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![THE CONTENT MODEL
Any Category in ICD is represented by:
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](https://image.slidesharecdn.com/ustunhagueshow-151016063736-lva1-app6892/75/ICD11-DRGs-12-2048.jpg)
Uploaded byBedirhan Ustun
ICD11 & DRGs
The document discusses the advancements and goals pertaining to the ICD-11 revision, which aims to enhance clinical documentation, interoperability, and the overall classification of health conditions. It critiques the limitations of ICD-10, emphasizing the need for a more contemporary classification that accommodates digital environments and aligns with current clinical practices and terminologies. Additionally, it outlines the structure, functionality, and intended applications of ICD-11 within various health systems, including mortality and morbidity coding, healthcare resource allocation, and improved patient care.
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ICD11 & DRGs
- 1. ICD Developments How canICD-11 possibly help you enhancing your casemix ? Dr. T. Bedirhan Üstün World Health Organization Classifications, Terminologies, Standards
- 2. How can ICDRevision enhance PCS ? • ICD follows current clinical thinking and scientific updates • the clinical documentation will be accurately coded • meaningful patient information is captured. • ICD is an opportunity to review and align the classification to: • current clinical thinking, morbidity and other use cases • PCS, Casemix, DRGs etc • Computerization: • Deconstruction into data elements • Meta data 2018
- 3. What is wrongwith ICD-10? • It is produced in 1990 – with 1980s scientific input • An update mechanism was built in 1998 and still functions but updates are restricted to system boundaries • Digital representation is not up to todays IT needs • Classification logic, rules and applications contains errors and gaps • Limited use: • in mortality in 110 countries • in morbidity beyond 30 countries • Translations limited and not quality assured • No OFFICIAL PRIMARY CARE VERSION • National Modifications exist without international coordination • Specialty Adaptations exist without international coordination
- 4. ICD-11 Revision Goals 1.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
- 5. Genealogy of ICD 1664 350 years
- 6. ICD Revisions 139 161 179 189 205 214 200 954 965 1,040 1,164 8,173 1,967 14,473 1 10 100 1000 10000 100000 Farr/d'Espine Bertillon ICD1 ICD2 ICD3 ICD4 ICD5 ICD6 ICD7 ICD8 ICD9 ICD-9-M ICD10 ICD-10-M 1853 18931900 1909 1920 1929 1938 1948 1955 1968 1975 1979 1993 1993
- 7. Placing WHO Classificationsin HIS & IT Population Health • Births • Deaths • Diseases • Disability • Risk factors e-Health Record Systems ICD ICF ICHI Classifications KRs Terminologies Clinical • Decision Support • Integration of care • Outcome Administration • Scheduling • Resources • Billing Reporting • Cost • Needs • Outcome
- 8. How do wego from Here to 21st Century?
- 9. How do we optimizeour health services Health Systems & Information Systems: Analog to Digital
- 10. Ontology (philosophy) the Organizationof Reality !!! Ontology (computer science) – the explicit – operational description of the conceptualization of a domain • Entities • Atributes • Values • An ontology defines: – a common vocabulary – a shared understanding / exchange: • among software agents • between people and software – to reuse data - information – to introduce standards to allow interoperability among people What is “NOntology” ?
- 11. • Open andCollaborative Platform • Web based • Like WIKIPEDIA • But • by the Content Model • with • by the TAGs , and scientific peers
- 12. THE CONTENT MODEL AnyCategory in ICD is represented by: 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
- 13. ICD11 βeta http://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
- 14. What is available: •ICD-11 Beta version 2015 for review and field trials • Maps between ICD versions 10 – and 11 • For longitudinal data analysis • 10 DRGs: can they be re-built in 11? • Can we build better DRGs using extra features in ICD11?
- 15. The ICD FoundationComponent • 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, songs, lego pieces.
- 16. 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
- 17. What is aCasemix System or DRGs ? • a set of classes of patient treatment episodes which are relatively homogenous in: • clinical characteristics • resources used • Used for: • Budgeting/Funding • Reimbursement /Paying the health care providers • Cost control • Quality control • Benchmarking Efficiency Quality Better Information Better Decision-making
- 18. 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
- 22. Level Name UseCase Size Pre –Post Coordination 1 SHORT Linearization Primary Care – Low Resource o {Short Mortality - Verbal Autopsy ?} ~ 1500 categories Pre- coordinated 2 Intermediate Linearization Primary Care – High Resource ~ 3000 categories Pre- coordinated 3 Common Linearization Joint Linearization for Mortality and Morbidity Statistics Volume I tabular list 15,000 categories Pre-coordinated (mortality) Pre + Post Coordinated (morbidity) 4 Extension Linearizations National Linearizations Specialty Linearizations > 15,000 categories Pre + Post Coordinated
- 23.
- 24. Linearizations: PC short PCIntermediate JLMMS
- 25. Title Primary C.Joint Lin. Ophthalm. Cataract code code code Age-related cataract code code code Cortical age-related cataract other other code Nuclear age-related cataract other other code Cataracta brunescens other other code Nuclear sclerosis cataract other other code Capsular and Subcapsular age-related cataract other other code Capsular age-related cataract other other code Anterior subcapsular polar age-related cataract other other code Posterior subcapsular polar age-related cataract other other code Incipient age-related cataract other other code Coronary age-related cataract other code code Punctate age-related cataract other code code Water clefts other other code Advanced 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 code Morgagnian age-related cataract other other code Calcified age-related cataract other other code Combined forms of age-related cataract other other code DIGITAL ZOOMING
- 26. Current Status • FrozenMay 2015 … JLMMS • iCAT continues real time… BROWSER • Linearization errors < 274 (from 10K) • Duplicates < 269 (from 3K) • Definitions • Top level > 75 % ~ 10,000 definitions
- 27. What Can ICD11offer systematically? A systematic meaningful integrated system of clinical conditions (not only for DRGs … ) • Better clinical description • Better severity grading • Better coding of co-morbidity • Inherent functional information (key ICF classes) • Integrated information system between ICD, ICF, ICHI • Deconstructing Diagnosis into subgroups • Computerized information processing
- 28. • Mortality • Morbidity •ICD-10-WHO with ICD-11-WHO • ICD-10&11-WHO with ICD-10-GM • ICD-10&11-WHO with ICD-10-CA • ICD-10&11-WHO with ICD-10-AM • ICD-10&11-WHO with ICD-10-CM Stability Analysis Types & Methodology
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- 30. Transcoding tables ICD-10to ICD-11 in excel
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- 32.
- 33. ICD-10 ICD-11 correspondence •3 character w/o ECI & Residuals • 930 Equivalent • 189 mapped to a larger entity in 11 • with post coordination many have equivalent maps • 6 not mapped 1125 TOTAL • 4 character • 3980 Equivalent • 1108 mapped to a larger entity in 11 • with post coordination many have equivalent maps • 4 not mapped • 5092 TOTAL
- 34. ICD-10 ICD-11 correspondence •3 character w/o with ECI & Residuals • 930 1412 Equivalent • 189 615 mapped to a larger entity in 11 • with post coordination many have equivalent maps • 6 112 not mapped 1125 2249 TOTAL • 4 character • 3980 5262 Equivalent • 1108 3769 mapped to a larger entity in 11 • with post coordination many have equivalent maps • 4 43 not mapped • 5092 9074 TOTAL
- 35. 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 Topology Specific Anatomic Location Provisional diagnosis Histopathology Diagnosis confirmed by Biological Indicators Rule out / Differential Consciousness External Causes (detail) Injury Specific (detail)
- 36. What can aICD11 CODE represent? 1 2 3 4 Service Contacts Episode of Care Inpatient Community Residential Ambulatory 1 2 3 54 Course A B C D Illness A B
- 37. Multiple Coding Equivalent Expressions Chain/ String Style JH6.100/ XT0.???/ XD0.100 STEMI - posterior wall – confirmed by EKG Cluster Style • JH6.1001 Myocardial Infarction with ST Elevation • XT0.???1 Posterior wall of heart • XD0.1001 Diagnosis Confirmed by EKG • 1 CLUSTERING indicator.
- 39. Defusing the explodingbicycle: 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 traffic 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
- 40. • 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
- 42. Multiple Coding Equivalent Expressions ClusterStyle • Code1* • Code2* • Code3* • .. • * CLUSTERING IND. Chain / String Style • Code1/Code2/Code3
- 43. Multiple Coding Equivalent Expressions Chain/ String Style JH6.100/ XT0.???/ XD0.100 STEMI - posterior wall – confirmed by EKG Cluster Style • JH6.1001 Myocardial Infarction with ST Elevation • XT0.???1 Posterior wall of heart • XD0.1001 Diagnosis Confirmed by EKG • 1 CLUSTERING indicator.
- 44. POST COORDINATION MECHANISM •Extension codes are implemented in iCAT • Sanctioning tables are being generated • REQUIRED • ALLOWED • DISALLOWED • First target group is the REQUIRED a. ICD-10 categories which have equivalence with ICD11 STEM + X codes (around 1000 codes) b. other
- 45. Background 1: National Linearization(s) level3 - JLMMS level 4 National Linearization(s) - Morbidity only ! - Mortality will use JLMMS Specialty Linearizations - Morbidity only - Research 48 3 4
- 46. Background 2: STEM CODES& Extension codes • Precoordinated ICD-11 codes are called STEM CODES • STEM CODES give the basic classification tree structure • Additional details are added to STEM CODES by EXTENSION CODES Pre-coord. Post-coordination 1 - 3 / 4 5 – 6 STEM Code EXTENSION CODES ICD11 levels
- 47. Background 3: Sanctioning Tables 50 •Not all extension codes could be used for a given STEM CODE • Applicable extensions for a stem code will be specified in SANCTIONING TABLES • Sanctioning tables will identify each relevant item as: • Required (this set is essential for JLMMS – Morbidity) • Applicable • Non-applicable
- 48. • 2015 :Beta version for Review & Field Trials • +2 YR : Field trials • 2016 : Information Session at WHA • 2018 : Final version for WHA Approval • 2019+ implementation • Continuous Annual Cycles • ICD 2019 • ICD 2020 ICD-11 Timeline
- 49. Achievements • Good foundation– linearization mechanism • Joint Linearization for Mortality and Morbidity Statistics • Model for Multiple Linearizations ( Primary Care1, Others) • Model for retrofitting: ICD-10, ICD-10-CM or others… • Model for future updates and maintenance • Stability with ICD-10 with Transcoding and Crosswalk tables • Definitions • Content Model – allow semantic web properties • Quality Check mechanisms • Annotations for reasons for changes • Post-coordination Mechanism • Proposal Mechanism • Review Mechanism • Computerized Index • CODING TOOL • Multilingual Presentation: Computer-assisted crowd sourced Translations • SNOMED Linkages: • > 4000 New Codes
- 50. Still To Do… •Continue improvements… JLMMS vs Clinical • Finalization of key linearizations: JLMMS first • National linearizations - • Specialty linearizations – • Continuous Review Process • Improvement of INDEX • Continuation: RSG URC • URIs - web services • Automated Coding Tools for Mortality ? • DRG groupers?
- 51. Why a ReviewProcess • 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
- 52. ICD11 Field Trials •Applicability (Feasibility) – • Is the classification easy to implement in the hands of the real life users (coders, doctors etc.) ? • Reliability – • Is the classification used in the same manner by different users? • Do two different users code the same case with the same code? • What are the sources of discrepancy? • What are the factors to improve comparability and consistency? • Utility – • What is the value of the classification to enhancing data capture and its uses? • Does it improve recognition? • Does it serve for better documentation? • Does it enable re-use? • Does it guide better diagnosis? • Does it allow better resource allocation?
- 53. Field Trials • KEYUSES: • Mortality: cause of death coding, verbal autopsy • Morbidity: various morbidity codings – hospital discharge, DRG etc. • Quality – Safety • Other uses • DIFFERENT SETTINGS: • Primary Care • High-resource settings • Low-resource settings • General Health Care • Specialty settings • Research settings • Use in population studies - epidemiology • Use in clinical research
- 54. Inter-rater reliability • TheCase information • live • medical record • Coded using ICD11 by at least two different people • Agreement rates measured
- 55. Bridge Coding • TheCase information • live • medical record • Coded using • ICD10 • ICD11 • Agreement rates measured
- 56. ICD-10 B24 HIVdisease B24 HIV disease ICF activity limitations performance restriction in: Moving around (d455.44) Washing (d510.33) Education (d830.44) … Almost fully functional moderate participation restriction in Higher education (d830.03)
- 57. Separate Classification of Diseaseand Disability + = case Diagnosis Disability => better formulation of caseness
- 58. Added Value ofDisability Information Predictive power 13% 8% 19% 28% 100% 100% 150% 123% OR 1 OR 1 OR 1 OR 14 OR 4 OR 15 Functioning Information
- 59. FUTURE: AMA +WHO + = 62 2018 alpha
- 60. It is YOU whois going to build the WHO FIC
- 61. SNOMED : Oldand Current Former SNOMED Enterprise College American Pathologists Global Network Overall Health Care
- 62. Why work together? –WHO & IHTSDO – Coverage & Adequacy – Quality – Reliability - Utility – MultiLingual Applicability – Interoperability – Sustainability – Member States: Enable health care delivery and compile health information SNOMED & WHO Classifications are synergistic and not antagonistic
- 63. Myths to debunk •If you use SNOMED you don’t need ICD • ICD is for statistics only
- 64. The «Common Ontology» Purpose •To provide a common formal knowledge representation structure to enable interoperability between: • ICD-11 and SNOMED CT. • a shared semantics
- 65. Ultimate “Turing-like” Test Ifcommon ontology achieved
- 66.
- 67. Grade 3 hypertension Grade2 hypertension Grade 1 hypertension High normal normal optimal 120 130 140 150 160 170 180 Systolic pressure Diastolicpressure 172 102 110 105 100 95 90 85 80 Knowledge Representation 70
- 68. Rewriting ICD UsingSNOMED example of Depressive Disorder F32.0 A. Low mood {41006004} Loss of interest {417523004 } Low energy {248274002} 1. Appetite (decrease, increase) {64379006, 72405004} 2. Body weight (decrease, increase) {89362005, 8943002} 3. Sleep (decrease, increase) {59050008, 77692006} 4. Psychomotor (decrease, increase) {398991009, 47295007} 5. Libido loss {8357008} 6. Low self esteem {286647002, 162220005} 7. Guilt, self blame {7571003} 8. Thoughts of death … 9. Suicide Ideation {102911000, 6471006} B.
- 69. Beyond Semantic Interoperability forHIS • Search using Concepts above Words • How many patients do have diabetes mellitus type II? • Extraction of Concepts from Health Records • Automated extraction of Hb1Ac results of selected patients with DM type II from lab reports within last year • Statistical Index on Community Collections • Calculation of coverage gap for treatment need for diabetes mellitus • Concept Navigation across Collections • Comparison of region A with region B etc
- 70.
- 71.