ICD11 βetaA caterpillar,This deep in fall-  Still not a butterfly        Basho
Beta Phase• Comments• Proposals• Review Mechanism• Field Trials
How to deal with the TAG        proposals after locking iCAT• All TAG proposals should be send to Bedirhan Ustun (ustunb@w...
Information Notes1. ICD Revision Communication   10. Diagnosis Type2. ICD Revision Timelines       11.Main Condition3. TAG...
Information Notes                 under development20. Cross-cutting TAG Roles      a.   Mortality      b.   Morbidity    ...
ICD Organization• Pre-coordination - fixed names    V12.24 Pedal cyclist injured in collision with two- or three-wheeled  ...
X – Chapter:                            Extension Codes            Type 1                           Type 2                ...
Multiple Coding        Equivalent ExpressionsCluster Style            Chain / String Style–   Code1*                – Code...
Multiple Coding           Equivalent Expressions    STEMI - posterior wall – confirmed by EKG     Cluster Style           ...
Stability Analysis    Objectives    • Ensure a seamless transition      between ICD-10 and ICD-11       – national       –...
Stability Analysis                 Types & Methodology• Mortality• Morbidity   –   ICD-10-WHO with ICD-11-WHO   –   ICD-10...
Why a Review Process• The review process will help WHO assure  the quality of the Beta Content• Review focus:  – Scientifi...
Review Process• The review process :  – the content    • Definitions    • Content model parameters  – The structure - of t...
Initial Review1. Linearization Review2. Content Review
Linearization Review1.   Mortality Linearization Review2.   Morbidity Linearization Review3.   Primary Care Linearization ...
Linearization Review1. Review Unit is the whole linearization in   question  –       e.g. Four-character Codes in MORTALIT...
Morbidity Linearization1. Review of Five or more character codes2. Results of the Stability Analysis3. Results of the reso...
Primary Care Linearization(s)• Expect to produce two different  linearizations  – Low resource PC linearization     • Fewe...
Initial Review   • Initial Review of the current Beta draft:        – Linearization Structure(s) (e.g. Mortality and Morbi...
Content Review1. Initial review:  – Selected sections of ICD-11 where    •   work has been completed        –   specific r...
Content Review• Proposal Generation Phase  – When proposals are mature (decide how)  – Submit to 5 reviewers  – Obtain 3 c...
Review Units1. Linearizations2. Chapters – Sub Chapters – Code clusters3. Single categories  – Initial selection from:    ...
Review SoftwareA. Process manager – Identify Review Units – Identify Reviewers – Send invitations   •   Letter   •   Revie...
Reviewers• Content Reviewers: Pool of specialist  experts to review in their area of expertise,  similar to quality assess...
Call for Reviewers• WHO Requests all TAGs and WGs to provide  nominations of reviewers for the next step in the Beta  Phas...
Reviewers1.   WHO search     –     From PUBMed, Google Scholar     –     WHO expert database2.   TAG Nominations3.       I...
Contributor - Reviewer                Acknowledgement • WHO is currently creating a list to acknowledge all participants: ...
Incentives for Reviewers
Content Review – Schedule1st Wave                               3rd Wave    • GURM                                –   Musc...
ICD11 Field Trials• Basic aims   – To test the “fitness of ICD-11 for multiple purposes”       • Mortality coding       • ...
ICD11 Field Trials•   Applicability (Feasibility) –     –   Is the classification easy to implement in the hands of the re...
Field Trials•   KEY USES:    – Mortality: cause of death coding, verbal autopsy    – Morbidity: various morbidity codings ...
Core Studies• Study One:  – Feasibility and Reliability for live Cases and Case    Summaries coding with     • ICD-11 Chap...
Study 1 Components• Feasibility in evaluations: The rater will administer the ICD and    assign codes for the case and rec...
Study 2 ComponentsConsensus Conference ApproachEach field trial centre will conduct at least one consensus conference todi...
Field Trials Work Plans– Plan for field trials   • Essential components   • Additional components      – Methodology      ...
Inter-rater reliability• The Case information    • live    • medical record• Coded using ICD11 by  at least two different ...
Bridge Coding• The Case information    • live    • medical record• Coded using    • ICD10    • ICD11• Agreement rates  mea...
Transition Strategy                     ICD-10                ICD-11 ICD-975       79     90            13      15        ...
Roadmap during Beta Phase         • TAG serving as an           Editorial Board          • Reviews          • Organizing F...
Common Ontology with SNOMED           CVD Use Case• Nearly 1200 entries in ICD for matching• Nearly 5000 entries in SCT fo...
SCT Disorders of                             CardioVascular System                                   Top-Level•   Acute di...
Current ICD Key Groups –                 Heart1.   Rheumatic Disease2.   Hypertensive Disease3.   Ischemic Heart Disease4....
Current ICD Key Groups -                        Heart1.       Rheumatic Disease     –      acute-chronic     –      With h...
Current ICD Key Groups –                  Vascular1. Arterial  – Systemic arterial ( non-coronary)     •    Aorta     •   ...
Current ICD Key Groups –               Congenital1. Developmental  – Intrauterine / At birth / later in life2. Structural ...
Poly hierarchies in ICD and SCT• Tree visualization  – Tree- stem- brach – subbranch – leaf…  – Essential top layers 1-2-3...
Sorting out      conceptual equivalence– Angina Pectoris  • Syndrome ? : Acute Coronary Syndrome  • Clinical sign : Chest ...
Shared etiological grouping•   Ischemia•   Hemorrhage•   Thrombosis•   Abnormal heart rate•   Gangrene•   Rupture•   Vascu...
Time equivalence• Myocardial Infarction:  – ACUTE up to 28 days     • arbitrary ICD-10 definition• CVD TAG to define  – su...
Remaining Work• Complete entries  – TAG – Work Groups ( temporary pass)  – Harmonization between TAGs    • Mortality    • ...
Checks of linearizations– Check with Infectious Diseases  • e.g. Broncopnuemonia  Respiratory– Check with Neoplasms  • e....
Pre- or Post- coordination• Check the existing pre-coordination whether it  can be post coordinated ( “unbundling” )  – V1...
Harmonization– Stability Analysis  • ICD-10  ICD-11     -explanation of change– Linearization decisions  • Mortality  • M...
Current Status           as of end Jan.2013• Some Chapters need further work  – Infectious Disease A  – Neoplasms B,C  – S...
Remaining Content Model            Parameters• Laboratory Tests• Genetic Linkages• Treatment Properties
ICD Revision 2013 Internal Medicine - DAY2
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ICD Revision 2013 Internal Medicine - DAY2

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ICD Revision Process had a great meeting in Tokyo with the Internal Medicine Topic Advisory Group discussing the latest edits in Cardiology, Endocrinology, Gastroenterology, Hematology, Hepatology, Nephrology, Rheumatology and Respiratory Diseases

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  • There is currently great diversity in the level of work completed in the Beta draft
  • ICD Revision 2013 Internal Medicine - DAY2

    1. 1. ICD11 βetaA caterpillar,This deep in fall- Still not a butterfly Basho
    2. 2. Beta Phase• Comments• Proposals• Review Mechanism• Field Trials
    3. 3. How to deal with the TAG proposals after locking iCAT• All TAG proposals should be send to Bedirhan Ustun (ustunb@who.int) and Eva Foust (fouste@who.int)• WHO will post the TAG proposal(s) on Redmine: http://informatics.mayo.edu/WHO/ICD11/collaboratory/projects/icatbeta proposal and will give identified editors TEMPORARY PASS• All TAG Chairs/WG Chairs and Managing Editors will be alerted AUTOMATICALLY every time a new proposal is posted on Redmine.• TAGs will have 1 week to make comments on proposals. – If there are NO evidence-based objections, the proposal(s) will be entered in iCAT. – If there are major issues raised, WHO will contact the involved parties and will facilitate discussions to sort out these issues.
    4. 4. Information Notes1. ICD Revision Communication 10. Diagnosis Type2. ICD Revision Timelines 11.Main Condition3. TAG Allocation 12.Review Process4. Content Model 13.Mirror Coding5. Foundation Component and Linearizations 14.Modifiers and Qualifiers6. Legacy Linearizations 15.Field Trials7. Code Structure 16.Stability Analysis8. Multidimensional Coding 17.Multilingual ICD Platform9. Index 18.Dagger and Asterisk resolution 19.Multisystem Chapter
    5. 5. Information Notes under development20. Cross-cutting TAG Roles a. Mortality b. Morbidity c. Functioning d. Quality & Safety21. Post-Coordination Principles and Rules22. Residual Categories23. Common Ontology with SCT24. Coding Rules25. National Linearizations in ICD-1126. ICD-11 Definitions
    6. 6. ICD Organization• 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• Post- Coordination - extensions • Bicycle Accident • Hit • Role • Context • Activity
    7. 7. 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)
    8. 8. Multiple Coding Equivalent ExpressionsCluster Style Chain / String Style– Code1* – Code1/Code2/Code3– Code2*– Code3*– ..– * CLUSTERING IND.
    9. 9. Multiple Coding Equivalent Expressions STEMI - posterior wall – confirmed by EKG Cluster Style Chain / String Style• JH6.1001 Myocardial Infarction with ST Elevation JH6.100/ XT0.???/ XD0.100• XT0.???1 Posterior wall of heart• XD0.1001 Diagnosis Confirmed by EKG• 1 CLUSTERING indicator.
    10. 10. Stability Analysis Objectives • Ensure a seamless transition between ICD-10 and ICD-11 – national – international levels • Represent knowledge gained from national clinical modifications in the revised ICD. • CrossCutting TAGs review and confirm continuity between ICD-10 and ICD- 11
    11. 11. Stability Analysis Types & Methodology• Mortality• Morbidity – ICD-10-WHO with ICD-11-WHO – ICD-10&11-WHO with ICD-10-GM – ICD-10&11-WHO with ICD-10-AM – ICD-10&11-WHO with ICD-10-CM – ICD-10&11-WHO with ICD-10-CA
    12. 12. 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
    13. 13. 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
    14. 14. Initial Review1. Linearization Review2. Content Review
    15. 15. Linearization Review1. Mortality Linearization Review2. Morbidity Linearization Review3. Primary Care Linearization Review4. Mirror-Coding Review
    16. 16. Linearization Review1. Review Unit is the whole linearization in question – e.g. Four-character Codes in MORTALITY – Review the results of Stability Analysis – Mark-up in iCAT – Review restricted to the relevant TAG only • e.g. M TAG for Mortality Linearization
    17. 17. Morbidity Linearization1. Review of Five or more character codes2. Results of the Stability Analysis3. Results of the resolution of Dagger- Asterisk resolution
    18. 18. Primary Care Linearization(s)• Expect to produce two different linearizations – Low resource PC linearization • Fewer categories – large groupings – High resource PC linearization • Frequent health conditions in PC with high resources (same as Morbidity linearization in resolution, but representing only PC relevant cases)
    19. 19. 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
    20. 20. Content Review1. Initial review: – Selected sections of ICD-11 where • work has been completed – specific review is needed – there is special interest • Accuracy • Scientific quality • Completeness • Clinical or Public Health Utility
    21. 21. Content Review• Proposal Generation Phase – When proposals are mature (decide how) – Submit to 5 reviewers – Obtain 3 complete reviews – Generate combined statement – Submit to TAG in a combined list – Implement results – Submit conflicts to RSG
    22. 22. Review Units1. Linearizations2. Chapters – Sub Chapters – Code clusters3. Single categories – Initial selection from: • Completed content • Hot Categories – with differential aspects in XMs. • Public Health Importance4. Set of Content Model parameters across multiple categories – e.g. Lab findings , genomics, etc.
    23. 23. Review SoftwareA. Process manager – Identify Review Units – Identify Reviewers – Send invitations • Letter • Review questions – Send reminders, if necessary – Compile results
    24. 24. 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.
    25. 25. 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)
    26. 26. Reviewers1. WHO search – From PUBMed, Google Scholar – WHO expert database2. TAG Nominations3. ICD-11 Web-site – Self-nomination4. Solicited Reviews – NGOs ( e.g. WONCA etc ) – Genetics institutions
    27. 27. Contributor - Reviewer Acknowledgement • WHO is currently creating a list to acknowledge all participants: – ICD website – Print version of the ICD-11. • Please include all with participant contact information. The following individuals will be – Managing Editors acknowledged: – NGOs – RSG – Other Contributors – RSG-SEG – WHO-FIC Collaborating Centres – TAG – WHO Staff – TAG WGs
    28. 28. Incentives for Reviewers
    29. 29. 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
    30. 30. ICD11 Field Trials• Basic aims – To test the “fitness of ICD-11 for multiple purposes” • Mortality coding • Morbidity coding • Other use cases – To ensure the comparability between ICD-10 and ICD-11 – To increase consistency, identify improvement paths, and reduce errors .• Key Assessments: • Applicability – feasibility  easy to use • Reliability - consistency  gives same results in the hands of all • Utility - added value  renders useful information
    31. 31. ICD11 Field Trials• Applicability (Feasibility) – – Is the classification easy to implement in the hands of the real life users (coders, doctors etc.) ?• 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?• 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?
    32. 32. Field Trials• KEY USES: – Mortality: cause of death coding, verbal autopsy – Morbidity: various morbidity codings – hospital discharge, DRG etc. – 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
    33. 33. Core Studies• Study One: – Feasibility and Reliability for live Cases and Case Summaries coding with • ICD-11 Chapters (double coding)• Study Two: – Basic Questions
    34. 34. Study 1 Components• Feasibility in evaluations: The rater will administer the ICD and assign codes for the case and record some other pertinent information on the Form A.• Inter-rater reliability in evaluations: This component will assess the agreement between two of more raters rating the same case evaluation. Data for all the raters will be collected on Form A, one for each rater.After finishing the data collection for all the two components, eachinterviewer will be asked to respond to a short post-study questionnaireprovided in the protocol (Form B). Data for all two components and thepost-study questionnaire will be submitted as electronic spread sheetsto WHO Geneva.
    35. 35. Study 2 ComponentsConsensus Conference ApproachEach field trial centre will conduct at least one consensus conference todiscuss the basic questions. The results of the consensus conferencewill be summarised in a report and forwarded to WHO Geneva.Individual Response ApproachResponses to the basic questions should be collected by each field trialcentre from multiple individuals who have expertise in the area of TMcoding. Each person should provide a written response to the basicquestions on the Response Form provided in the protocol. The field trialcentre will collect these responses and provide a summary using thesame format as for the Consensus Conference.
    36. 36. Field Trials Work Plans– Plan for field trials • Essential components • Additional components – Methodology – Timelines– Possible Participants– Data collection – Analysis - Publications
    37. 37. Inter-rater reliability• The Case information • live • medical record• Coded using ICD11 by at least two different people• Agreement rates measured
    38. 38. Bridge Coding• The Case information • live • medical record• Coded using • ICD10 • ICD11• Agreement rates measured
    39. 39. Transition Strategy ICD-10 ICD-11 ICD-975 79 90 13 15 ?? 4 23 ICD - 2016 ICD - 2018 ICD - 2019 ICD - 2017 2015
    40. 40. Roadmap during Beta Phase • TAG serving as an Editorial Board • Reviews • Organizing Field testing • Feasibility • Quality assurance • Reliability
    41. 41. Common Ontology with SNOMED CVD Use Case• Nearly 1200 entries in ICD for matching• Nearly 5000 entries in SCT for matching• Caveats: – Updates • CVD TAG is pending • pre-coordination / post coordination selection to be made
    42. 42. SCT Disorders of CardioVascular System Top-Level• Acute disease of cardiovascular system• Aneurysm• Cardiovascular injury• Cardiovascular system hereditary disorder• Chronic disease of cardiovascular system• Congenital anomaly of cardiovascular system• Disease affecting entire cardiovascular system• Disorder of cardiovascular prostheses and implants• Disorder of pericardium• Disorder of portal venous system• Eclampsia in pregnancy• Fetal cardiovascular disorder• Foreign body of cardiovascular structure• Heart disease• Infectious disease of cardiovascular system• Inflammatory disorder of the cardiovascular system• Near syncope• Neonatal cardiovascular disorder• Neoplasm of heart AND/OR pericardium• Perinatal cardiovascular disorders• Peripheral vascular disease• Pseudoaneurysm• Syncope• Thrombosis• Vascular disorder• Vasovagal attack
    43. 43. Current ICD Key Groups – Heart1. Rheumatic Disease2. Hypertensive Disease3. Ischemic Heart Disease4. Pulmonary Heart Disease5. Arrhythmia6. Pericard Disease7. Myocarditis8. Heart Failure
    44. 44. Current ICD Key Groups - Heart1. Rheumatic Disease – acute-chronic – With heart involvement- chorea – With valve involvement2. Hypertensive Disease – Heart – Renal3. Ischemic Heart Disease – Angina – MI – MI complications4. Pulmonary Heart Disease5. Arrythmia6. Pericard Disease7. Myocarditis8. Heart Failure
    45. 45. Current ICD Key Groups – Vascular1. Arterial – Systemic arterial ( non-coronary) • Aorta • Peripheral Arteries • Exclusions: cerebrovascular ( brain attack )2. Venous – Systemic – Portal3. Lymphatic
    46. 46. Current ICD Key Groups – Congenital1. Developmental – Intrauterine / At birth / later in life2. Structural – Anatomical – Functional
    47. 47. Poly hierarchies in ICD and SCT• Tree visualization – Tree- stem- brach – subbranch – leaf… – Essential top layers 1-2-3-4 harmonization
    48. 48. Sorting out conceptual equivalence– Angina Pectoris • Syndrome ? : Acute Coronary Syndrome • Clinical sign : Chest pain
    49. 49. Shared etiological grouping• Ischemia• Hemorrhage• Thrombosis• Abnormal heart rate• Gangrene• Rupture• Vascular complications – Plaque, stenosis, … aneursym, dissection/splitting• Procedural – post-operative…
    50. 50. Time equivalence• Myocardial Infarction: – ACUTE up to 28 days • arbitrary ICD-10 definition• CVD TAG to define – subacute, chronic, old MI » OLD MI >28 day
    51. 51. Remaining Work• Complete entries – TAG – Work Groups ( temporary pass) – Harmonization between TAGs • Mortality • Morbidity • Other Overlap Areas (Rare Diseases, etc)
    52. 52. Checks of linearizations– Check with Infectious Diseases • e.g. Broncopnuemonia  Respiratory– Check with Neoplasms • e.g. Lung Ca  Respiratory– Check with CLINICAL FORMS ( R Chapter) • e.g. with bleeding ( extension code – R chapter)
    53. 53. Pre- or Post- coordination• Check the existing pre-coordination whether it can be post coordinated ( “unbundling” ) – 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 • Hit • roles • Context • Activity• Compatibility with the NEW code structure
    54. 54. Harmonization– Stability Analysis • ICD-10  ICD-11 -explanation of change– Linearization decisions • Mortality • Morbidity Telescoping – Zoom in/out • Primary Care– Consistency with ontology – SNOMED/ GO other • Common Ontology
    55. 55. Current Status as of end Jan.2013• 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 %
    56. 56. Remaining Content Model Parameters• Laboratory Tests• Genetic Linkages• Treatment Properties

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