Tokyo 2012 ustun (show)

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WHO is revising the ICD to be completed by 2015. It is going to enter into a Beta phase by 2012 May during which all stakeholders could see and comment on the ICD as well as propose changes, test in practice.

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  • E4 = potential expansion subtype (optional pre-coordinating ) E5= expansion subtype 2 ( specialty adaptations’ expansion space )In E5 = numeric qualifier ( X= more information ,Y=Other specified Z=Not specified)  Multi-dimensional coding – with CODE ALSO e.g. EA1.X indicates that there is more
  • Tokyo 2012 ustun (show)

    1. 1. ICD Revision OverviewInternal Medicine TAG 2012 Dr. T. Bedirhan ÜstünCoordinator, Classifications, Terminologies, Standards. World Health Organization
    2. 2. • ICD revision is – Multiple: uses/purposes; histories; principles/styles… • Dimensions: deaths, diseases, risk factors, disability, treatments, … • Science and Practice needs: genes, patient care, population health … Fragmented Information  integration is needed• ICD has to be re-engineered as – IT sector, economics, governments, international regulations – Information Systems Formal representation of Biomedical Knowledge Common Exchange platform for Health Information Systems• Multiple stakeholders are involved: Policymakers; Providers; Clients; – a common language is needed ICD needs to be built jointly
    3. 3. Construction of ICD-10:Revision Process in 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
    4. 4. 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
    5. 5. How do we gofrom Here to 21st Century?
    6. 6. ICD-11 Timeline• 2011 : Alpha version ( ICD 11 alpha draft) – +1 YR : Commentaries and consultations• 2012 : Beta version & Field Trials Version – +2 YR : Field trials• 2014 : Final version for public viewing –2015 : WHA Approval• 2015+ implementation
    7. 7. ICD Revisionhttp://who.int/classifications
    8. 8. ICD11 αlpha http://www.who.int/classifications/icd/revision • Alpha – Browser & Print 10 look & feel + descriptions – code structure ! • ICD-11 alpha draft is INCOMPLETE • updated on a daily basis • NOT TO BE USED for CODING at this stage • not yet been approved by the TAGs, RSG or WHO
    9. 9. • Open and Collaborative Platform – Web based – Like WIKI – Trip Advisor • But structured – by the Content Model • Editorial Oversight – by the TAGs
    10. 10. Required Parameters: Any Category in ICD is represented by:1. TITLE of ENTITY: Name of disease, disorder, syndrome…2. Classification Properties3. Textual definition4. Terms: Synonyms - Inclusion – Exclusion - Index terms5. Body System(s) / Part(s)6. Temporal Properties7. Severity Properties
    11. 11. Optional Parameters:8. Manifestation Properties9. Causal Properties10. Functioning Properties11. Specific Condition Properties12. Treatment Properties13. Diagnostic Criteria
    12. 12. Browsing ICD Entities
    13. 13. Advanced Search
    14. 14. OpenID Logon
    15. 15. User Profile
    16. 16. Threaded Comments
    17. 17. Single Assessment Questions
    18. 18. Suggesting Definitions
    19. 19. Comments
    20. 20. Dashboard (Foundation)
    21. 21. ICD-11 Features Internet Based Input from Platform all Stakeholders Content Model Definitions Field Trials for Electronic Health Record Use Cases Ready Arabic Chinese English English Français FrenchMulti Lingual Representations Русский язык Russian Español Spanish Deutsch German Português Portuguese
    22. 22. Information Notes:1. Communication & Dissemination2. Revision Timelines3. TAG Allocations4. Content Model5. Foundation Component & Linearizations6. Legacy Linearizations7. Code Structure8. Multidimensional Coding9. Index10. < …>
    23. 23. Primary CareFoundation: ICDcategories with Linearizations - Definitions, synonyms - Clinical descriptions Morbidity - Diagnostic criteria - Causal mechanism - Functional Properties Find Term MortalitySNOMED-CT,International Classification of 26Functioning, Disability and Health (ICF)…
    24. 24. 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)
    25. 25. ICD11 Code Structure Information Note 7 – under SEG Consideration• Default ICD Code format: E1D213 .E4E5 E: base 34 (0-9; A-Z caps – less I, O) D: base 26 (A-Z caps caps – less I, O) 1: base 10 integers (0-9)• Optimum expressive space – Block and chapters not included in design – but accommodated• E1D213 = Same pre-coordinated set for mortality, morbidity – Russian Dolls – Telescopic expansion
    26. 26. ICD Multi-dimensional CodingInformation Note 8 – under SEG Consideration• Representing qualifiers by post-coordination• E1D213 .• Agreed Multiple Dimensions will include: • Anatomic detail, including Laterality • Severity • Temporality • Causal agent/etiology
    27. 27. Issue of Pre-coordinated Categories: Coding cycling accident in ICD-10 • V12.24 Pedal cyclist injured in collision with two- or three- wheeled motor vehicle, unspecified pedal cyclist, non- traffic accident, while resting, sleeping, eati ng or engaging in other vital activities
    28. 28. The history of cycling codes• 1972 ICD-9 (E826): 8 codes• READ-2 (T30..): 81 codes• READ-3: 87: 82 codes• 1999 ICD-10: 587 codes
    29. 29. Defusing the exploding bicycle: 500 codes in pieces• 10 things to hit… – Pedestrian / cycle / motorbike / car / HGV / train / unpowered vehicle / a tree / other• 5 roles for the injured… – Driving / passenger / cyclist / getting in / other• 5 activities when injured… – resting / at work / sporting / at leisure / other• 2 contexts… – In traffic / not in trafficV12.24 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
    30. 30. Conceptual Lego… it could be... Post-coordinated Structured Data EntryFile Edit HelpCycling Accident What you hit Your Role Activity Location
    31. 31. Managing ExpectationsMarch 2012 May 2012• vTAG input finished • Representation of• SEG finalizes the key Mortality and Morbidity linearizations Linearizations • Reference Guide ( vol II) • Index (vol III) • Field Trial protocols • Multilingual Prototype
    32. 32. Current Status as of end Jan.2012• Some Chapters need further work – Infectious Disease A – Neoplasms B,C – Sign & Symptoms R – Z codes• Other chapters’ structure reported to be complete• Definitions > 50% – Top level > 70 %
    33. 33. ICD-11 FeaturesInternet Based Input fromPlatform all StakeholdersContent Model DefinitionsTranslationsField Trials for Electronic Health RecordUse Cases Ready
    34. 34. Bridge Coding • The information on a case (live or medical record) will be coded: • ICD10 • ICD11 to see whether both systems yield the same codes.
    35. 35. BETA PHASE FIELD TESTS: How TWO different users code the same case ? Measles Rubella MeaslesRubella
    36. 36. Stability Analysis of ICD-11 key linearizations• Categories remain constant vs changed • Mortality • ICD Morbidity - DRGs changed 11 10 constant
    37. 37. ICD11 alpha - DIFF • Shows the change from ICD-10 – Backwards compatible
    38. 38. “DIFF”Tracking incremental changes from ICD
    39. 39. The curious case of …
    40. 40. Transition Strategy ICD-10 ICD-11 ICD-975 79 90 13 15 ?? 4 23 ICD - 2016 ICD - 2018 ICD - 2019 ICD - 2017 2015
    41. 41. Collaboration with IM TAG Post TOKYO: • Participation in the ICD Revision • Joint Authoring • Review Panels • Organizing Field testing • Other BUSINESS Applications: • Electronic Health Records • Education
    42. 42. ICD Revision OverviewInternal Medicine TAG 2012 Dr. T. Bedirhan ÜstünCoordinator, Classifications, Terminologies, Standards. World Health Organization

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