icd

1. GOOD AFTERNOON

2. SHORT TALK
Dr. Megha Bhengra
Junior Resident II
Community Medicine
GMC Miraj

3. CONTENTS
Introduction
Historical evolution of ICD
Features of ICD-11
New elements of ICD-11
ICD-11 Revision updates
References

4. INTRODUCTION
 The International Classification of Diseases is the international
standard diagnostic tool for epidemiology, health management
and clinical purposes.
 Its full official name is international statistical classification of
diseases and related health problems.
 The is the global health information standard for morbidity and
mortality statistics. ICD is increasingly used in clinical care and
research to define diseases and study disease patterns as well as
managing health care monitor outcomes and allocation of
resources.

5. Continued
 ICD defines the universe of diseases, disorders, injuries and
other related health conditions, listed in a comprehensive
hierarchical fashion that allows for:
1. Easy storage , retrieval and analysis of health information for
evidenced-based decision -making.
2. Sharing and comparing health information between hospitals,
regions, settings and countries.
3. Data comparisons in the same location across different time
periods.

6. HISTORICAL EVOLUTION OF ICD
 Francois Bossier de Lacroix better known as Sauvages is
credited with the first attempt to classify diseases systematically,
in his comprehensive treatise under the title Nosologia
Methodica.

7. CONTINUED
 William Cullen of Edinburgh published the classification of disease
in 1785 under the title Synopsis nosologiae methodica.
 However, the statistical study of disease began with the work of
John Graunt on the London Bills of Mortality. He attempted to
estimate the proportion of liveborn children who died before
reaching the age of six years .

8. Continued
 In 1837, the General Register office of England and Wales,
William Farr labored to perfect the classifications of diseases
available at that time and tried to secure better classifications
and international classifications and international uniformity in
their use.

9. Continued
 However the first international classification edition , known as the
International list of causes of death, was adopted by the
International Statistical Institute in 1983 through a committee
chaired by French man Jaques Bertillon.

10. Continued
 WHO was entrusted with the ICD at its creation in 1948 and
published the 6th version, ICD-6 that incorporated morbidity for
the first time. The 6th revision included morbidity and mortality
conditions and its title was modified to reflect the changes:
Manual of International Statistical Classification of Diseases,
Injuries and Causes of Death.
 The WHO Nomenclature Regulations, adopted in 1967 ,
stipulated that member states use the most current ICD
revision for mortality and morbidity statistics. The ICD has been
revised and published in a series of editions to reflect
advances in health and medical science over time.

11. ICD REVISIONS
1900-ICD 1
1910-ICD 2
1921-ICD 3
1930-ICD 4
1939-ICD 5
1949-ICD 6
1958-ICD 7
1968-ICD 8
1979-ICD 9
1999-ICD 10
IN PROCESS-ICD 11

12. A NEW WAY TO BUILD ICD

13. TIME LINE OF ICD 11 REVISION
MAY
2011
JULY
2011
MAY
2012
MAY
2018
Open ICD-11 Alpha
Browser to the
Public for viewing.
Open ICD-11 Alpha
Browser to the Public
for commenting.
Open ICD-11 Beta
To the Public.
• WHO is engaged with
interested stakeholder
for ICD revision.
• Individuals are able to
make comments, make
proposal, participate
field trial and assist in
translating.
Present the ICD-11
to the World
Health Assembly.

14. FEATURES OF ICD 11
1. Internet based platform
2. Input from all Stakeholders
3. Content Model

15. 4.Definitions
5. Field Trials
for use cases

16. 6. Electronic Health Records
7. Multi Lingual Representations ‫لألمراض‬ ‫الدولي‬ ‫التصنيف‬
國際疾病與相關健康問題統計分類
International Classification of Diseases
Classification internationale des maladies
Международная классификация болезней
Clasificación internacional de enfermedades

17. 1. INTERNET BASED PLATFORM
• Open all year around with continuous updates.
i. ICD-11 Browser is a website that allows the user see the
current state of the development of the ICD 11th Revision.
ii. The content on the site is updated daily with new content.
iii. It also allow it users to contribute to the ICD 11 development
by writing comments, making change in proposals, help translation
etc.
• Open to all interested people
i. Health care providers, Health information managers, researchers,
policy makers, insurers and National Health programmes managers.
ii. Also for structured review by experts ( TAG, RSG, JTF)

18. COUNTINUED
• Presented in a Structured Web Platform I CAT i.e. The
Collaborative Authoring Tool for the 11th Revision of
International Classification Of Diseases.
• The access to iCAT is restricted to Topic Advisory Group (TAG)
members only.
• Open and Collaborative platform.
i. Web based.
ii. Like Wikipedia but structured by the Content Model.
iii. With editorial oversight by TAG and scientific peers.

19. 2. INPUT FROM ALL STAKEHOLDERS
 Participation of interested stakeholders using a Collaborative
Authoring Tool in which WHO aims to engage all experts and
stakeholders to
i. Make Comments.
ii. Make Proposals.
iii. Take part in Field Trials.
iv. Engage in translations for multilingual representations.
v. Subjected to the scientific peer review process guided by
experts groups such as TAG, RSG etc.

20. GOVERNANCE STRUCTURE OF ICD 11
Revision Steering
Group –Small
Executive Group
( RSG-SEG)
• The RSG-SEG advises
on high level
connections within
and outside ICD-
11and helps resolve
possible conflicts
arising in the design of
the JLMMS.
JLMMS Taskforce
(JTF)
• The JTF is the
steering group of
JLMMS. The JTF
provides strategic and
technical advice to
WHO for the
finalisation.
Revision Steering
Group
(RSG)
• The RSG serves as a
forum for the bilateral
exchange of
information and
concerns of TAG
Chairs representing
the membership of
TAGs and
dissemination of
revision or
maintenance related
general information.

21. Continued
Vertical Topic Advisory Group
(TAGs)
• They have the role of scientific
Editorial Board, with the
responsibility to advise WHO
on the scientific validity of the
content and relationship in the
foundation component.
Cross-cutting Topic Advisory
Group (TAGs)
• They provide expertise in
coding practice and guidelines
as well as development and
implementation of
classification, with the
responsibility to advise WHO
on the quality and utility of
classification.

22. ICD REVISION ORGANIZATIONAL STRUCTURE
WHO
Revision Steering Group
Health Informatics and Modeling TAG
(HIM TAG)
iCAT Software Team
Functioning TAG
Mortality TAG
Morbidity TAG
Quality & Safety TAG
Traditional Medicine TAG
Dentistry TAG
Musculoskeletal TAG
Mental Health TAG
Maternal, Neonatal and
Urogenital TAG
External Causes and
Injuries TAG
Dermatology TAG
Internal Medicine TAG
Neurology TAG
Ophthalmology TAG
Paediatrics TAG Gastroenterology WG
Cardiovascular WG
Hepatology &
Pancreatobiliary WG
Nephrology WG
Endocrinology WG
Rheumatology WG

23. 3. CONTENT MODEL
 The Content Model is a structured framework that captures the
knowledge that underpins the definition of ICD entity.
i. Represents ICD entities in a standard way.
ii. Allows Computerisation.
iii. Each ICD entity can be seen from different dimensions or
“parameters”. There are currently 13 parameters.
iv. A parameters is expressed using standard terminologies
known as value sets.

24. THE CONTENT MODEL PARAMETERS
1. ICD Concept Title
1.1. Fully Specified Name
2. Classification Properties
2.1. Parents
2.2 Type
2.3. Use and Linearization(s)
3. Textual Definition(s)
4. Terms
4.1. Base Index Terms
4.2. Inclusion Terms
4.3. Exclusions
5. Body Structure Description
5.1. Body System(s)
5.2. Body Part(s) [Anatomical Site(s)]
5.3. Morphological Properties
6. Manifestation Properties
6.1. Signs & Symptoms
6.2. Investigation findings
7. Causal Properties
7.1. Etiology Type
7.2. Causal Properties - Agents
7.3. Causal Properties - Causal Mechanisms
7.4. Genomic Linkages
7.5. Risk Factors
8. Temporal Properties
8.1. Age of Occurrence & Occurrence
Frequency
8.2. Development Course/Stage
9. Severity of Subtypes Properties
10. Functioning Properties
10.1. Impact on Activities and Participation
10.2. Contextual factors
10.3. Body functions
11. Specific Condition Properties
11.1 Biological Sex
11.2. Life-Cycle Properties
12. Treatment Properties
13. Diagnostic Criteria

25. 4. DEFINITIONS
 All ICD entities will have definitions :
1. Key descriptions of the meaning of the category.
2. In human readable forms to guide users.
(This is an advancement over ICD 10, which had only title Headings)
3. Limited definition in print version.
 Definitions will be compatible with:
1. The Content Model.
2. Diagnostic Criteria.
3. Across the whole classification of ICD-11 version.

26. 5. FIELD TRIALS
BETA PHASE FIELD TESTS:
How TWO different users code the same case ?
Measles
Rubella
Measles
Rubella

27. CONTINUED
 Aims to test the “ Fitness to the ICD 11 for multiple purposes.”
1. Mortality Coding.
2. Morbidity Coding.
 To ensure the comparability between ICD-10 and ICD-11.
 To increase consistency, identify improvement paths and reduce
errors.
 Use to assess applicability, feasibility, consistency and utility.

28. CONTINUED
 Different types of core studies and additional studies have been
developed along with instruments and procedures to ascertain
issues with ICD-11 or its implementation, to undertake:
1. Bridge coding .
2. Studies of inter coder reliability.

29. Bridge / Line Coding
 The information on a case ( live or medical record ) will be coded
1. In ICD -10 Version.
2. In ICD-11 Version.
 So, to assess whether both the system yield the same code.

30. INTER CODER RELIABILITY
 The information on a case ( live or medical record) will be
coded by two different medical coder to assess whether they
concur on the same code.

31. 6. ELECTRONIC HEALTH RECORDS
 The organisation or groups sees
ICD -11 as representing the key
strategic issues for current and future
health information system, with its
capabilities to open in an EHR and
terminology environment.
 The theme for the ICD 11 Revision
Conference held in October 2016, was
“Health information in new era”.
 ICD-11 is regarded as future proofing
to make classification acceptable for
clinicians in an e-health environment.

32. 7. ICD 11 IN MUTIPLE LANGUAGES
 ICD has been translated into 43 languages so far.
 Built on the experience in previous ICD translations and using
the Content Model and standard terminologies in ICD-11
revision process, the ICD-11 have the computerised assistance
for its development in multiple languages with human experts
verifying concept equivalence.
1. This is called a multilingual representation and not translation.
2. Aim is to represent equivocal concept rather than word by word
translation.

33. CONTINUED
 The priority is on 6 official Languages.
− English
− French
− Spanish
− Russian
− Chinese
− Arabic
− Two WHO regional official Languages, German and
Portuguese.
 Other language representations is done at the request of WHO
Collaborating centres in different languages area.

34. ROLE OF SNOMED CT IN ICD-11
 The International Health Terminology standards development
organisation (IHTSDO), developers and owner of SNOMED CT
i.e. Scientific Nomenclature of Medicine Clinical Terms, has a
collaboration agreement with WHO to ensure linkages between
SNOMED CT and WHO classification.
 IHTSDO is working to ensure alignment between SNOMED CT
content and that proposed in ICD-11, so clinicians can
globally use SNOMED CT in the electronic record for clinical
information and users can then link across to ICD-11 for
information related to healthcare statistics, billing ,public health,
epidemiology etc.

35. CONTINUED
 The review focuses on identifying in SNOMED CT, such as
specific classification terms.
 The IHTSDO is working through ICD-11 beta version chapter
by chapter and preparing an initial assessment.
 This is followed by a review by clinical specialists – to review
what SNOMET CT changes are being proposed, to ensure
clinical relevant for international usage as well as ensuring that
the clinical definitions are understandable in line with current
clinical Practice.

36. CONTINUED
2017 Project Scope Deliverables Release
1. Alignment between SNOMED CT
and ICD-11
1. Delivery of 1200 concepts to
support MMS in the July 2017
SNOMED CT.
2. Delivery of 1200 concepts to
support MMS in the Jan 2018
SNOMED CT.
3. Potential of 400 plus concepts that
may be include in Jan 2018 release.
1. In progress,
July 2017.
2. Jan 2018
3. Jan 2018
2. ICD11 Map 1. Create Map for ICD-11 alignment to
scope of MMS.
1. In progress,
2017, multi
release project.
3. Additional ICD-11 chapters. 1. Delivery of additional chapters
1.2018 -
dependent on
funding and
priority.

37. WHY WORK TOGETHER ?
 WHO and IHTSDO
i. Coverage and adequacy.
ii. Quality, reliability and utility.
iii. Multilingual acceptability
iv. Interoperability.
v. Sustainability.

38. NEW ELEMENTS OF ICD-11
 New chapters:
i. Chapter 3: Diseases of blood and blood forming Organs.
ii. Chapter 4: Disorder of immune system.
iii. Chapter 5: Conditions related to sexual health.
iv. Chapter 8: Sleep-wake disorder.
v. Chapter 26: Extension code.
vi. Chapter 27: Traditional Medicine.
Differences to ICD-10

39.  New Concepts:
i. Foundation: Everything in ICD.
ii. Entity: Each element in the foundation.
iii. Linearization: also known as classification.
iv. Stem code: Category (includes former dagger codes).
v. Extension Codes: additional information.
vi. Linearization parents: Classification Hierarchy , chapters,
blocks, category.

40.  Content Model
1. ICD-11 categories have a short and long definitions.
2. All ICD-11 categories include separate information on
anatomy, aetiology, and other aspects.
3. These can be assessed through searches, or when browsing the
tabular list.

41. Example-
 In ICD 11 Beta draft version, in chapter 1 of infectious diseases
Tuberculosis
Tuberculosis of the respiratory system
1B30 Respiratory Tuberculosis, confirmed
1B31 Respiratory Tuberculosis, not confirmed.
Tuberculosis of system other than respiratory system
1B40 Tuberculosis of nervous system.
1B40.1 Tuberculosis Meningitis.
1B40.3 Tuberculous meningo encephalitis.

42.  New coding Scheme.
1. The chapter numbering: now Arabic , not roman numerals.
2. The coding scheme for categories: now minimum 4 characters,
2 levels of subcategories.
3. Asterisk codes become clinical forms and extension codes..

43.  Terminology
1. ICD-10 had a range of expressions to describe a causal
relationship between conditions in a code title. In ICD-11, the
preferred term is “due to”.
2. ICD-10 had a range of expressions indicating the coincidence of
two conditions in a code title (e.g. “in or with”).In ICD-11
preferred term is “associated with”.

44. ICD-11 RECENT UPDATES
 WHO publishes quarterly newspapers to inform key stakeholders
and the public about the progress and advancements within the 11th
ICD revision progress.
 Latest newspaper on ICD-11 revision is published on January
2017.
 WHO organized a high level ICD-11 conference for member
states, hosted by the collaborating centre WHO-FIC in Japan
from 12-14 October 2016.
 The Theme for the conference was “ Health information in the
new era “ and the opening session aimed to frame the ICD in the
global health, the Sustainable Development Goals (SDGs) 2016-
2030 and country realities.

45. (A) ICD-11 : TAKING SHAPE
 Following the ICD-11 conference ,WHO team has been focussing
on cross-cutting view of the classification with the help of TAG.
 The horizontal work is done to ensure the chapters work together
and are consistent in their approach to classifying entities .
 There has also been work done on the index to confirm that term
points to the correct location and are correctly written in the
natural languages.
 The mapping of concepts between the ICD-10 and ICD-11 is in
the review process.
 Movements of entities between chapters are verified and corrected
where necessary.

46. ICD INFORMATICS UPDATE
 Currently, the ICD-11 browser is in the beta phase.
ICD-11 Beta Draft ( Mortality and Morbidity Statistics)
Search [ Advanced Search ]
Last Update:
[ Register ] | [ Log In ]
?
?
?
Foundation Linearization Contributions Info
 01Certain infectious and parasitic disease
 02 Neoplasms
 03 Diseases of blood or blood forming organ
 04 Diseases of immune system
 05 Endocrine, nutritional or metabolic diseases
 06 Mental , behavioural or neurodevelopment disorders
 07 Sleep-wake disorders
 08 Diseases of nervous system
 09 Diseases of visual system
 10 Diseases of ear and mastoid process
 11 Diseases of circulatory system
 12 Diseases of respiratory system
 13 Diseases of digestive system
 14 Diseases of the skin
 15 Diseases of musculo-skeletal system or connective tissue
 16 Diseases of genitourinary system
 17 Conditions related to sexual health
 18 Pregnancy, childbirth and puerperium
 19 Certain conditions originating in the perinatal period
 20 Developmental anomalies
 21 Symptoms, signs and clinical finding
Foundation Id : http://id.who.int/icd/entity/1435254666
01 Certain infectious and parasitic diseases -
Description
This chapter includes certain conditions caused by a pathogenic
organism, such as bacterium, virus, parasites
Exclusions
• Infections of the foetus and new born *(KA40-KA4Z)
• Human prion diseases* (8C60-18C6Z)
• Pneumonia * (CA20)
All Index Terms
There are no index terms associated with this entity.
ICD-11 Beta Draft-Morbidity and Mortality
statistics

47. POST-COORDINATION IN ICD-11 BROWSER
 Post-coordination system allows adding more details to a
category. Different types of information can be added to different
entities.
 For example, additional histopathology information could be
added to most part of the neoplasms categories.
 Displaying / searching value sets of post-coordination-
1. Some post-coordination axis can get values from a small set of
possible values such as laterality.
2. Some axes can get values from a rather large value set such as
histopathology.

48. Post-coordination ?
2D1Z Malignant neoplasm of breast , unspecified. Code: 2D1Z&XB32&XC56
Laterality XB32 Right
Specific Anatomy XC56 Upper outer quadrant of breast
Add detail to Malignant neoplasms of breast, unspecified
Laterality (Use additional code, if desired)
XB30 Bilateral
XB31 Left
XB32 Right
XB33 Unilateral, unspecified
XB34 Unspecified laterality
Specific Anatomy (Use additional code, if desired)
XC50 Nipple
XC51 Lactiferous duct
XC52 Areola
XC53 Upper inner quadrant of breast
XC54 Lower inner quadrant of breast
XC55 Lower outer quadrant of breast
XC56 Upper outer quadrant of breast
XC57 Axillary tail of breast
Histopathology (Use additional code, if desired)
Search ?
 Histopathology
- Acinar cell neoplasms
- Adenomas and adenocarcinoma
- Adnexal and skin appendages
neoplasms
- Basal cell neoplasms
- Blood vessel tumour
- Complex epithelial neoplasms
- Complex mixed and stromal
neoplasms
- Cystic,mucinous and serous
neoplasms.

49. BUILDING A CODE STRING
 Building a code string: click on the values that are displayed
in the search results , in the hierarchy or in the shorter lists.
 The example shows malignant neoplasm of breast with detailed
laterality and specific anatomy. The code generated at the right top
area.

50. (B) ICD-11 FOUNDATION UPDATE
 Updates have been informed by proposals as well as the reviews
conducted by medical societies and together with Joint Task Force.
 Proposals and review outputs received by 31st December 2016 have
become part of ICD-11 version for the extended quality assurance
which has began in March 2017.
 Proposals that are received between 1st January 2017 and 30th March
2017 will be taken into account for the implementation of final
version.
 Proposals received after that date will be considered in the context of
ICD-11 maintenance after 2018.

51. Continued
 In addition to the changes in classification
1. Review of 35,000 Index entries, which were edited in terms of
titles, spelling , languages and with appropriately guiding users to
the correct entities.
2. An additional 4000 terms were added to the foundation from the
review of national death certificate reporting.
3. At the structural level, 11000 parenting changes, 6163 entity titles
were edited for completeness and accuracy. 4255 changes were
made to the shoreline, 2200 changes to the different grouping in
hierarchy.

52. ( C) Implementing line coding pilot testing in ICD-11-MMS
 Morbidity line coding pilot testing:
1. 22 countries are participating ,fifteen countries are conducting
pilot testing in English and seven in Spanish.
2. The pilot testing started in august 2016 with coding of 308
diagnostic terms (1st and 2nd batch) uploaded to the web based
data entry platform.
3. In the end of November 2016 ,a third batch with 88 diagnostic
term was released for coding.
4. They included coding two or more stem codes with and without
post-coordination, coding of stem codes with one or more
extension codes and coding of “dagger” codes and “asterisk”
codes.

53. continued
 Morbidity line coding pilot testing:
1. Initiated at the end of January 2017.
2. Fourteen countries are lined up to participate in the exercise
3. Compilation of list of terms most commonly found in Death
certificates at national levels from selected countries.
4. A first batch with 100 Cause of death terms was identified and
uploaded.

54. SUMMARY
 The ICD is the global health information standard for mortality
and morbidity statistics.
 117 countries use the system to report mortality data, a primary
indicator of health status.
 ICD-11 has been aimed in the last conference to be the part
of SDGs 2016-2030.
 It has been translated into 43 languages.
 About 70% of the World’s health expenditure (USD$ 3.5 billion)
are allocated using ICD for reimbursement and resource
allocation.
 The 11th revision process is under way and the final ICD-11 version
will be released in 2018.

55. REFERENCES
 WHO information sheet-Key facts of ICD (2017),
http://www.who.int/classifications/icd/factsheet/en/
 Bhalwar R.et al, Classification of diseases, In: Text book of Public Health and community medicine,
Department of community medicine, AFMC in collaboration with WHO, India office, New Delhi
Publishers,1st edition,Pune,2009,Page no:35-37
 WHO ICD-11 Revision quarterly news paper (2017), www.who.int/classifications/icd/revision/en/

56. THANK YOU !