11 Classification, Assessment, Terminology Team WHO.

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