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World Health Organization
Classifications, Terminologies, Standards
ICD Revision: Where Are We?
Overview
1. ICD-11 progress
– Current status of progress
– Vol II  ICD knowledge base
– Review Process
– Field Trials
2. ...
Current Status:
• All input from Vertical TAGs received
– Minor exceptions: sexual disorders, some GURM, Mental Health, Ne...
Outline
ICD2013 Beta for Review
• Mortality Package:
1. Mortality Linearization
2. Mortality Stability Tables
3. Annotatio...
Critical Timelines
• Current Packages  mTAG, MbTAG
– Updates in September
• Webex or Live Meetings with vertical TAGs to ...
ICD 2013 Beta
Infrastructure is ready for:
1. Linearization generation
• Index Generation (Print + Electronic)
• Post Coor...
Shoreline
Boundary between Pre- and Post-Coordination
– Mortality Linearization is always Pre-coordinated
– Morbidity Line...
General Rules for
(Pre- and Post-) Coordination
• Items at ICD-10 three-character level would be pre-
coordinated
– unless...
General criteria
for determining pre-coordination
• What to keep in the “Mortality – Morbidity”
Linearizations?
1. Legacy ...
Digital Telescoping
(Russian Dolls)
10
Digital Telescoping
(Russian Dolls)
11
Mort/PCHigh 11
Mort/PCHigh 12
Mort/PCHigh 13
Mort/PCHigh 21
Mort/PCHigh 22
Mort/PCHigh 31
Mort/PCHigh 33
Mort/PCHigh 34
Mo...
Mortality Linearization
– Will include all ICD-10 entities have legacy
for appropriate time series analysis:
• Infant & Ch...
Mortality Linearization
• Mortality Linearization is a
proper subset of Morbidity
Linearization
• There should not be any ...
Mortality Linearization
• Mortality Linearization should only contain items
relevant causes of death
• Each entity to be e...
Mortality Linearization
16
ICD 2013 Beta Mortality Linearization
as of 29 August
• 1,039 categories at ICD10 3 Character-equivalent level
• 3,892 cat...
Morbidity Linearization(s)
• The main international reference for
reporting and data exchange:
– hospital discharge summar...
Morbidity Linearization(s)
1. International WHO Morbidity Linearization
2. National Morbidity Linearization(s)
3. Specialt...
STEM CODES
• Precoordinated ICD-11 codes are called ‘STEM CODES’
• STEM CODES give the basic classification tree structure...
Sanctioning Tables
• Not all extension codes could be used for a
given STEM CODE
• Applicable extensions for a stem code w...
National Linearizations
• Countries who adopt ICD-11
– Use as is: ICD WHO version
– May generate their own “National Linea...
Specialty Linearizations
• Further detail for specialty care could be done
in two ways:
1. Extensions of the Morbidity Lin...
• Ensure a seamless transition
between ICD-10 and ICD-11
– national
– international levels
• CrossCutting TAGs review and ...
• 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-1...
Age-adjusted death rates for
nephritis, nephrotic syndrome, and nephrosis:
United States, 1968-2005
Overall Evaluation
+
• Solid Digitalization
– iCAT
– Browser
– Proposal Mechanism
– Linkage to SNOMED
– URIs
• Engagement ...
ICD-11 Timeline
• 2013 : Beta version & Field Trials Version
– +2 YR : Field trials
• 2015 : Final version for WHA Approva...
ICD-11 Timeline
• WHA Adoption and Implementation
dates are separate
– Member States adopt ICD at their own
convenience
– ...
Transition Strategy
75 79 90 14 15 ??
ICD-9
ICD-10 ICD-11
4 24
2015
ICD-2016
ICD-2017
ICD-2018
ICD-2019
• TAG serving as an
Editorial Board
• Reviews
• Organizing Field testing
• Feasibility
• Quality assurance
• Reliability
R...
ICD-11
administrative data use case:
• Quality - Patient Safety indicators
• Case-mix groupings
• Data – Meta data standar...
ICD Revision use cases
Advanced computerised safety systems:
– Identification of common patterns in safety-relevant events...
Issues
• Is the remaining time sufficient for 2015
– Translations  No
– Implementation Preparation  No
– Proper wide sca...
ICD-11 Timeline
• 2015 : Final version for WHA Approval
– 2015+ implementation
• 2016 : WHA Approval
– More time for Revie...
ICD-11
• International Public Good
– Openly Accessible
– Free for WHO Member States
• Available in multiple formats:
– Pri...
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ICD Revision: Quality Safety Meeting 2013 September 9-10

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This is an overview for the ICD Revision Process particularly about the ICD 2013 Beta version: where are we? What remains to be done? Shall we have ICD WHA submission in 2015 or later?

Published in: Health & Medicine, Technology
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ICD Revision: Quality Safety Meeting 2013 September 9-10

  1. 1. World Health Organization Classifications, Terminologies, Standards ICD Revision: Where Are We?
  2. 2. Overview 1. ICD-11 progress – Current status of progress – Vol II  ICD knowledge base – Review Process – Field Trials 2. Issues and Solution Plans
  3. 3. Current Status: • All input from Vertical TAGs received – Minor exceptions: sexual disorders, some GURM, Mental Health, Neurology… • ICD 2013 Beta for Review  Mortality Linearization  Morbidity Linearization • Linearizations relatively stable – constant updates – Together with Stability Analyses » For review by mTAG and MbTAG » Q&S TAG – PS Indicators » fTAG – mirror codes – Sept  Review Process started – Sept  Community Proposals started 3
  4. 4. Outline ICD2013 Beta for Review • Mortality Package: 1. Mortality Linearization 2. Mortality Stability Tables 3. Annotation Document 4. Other documentation ( Electronic/Print Index files; updated rules ) • Morbidity Package: 1. Morbidity Linearization 2. Morbidity Stability Tables 3. Annotation Document 4. Other documentation ( Electronic/Print Index files; updated rules ) • Other TAGs – Shoreline Documents for each chapter – Current Status for Definitions, Content Model and Residuals 4
  5. 5. Critical Timelines • Current Packages  mTAG, MbTAG – Updates in September • Webex or Live Meetings with vertical TAGs to resolve issues – August - September • First review results of mTAG, MbTAG – in Beijing WHOFIC Annual Network Meeting October 2013 – Discussion of future steps • Scientific Peer Review of Vertical Chapters starting in September 5
  6. 6. ICD 2013 Beta Infrastructure is ready for: 1. Linearization generation • Index Generation (Print + Electronic) • Post Coordination modeling + sanctioning tables 2. NEW PROPOSAL GENERATION • by public 3. REVIEW mechanism • by selected Scientific Peers 4. Multi-lingual presentation 6
  7. 7. Shoreline Boundary between Pre- and Post-Coordination – Mortality Linearization is always Pre-coordinated – Morbidity Linearization is both Pre- and Post-Coordinated Post-Coordination : uses X- R- and Other Chapters » Specialty Linearizations may use: » Post-Coordination and other extensions 7
  8. 8. General Rules for (Pre- and Post-) Coordination • Items at ICD-10 three-character level would be pre- coordinated – unless there is compelling reason in the contrary • Items at ICD-10 four character level and higher will be mostly post-coordinated – unless evidence or use case requirement indicate otherwise Pre-coord. Pre- or Post-coordination Post-coordination 1 2 3 4 5 6 STEM Code Mostly Post–coordination; Can be Pre-Coordinated depending on evidence Post-coordination space (X, R, other chapters..) PRE COORDINATION by Exception 8 ICD10 levels
  9. 9. General criteria for determining pre-coordination • What to keep in the “Mortality – Morbidity” Linearizations? 1. Legacy (esp. if used previously in Mortality linearization) 2. Scientific evidence 3. Consistency according to Taxonomical and ontological rules 4. Utility a) Clinical – treatment grouping etc b) Public Health - reportable disease etc 5. “Use Case specific”: A. Frequency in practice setting for a given linearization ( e.g. Primary Care, Verbal Autopsy…) 9
  10. 10. Digital Telescoping (Russian Dolls) 10
  11. 11. Digital Telescoping (Russian Dolls) 11
  12. 12. Mort/PCHigh 11 Mort/PCHigh 12 Mort/PCHigh 13 Mort/PCHigh 21 Mort/PCHigh 22 Mort/PCHigh 31 Mort/PCHigh 33 Mort/PCHigh 34 Mort/PCHigh 32 Mort/PCHigh 35 Morbidity111 Morbidity112 Morbidity121 Morbidity133 Morbidity131 Morbidity132 Morbidity221 Morbidity222 Morbidity211 Morbidity311 Morbidity312 Morbidity321 Morbidity341 Morbidity342 Morbidity351 MORBIDITY PC – Low 1 PC – Low 2 PC – Low 3 PRIMARY CARE Low Resource (Verbal Autopsy ?) MORTALITY National Linearizations Specialty - Research Extensions 12
  13. 13. Mortality Linearization – Will include all ICD-10 entities have legacy for appropriate time series analysis: • Infant & Child Mortality • Maternal Mortality • General Mortality • Global Burden of Disease • Other major sources - e.g. Verbal Autopsy 13
  14. 14. Mortality Linearization • Mortality Linearization is a proper subset of Morbidity Linearization • There should not be any items that are in the mortality and are not expressed in the morbidity linearization 14
  15. 15. Mortality Linearization • Mortality Linearization should only contain items relevant causes of death • Each entity to be examined for its relevance in mortality statistics (internationally and nationally) – “Is it used?” – “What is the frequency among its parent category and its children?” 15
  16. 16. Mortality Linearization 16
  17. 17. ICD 2013 Beta Mortality Linearization as of 29 August • 1,039 categories at ICD10 3 Character-equivalent level • 3,892 categories at all levels (up to 7 ICD-10 Character level) Problems 1. Final Verification ongoing – Some 100 are not directly included out of a total of about 1000 codes either: • relevant part of major tabulations • frequent 95% of cases – They need to be explained in stability analysis
  18. 18. Morbidity Linearization(s) • The main international reference for reporting and data exchange: – hospital discharge summaries – case mix groupings – reimbursement – … • Morbidity Linearization – comprehensive enough – avoid unnecessary detail 18
  19. 19. Morbidity Linearization(s) 1. International WHO Morbidity Linearization 2. National Morbidity Linearization(s) 3. Specialty Linearizations 19
  20. 20. STEM 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 20 Pre-coord. Pre- or Post-coordination Post-coordination 1 - 4 5 6 STEM Code Mostly Post–coordination; Can be Pre-Coordinated depending on evidence Post-coordination space (X, R, other chapters..) PRE COORDINATION by Exception ICD11 levels
  21. 21. Sanctioning Tables • 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: – Applicable – Required – Non-applicable 21
  22. 22. National Linearizations • Countries who adopt ICD-11 – Use as is: ICD WHO version – May generate their own “National Linearizations” • National Linearizations will require: – extension items are in the foundation component (drawn from or if absent will be added to foundation) – Identify the mechanism of how they are linearized • Foundation – National Linearizations: – provides an enhanced coordination mechanism – avoids non-standard development – ensures comparability 22
  23. 23. Specialty Linearizations • Further detail for specialty care could be done in two ways: 1. Extensions of the Morbidity Linearization 2. New groupings from the Foundation Component (Research Linearizations ?) • Both methods would use by post-coordination & sanctioning rules 23
  24. 24. • Ensure a seamless transition between ICD-10 and ICD-11 – national – international levels • CrossCutting TAGs review and confirm continuity between ICD-10 and ICD- 11 • Represent knowledge gained from national clinical modifications in the revised ICD. Stability Analysis Objectives
  25. 25. • 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
  26. 26. Age-adjusted death rates for nephritis, nephrotic syndrome, and nephrosis: United States, 1968-2005
  27. 27. Overall Evaluation + • Solid Digitalization – iCAT – Browser – Proposal Mechanism – Linkage to SNOMED – URIs • Engagement of Partners – TAGs • Review Mechanism • Field Trials - / ? • Project Management • Remaining Time • Communication • Funding – Japan, EU, TM – PS
  28. 28. ICD-11 Timeline • 2013 : Beta version & Field Trials Version – +2 YR : Field trials • 2015 : Final version for WHA Approval – 2015+ implementation
  29. 29. ICD-11 Timeline • WHA Adoption and Implementation dates are separate – Member States adopt ICD at their own convenience – WHA adoption enables official use for countries who wish to switch
  30. 30. Transition Strategy 75 79 90 14 15 ?? ICD-9 ICD-10 ICD-11 4 24 2015 ICD-2016 ICD-2017 ICD-2018 ICD-2019
  31. 31. • TAG serving as an Editorial Board • Reviews • Organizing Field testing • Feasibility • Quality assurance • Reliability Roadmap during Beta Phase
  32. 32. ICD-11 administrative data use case: • Quality - Patient Safety indicators • Case-mix groupings • Data – Meta data standards, documentation • Diagnostic algorithms • Chart-Database comparison studies • "True" gold standards • International Morbidity comparisons • …
  33. 33. ICD Revision use cases Advanced computerised safety systems: – Identification of common patterns in safety-relevant events. – New tools for prediction, detection and monitoring of adverse events and other relevant information. – Use ICD in innovative data mining and integration techniques of existing databases and specific applications • like electronic health record systems, • decision support systems, • adverse event reporting systems. – Include validation leading to quantitative benefits.
  34. 34. Issues • Is the remaining time sufficient for 2015 – Translations  No – Implementation Preparation  No – Proper wide scale testing  No – Completing Reviews  Yes – Producing a better usable ICD  Yes
  35. 35. ICD-11 Timeline • 2015 : Final version for WHA Approval – 2015+ implementation • 2016 : WHA Approval – More time for Review and FT • 2017 : WHA Approval – More time for Review , Field Trial and Translations
  36. 36. ICD-11 • International Public Good – Openly Accessible – Free for WHO Member States • Available in multiple formats: – Printed Book editions – Internet-edition – Various computerized tools

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