ICD Revision Beta 2013 - Internal Medicine

ICD Revision Overview Tevfik Bedirhan Üstün Classifications, Terminologies, Standards Team World Health Organization

Tokyo 2007 April  2013 February ICD - Revision Journey Thanks to: • WHOFIC Network • Japanese MHLW • Japan Hospital Association Table 1: Major Japanese academic societies • Japanesesupporting Organizations Medical ICD revision project The Japanese Society of Internal Medicine The Japanese Society of Gastroenterology The Japanese Respiratory Society Japanese Society of Nephrology The Japan Endocrine Society Japan Diabetes Society Japanese Society of Hematology The Japanese Circulation Society Japanese Society of Neurology Japan College of Rhumatology Japan Association for Medical Informatics The Japanese Society of Medical Record Administra

IM TAG Brazil Poster Conclusions - Request• Japanese government and academic societies have heavily involved in the IM-TAG activities.• As ICD is used in many countries with various ways it should be supported financially by WHO and a number of governments.• Also, it is essential to provide concrete and logical leadership by WHO for conducting such a large international project effectively.

You can find the slides in…

Genealogy of ICD  1664

Age-adjusted death rates fornephritis, nephrotic syndrome, and nephrosis: United States, 1968-2005

ICD-11 Revision Goals1. Evolve a multi-purpose and coherent classification – Mortality, morbidity, primary care, clinical care, research, public health… – Consistency & interoperability across different uses2. Serve as an international and multilingual reference standard for scientific comparability and communication purposes3. 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

ICD-11 Timeline• 2012 : Beta version & Field Trials Version – +2 YR : Field trials• 2015 : Final version for WHA Approval – 2015+ implementation – Continuous Annual Cycles • ICD 2015 • ICD 2016 • ICD 2017

How do we gofrom Here to 21st Century?

• Open and Collaborative Platform – Web based – Like WIKIPEDIA • But – by the Content Model • with – by the TAGs , and scientific peers

ICD11 βeta • http://www.who.int/classifications/icd/revision • Beta – Browser & Print 10 look & feel + descriptions – code structure !βeta • ICD-11 Beta draft is NOT FINAL • updated on a daily basis •NOT TO BE USED for CODING except for agreed FIELD TRIALS

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

Primary CareFoundation: ICDcategories with Linearizations - Definitions, synonyms - Clinical descriptions Morbidity - Diagnostic criteria - Causal mechanism - Functional Properties Find Term MortalitySNOMED-CT,International Classification of 23Functioning, Disability and Health (ICF)…

Linerization requirements• Classical ICD – Mutually Exclusive MEJE priniciple – Jointly Exhaustive No double counting All categories will be in Residuals: Other (*.8) Unspecified (*.9) should be generated for each linearization

Building Linearizations• Multiple Parenting Allowed – Pneumonia • Lung Disease • Sometimes Infectious Disease• Permanence of meaning across different linearizations – Telescopic principle • Zoom in – zoom out

Morbidity111 Morbidity112 Morbidity121 Morbidity131 Morbidity132 Morbidity133 Morbidity211 Morbidity221 Morbidity222 Morbidity311 Morbidity312 Morbidity321 Morbidity341 Morbidity342 Morbidity351MORBIDITYInternational

PC – Low 1 PC – Low 2 PC – Low 3PRIMARY CARE Low Resource(Verbal Autopsy ?)

Mort/PCHigh 11 PC – Low 1 Mort/PCHigh 12 Mort/PCHigh 13 Mort/PCHigh 21 PC – Low 2 Mort/PCHigh 22 Mort/PCHigh 31 PC – Low 3 Mort/PCHigh 32 Mort/PCHigh 33 Mort/PCHigh 34 Mort/PCHigh 35PRIMARY CARE Low Resource PRIMARY CARE High Resource(Verbal Autopsy ?) MORTALITY

Morbidity111 Mort/PCHigh 11 Morbidity112 PC – Low 1 Mort/PCHigh 12 Morbidity121 Morbidity131 Mort/PCHigh 13 Morbidity132 Morbidity133 Mort/PCHigh 21 Morbidity211 PC – Low 2 Morbidity221 Mort/PCHigh 22 Morbidity222 Morbidity311 Mort/PCHigh 31 PC – Low 3 Morbidity312 Mort/PCHigh 32 Morbidity321 Mort/PCHigh 33 Morbidity341 Mort/PCHigh 34 Morbidity342 Mort/PCHigh 35 Morbidity351PRIMARY CARE Low Resource PRIMARY CARE High Resource MORBIDITY(Verbal Autopsy ?) MORTALITY International

Morbidity111 Mort/PCHigh 11 Morbidity112 PC – Low 1 Mort/PCHigh 12 Morbidity121 Morbidity131 Mort/PCHigh 13 Morbidity132 Morbidity133 Mort/PCHigh 21 Morbidity211 PC – Low 2 Morbidity221 Mort/PCHigh 22 Morbidity222 Morbidity311 Mort/PCHigh 31 PC – Low 3 Morbidity312 Mort/PCHigh 32 Morbidity321 Mort/PCHigh 33 Morbidity341 Mort/PCHigh 34 Morbidity342 Mort/PCHigh 35 Morbidity351PRIMARY CARE Low Resource PRIMARY CARE High Resource MORBIDITY Extensions(Verbal Autopsy ?) MORTALITY International National Linearizations Specialty - Research

X – Chapter: Extension Codes Type 1 Type 2 Type 3Severity Main Condition (types) History ofTemporality Reason for Family History of(course of the condition) encounter/admissionTemporality Main Resource Condition Screening/Evaluation(Time in Life)Etiology Present on AdmissionAnatomic detail Provisional diagnosis Topology Specific Anatomic LocationHistopathology Diagnosis confirmed byBiological Indicators Rule out / DifferentialConsciousnessExternal Causes (detail)Injury Specific (detail)

Beta Phase• Comments• Proposals• Review Mechanism• Field Trials

Why a Review Process• The review process will help WHO assure the quality of the Beta Content• Review focus: – Scientific accuracy – Completeness of each unit – Internal consistency – Utility / Relevance of each unit

Review Process• The review process : – the content • Definitions • Content model parameters – The structure - of the linearization (s) • Mortality • Morbidity • Primary Care• The reviewers: – scientific peers

Initial Review • Initial Review of the current Beta draft: – Linearization Structure(s) (e.g. Mortality and Morbidity or Primary Care) – Content • Review Units: may include individual entities or groups of entities at any level, such as: Structure Review Units  Content Review Units – Entire Linearization – Chapter – Chapter – Subchapter – Subchapter – Clusters – Clusters – Individual entities – Use Cases – Other groups of entities, as selected – Other structure groupings, as selected

Reviewers• Content Reviewers: Pool of specialist experts to review in their area of expertise, similar to quality assessment in peer-reviewed journals.• Structure Reviewers: Morbidity TAG and Mortality TAG• TAG and WG members : – will act as a scientific journal editorial board. – should NOT be nominated as reviewers.

Call for Reviewers• WHO Requests all TAGs and WGs to provide nominations of reviewers for the next step in the Beta Phase.• Please send the following information to WHO (robinsonm@who.int) and copy the message to Bedirhan (ustunb@who.int) : – Name of the nominee – Email address – Area(s) of expertise (content they are qualified to review) – CV of the nominee (preferred) – Linked-In or other professional profile link (if available)

Content Review – Schedule1st Wave 3rd Wave • GURM – Musculoskeletal • TM (Disorders) – Mental Health • Gastroenterology – Neurology – Rare Diseases • Nephrology – Circulatory • Hepato-pancreatobiliary 4th Wave2nd Wave – Dermatology • External Causes and Injuries – Hematology • Ophthalmology – Respiratory • Dentistry – Neoplasms • Rheumatology – Infectious Diseases • Endocrinology – Pediatrics

Transition Strategy ICD-10 ICD-11 ICD-975 79 90 13 15 ?? 4 23 ICD - 2016 ICD - 2018 ICD - 2019 ICD - 2017 2015

Roadmap during Beta Phase • TAG serving as an Editorial Board • Reviews • Organizing Field testing • Feasibility • Quality assurance • Reliability

ICD11 βetaA caterpillar,This deep in fall- Still not a butterfly Basho

ICD Revision Beta 2013 - Internal Medicine

by Bedirhan Ustun on Feb 07, 2013

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