World Health Organization Classifications, Terminologies, Standards

ICD Revision: Where Are We?

Overview• ICD Revision progress

– Current status – Stability: how similar to ICD10 – ICD10AM

– Next Steps: • Collaborative Authoring Tool improvements• Proposals • Peer Review• Field Trials• Other Products• …

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

Current Status

• Frozen September 30– iCAT continues real time– JLMMS is frozen for review – A new freeze is expected in Dec 2014.

• Definitions – Top level > 75 % > 10,000 definitions

• Linearization errors < 465 (from 10K) • Duplicates < 105 (from 3K)

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.

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

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

Linearizations:Zoom-in Zoom-Out

Title Primary C. Joint Lin. Ophthalm.Cataract code code code

Age-related cataract code code codeCortical age-related cataract other other codeNuclear age-related cataract other other codeCataracta brunescens other other codeNuclear sclerosis cataract other other codeCapsular and Subcapsular age-related cataract other other codeCapsular age-related cataract other other codeAnterior subcapsular polar age-related cataract other other codePosterior subcapsular polar age-related cataract other other codeIncipient age-related cataract other other code

Coronary age-related cataract other code codePunctate age-related cataract other code code

Water clefts other other codeAdvanced or mature age-related cataract other other code

Mature age-related cataract other code code Subtotal advanced or mature age-related cataract other other code

Advanced or mature age-related cataract, total cataract other other codeMorgagnian age-related cataract other other codeCalcified age-related cataract other other codeCombined forms of age-related cataract other other code

Example of Telescope

• Pre-coordination - fixed names

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

ICD Organization

• Post- Coordination - extensions• Bicycle Accident

• Hit • Role• Context• Activity

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)

POST COORDINATION MECHANISM

• Extension codes are implemented in iCAT• Sanctioning tables are being generated

– REQUIRED– ALLOWED– DISALLOWED

• First target group is the REQUIREDa. ICD-10 categories which have equivalence with

ICD11 STEM + X codes (around 1000 codes) b. other

• 2014 : Beta version & Field Trials Version – +2 YR : Field trials

• 2017 : Final version for WHA Approval– 2018+ implementation– Continuous Annual Cycles

• ICD 2018 • ICD 2019• ICD 2020

ICD-11 Timeline

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

ICD-11 Browser

Visualization

Print Versions

ICD 2014 September release

• Print version release includes:• Frozen “Joint Linearization for Mortality and

Morbidity Statistics” ( Vol. 1 Equivalent). • The ongoing work on iCAT will go ahead in further

completing the ICD definitions and improvements. • A future release is also planned in December.

Thereafter the releases will be made whenever necessary.

• Incremental changes from August Release are given in a separate document to enable tracking which parts remained stable – which parts changed.

Frozen Diff Files

Frozen Diff Files

Taxonomic Check• Taxonomic check includes the aggregation equivalence:

• with the Primary Care versions– PC Intermediate Resource version renamed: Intermediate Version– PC Low Resource version renamed: Short Version

• With Specialty Versions– see whether the specialty extensions roll up to JLMMS ( if this was the chosen option)

Annotation Document & Reviews

• An updated Annotation Document identifies the architecture, principles and known issues.

• Reviews by Mortality and Morbidity TAGs included for common reference and guiding future work

STABILITY ANALYSIS

• A Foundation based equivalence programme identifies equivalences between ICD-10 and ICD-11.

• a TRANSCODING table between ICD-10 and ICD-11 in

excel format• A CROSSWALK gives the detailed output in excel

format

• The ICD11 Beta Browser will display the ICD-10 equivalents accordingly.

Mapping Tool

Transcoding tables ICD-10 to ICD-11 in excel

ICD-10 ICD-11 correspondence

• 3 character – 1183 (w/o ECI & Residuals)– 951 Equivalent– 191 mapped to a larger entity in 11

• with post coordination many have equivalent maps– 41 not mapped

• 4 character - 6635– 4343 Equivalent– 2207 mapped to a larger entity in 11

• with post coordination many have equivalent maps– 85 not mapped

ICD Index

• Print Index is about 1900 pages with some lead terms running several pages.

• About 3000 ICD10 Index terms are “missing”. A human judgement is being made as to whether they are necessary and once included they point to the right code.

• Sublead terms missing• Improvements planned

Translation Platform

World Health Organization Classifications, Terminologies, Standards

ICD Revision: Where Are We?