WHO-FIC The WHO Family of International Classifications WHO-FIC
WHO-FIC UN Expert Group on International Economic and Social
Classifications New York, 8-10 December 2003 Bedirhan stn M.D.
Andre Lhours Nenad Kostanjsek Classification, Assessment, Surveys
& Terminology Group Classification, Assessment, Surveys &
Terminology Group World Health Organization
www.who.int/classification Slide 2 WHO-FIC Need for a Family of
Health Classifications lack of common languagelack of common
language Death, disease, disability, health need for health
information systemsneed for health information systems monitoring
MDGs, Life expectancy electronic health records identifying needs,
uses, cost and outcome monitoringcost and outcome monitoring health
care costs, major projects e.g. 3*5 lack of common languagelack of
common language Death, disease, disability, health need for health
information systemsneed for health information systems monitoring
MDGs, Life expectancy electronic health records identifying needs,
uses, cost and outcome monitoringcost and outcome monitoring health
care costs, major projects e.g. 3*5 Slide 3 WHO-FIC Interventions
procedures procedures Reasons for encounter ICD-10 ICD-10
International Statistical Classification of Diseases & Related
Health Problems ICF International Classification of Functioning,
Disability and Health Vobaularies,Terminologies.Nomenclature
Speciality adaptation s Primary care adaptations WHO Family of
International Classifications Associated Products Main
Classifications Adaptations Slide 4 WHO-FIC 150 years of the ICD
1853 International Statistical Congress William Farr (UK) and Marc
dEspine (Fr) prepared an international classification of causes of
death. 1853 International Statistical Congress William Farr (UK)
and Marc dEspine (Fr) prepared an international classification of
causes of death. 1893 first ICD adopted by Intl Statistical
Institute (ISI) 1893 first ICD adopted by Intl Statistical
Institute (ISI) Slide 5 WHO-FIC ICD-10 international standard
diagnostic classification for all general epidemiological and many
health management purposes. Mortality Morbidity international
standard diagnostic classification for all general epidemiological
and many health management purposes. Mortality Morbidity Slide 6
WHO-FIC Purpose of the ICD systematic recording analysis
interpretation comparison systematic recording analysis
interpretation comparison mortality data morbidity data within
countries between countries at a certain point in time over time
Slide 7 WHO-FIC Main uses of the ICD MORTALITY: Underlying and
multiple cause Hospital discharge diagnostic data Primary care
encounters Health surveys Disease registers Health insurance
reimbursement Resource allocation in health services MORTALITY:
Underlying and multiple cause Hospital discharge diagnostic data
Primary care encounters Health surveys Disease registers Health
insurance reimbursement Resource allocation in health services
Slide 8 WHO-FIC Specialty-based adaptations psychiatry neurology
dentistry oncology paediatrics dermatology psychiatry neurology
dentistry oncology paediatrics dermatology Slide 9 WHO-FIC The
ICD-10 Browser Version 2003 Volumes I III Publication in 2004 as
CD-ROM (PDF format) & web-based version Adobe Acrobat Reader
Bookmarks Hyperlinks Text Search Simple Search Advanced Search
(Boolean operators, proximity etc.) Version 2003 Volumes I III
Publication in 2004 as CD-ROM (PDF format) & web-based version
Adobe Acrobat Reader Bookmarks Hyperlinks Text Search Simple Search
Advanced Search (Boolean operators, proximity etc.) Slide 10
WHO-FIC http://www.who.int/whosis WHO Statistical Information
System http://www.who.int/whosis Links to Health Statistics
External sources for health related statistical information
Statistics by disease or condition Links to national health-
related websites Regional and member state information Comparison
of indicators All indicators for a member state Links to Health
Statistics External sources for health related statistical
information Statistics by disease or condition Links to national
health- related websites Regional and member state information
Comparison of indicators All indicators for a member state Slide 11
WHO-FIC Periodic updating of ICD-10 Since 1996 a mechanism has been
established for the periodic updating of ICD-10 minor updates each
year major updates every three years Since 1996 a mechanism has
been established for the periodic updating of ICD-10 minor updates
each year major updates every three years Slide 12 WHO-FIC ICD
Revisions Slide 13 WHO-FIC Policy for Revision Continuous life
cycle Knowledge Management strategic vision - purpose - users -
policy recognition of need & perspective: how & when
Software release methodology Beyond Prejudgement: conservatism vs
novelty undermining the ICD-10, ICF ? New = better ?; Old = better
? Marketing strategy Credibility management backward compatibility
real response to need systematic evaluation impact, process serious
planning for revision needs, resources, timeplan, customers,
partners Continuous life cycle Knowledge Management strategic
vision - purpose - users - policy recognition of need &
perspective: how & when Software release methodology Beyond
Prejudgement: conservatism vs novelty undermining the ICD-10, ICF ?
New = better ?; Old = better ? Marketing strategy Credibility
management backward compatibility real response to need systematic
evaluation impact, process serious planning for revision needs,
resources, timeplan, customers, partners Slide 14 WHO-FIC What
difference does it make? ICF in Health & Disability Statistics
Slide 15 WHO-FIC Universal Model vs. Minority Model Everyone may
have disability ContinuumMulti-dimensional Certain impairment
groups CategoricalUni-dimensional Slide 16 WHO-FIC Foundations of
ICF Human Functioning - not merely disability Universal Model - not
a minority model Integrative Model - not merely medical or social
Interactive Model - not linear progressive Parity - not etiological
causality Context - inclusive - not person alone Cultural
applicability - not western concepts Operational - not theory
driven alone Life span coverage - not adult driven Human
Functioning - not merely disability Universal Model - not a
minority model Integrative Model - not merely medical or social
Interactive Model - not linear progressive Parity - not etiological
causality Context - inclusive - not person alone Cultural
applicability - not western concepts Operational - not theory
driven alone Life span coverage - not adult driven Slide 17 WHO-FIC
Use of ICF framework BarriersFacilitators IMPAIRMENT of Functions
& Structure CAPACITY/ PERFORMANCE PROBLEM Body Functions
&StructuresActivities&Participation Environmental Factors
Medical treatment Rehab, back to work programme, education
Destigma. campaign Support informal care Slide 18 WHO-FIC b1100
b7809 b11420 b54509 b54509 s1100 s7609 s11000 s76009 s76009 d1550
d9309 e1100 e5959 3rd level and 4th level: 1424 sub-categories 2nd
level: 362 categories b110-b899s110-s899d110-d899e110-e599 4
Components 1st level: 34 Chapters ICF Functioning and Disability
Activitiesand Participation (d) Environmental Factors (e)
PersonalFactors Not classified yet b1 b8 Contextual Factors Body
Functions (b) and Body Structures (s) 2 Parts s1 s8 d1 d9 e1 e5
Slide 19 WHO-FIC Common language endorsed by 191 WHO Member States
in the 54 th WHA l Endorse and publish ICF l Use the ICF in Member
States in: research surveillance reporting l Joint use with ICD l
Operational subsets: surveys clinical encounters l Periodic
revision Slide 20 WHO-FIC WHO ICF framework for defining health
& disability l l places disability as an issue of a threshold
on a continuum of health l l clearly recognises the impact of the
environment on levels of functioning l l destigmatises ill-health
and disability by accepting it as a universal human experience
Slide 21 WHO-FIC The ICF Browser ICF Browser Multilingual ( 6+ 14
languages)Multilingual ( 6+ 14 languages) classification in its
tree structureclassification in its tree structure display two
languages at the same timedisplay two languages at the same time
advanced search functionadvanced search function cross references
via hyperlinkscross references via hyperlinks selects and work on
subsetsselects and work on subsets internet based upgrading
facilitiesinternet based upgrading facilities ICF Coding Tool (in
development) Case specific recordingCase specific recording ICF
Qualifier scaleICF Qualifier scale Customized Assessment
scaleCustomized Assessment scale Assessment Instrument
CrosswalkAssessment Instrument Crosswalk ICD Code & socio-demo.
Info.ICD Code & socio-demo. Info. ICF Browser Multilingual ( 6+
14 languages)Multilingual ( 6+ 14 languages) classification in its
tree structureclassification in its tree structure display two
languages at the same timedisplay two languages at the same time
advanced search functionadvanced search function cross references
via hyperlinkscross references via hyperlinks selects and work on
subsetsselects and work on subsets internet based upgrading
facilitiesinternet based upgrading facilities ICF Coding Tool (in
development) Case specific recordingCase specific recording ICF
Qualifier scaleICF Qualifier scale Customized Assessment
scaleCustomized Assessment scale Assessment Instrument
CrosswalkAssessment Instrument Crosswalk ICD Code & socio-demo.
Info.ICD Code & socio-demo. Info. Slide 22 WHO-FIC The World
Health Survey ICF domains used 1. Vision 2. Hearing 3. Digestion 4.
Bodily Excretions/ Continence 5. Fertility 6. Skin and
Disfiguration 7. Breathing Difficulty 8. Pain and Discomfort 9.
Affect 10. Sleep 11. Energy and Vitality 12. Understanding and
Interacting 13. Communication 14. Mobility and Physical Activity
15. Dexterity and Fine Motor Activity 16. Self Care 17.
Interpersonal Relationships 18. Usual Activities and Roles 19.
Social Functioning Slide 23 WHO-FIC 1. Population level Census
questions on health and disability Health and Disability Surveys
Indicator development & reporting in Health Info. Systems
Health and Social Policy Legislation (UN Disability Convention,
Right for Health 2. Specific Applications Clinical Encounters
Specific populations ElderlyElderly Administrative
RecordsAdministrative Records 3. Other uses Insurance Education 1.
Population level Census questions on health and disability Health
and Disability Surveys Indicator development & reporting in
Health Info. Systems Health and Social Policy Legislation (UN
Disability Convention, Right for Health 2. Specific Applications
Clinical Encounters Specific populations ElderlyElderly
Administrative RecordsAdministrative Records 3. Other uses
Insurance Education ICF Implementation Slide 24 WHO-FIC Information
Paradox Slide 25 WHO-FIC Drivers for change WHO as a Standards
Development Organization recognizing WHO FIC as Knowledge Assets
effectively owning & managing them Client needs &
Information technology needs Electronic Patient Records - billing-
outcome evaluation Clinical Terminology & Vocabulary SNOMED
Int, NLM, HL7 Clinical Currency HIV-AIDS, SARS, Diabetes,
Hypertension, Coronary disease definitions, risk factors Oncogenes
Single Gene Disorders Alzheimers; Narcolepsia, Huntingtons, Rye
Syndrome... New and expected developments: Human Genome Project,
treatments... Compatibility within the Family ICD - XM, updates of
AM, CM, CA, DM. ICF ICHI ICECI WHO as a Standards Development
Organization recognizing WHO FIC as Knowledge Assets effectively
owning & managing them Client needs & Information
technology needs Electronic Patient Records - billing- outcome
evaluation Clinical Terminology & Vocabulary SNOMED Int, NLM,
HL7 Clinical Currency HIV-AIDS, SARS, Diabetes, Hypertension,
Coronary disease definitions, risk factors Oncogenes Single Gene
Disorders Alzheimers; Narcolepsia, Huntingtons, Rye Syndrome... New
and expected developments: Human Genome Project, treatments...
Compatibility within the Family ICD - XM, updates of AM, CM, CA,
DM. ICF ICHI ICECI Slide 26 WHO-FIC Further information: Visit the
ICF website www.who.int/classifications/icf Contact us via e-mail:
[email protected] [email protected] [email protected] Contact WHO
Collaborating Centers for the Family of International
Classifications www.who.int/classifications/icf Visit the ICF
website www.who.int/classifications/icf Contact us via e-mail:
[email protected] [email protected] [email protected] Contact WHO
Collaborating Centers for the Family of International
Classifications www.who.int/classifications/icf
