1. ICD Revision Overview
Internal Medicine TAG 2012
Dr. T. Bedirhan Üstün
Coordinator, Classifications, Terminologies, Standards.
World Health Organization

3. • 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

4. 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

5. 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

6. How do we go
from Here to 21st Century?

7. 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

8. ICD Revision
http://who.int/classifications

9. 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

10. • Open and Collaborative Platform
– Web based
– Like WIKI – Trip Advisor
• But structured
– by the Content Model
• Editorial Oversight
– by the TAGs

11. Required Parameters:
Any Category in ICD is represented by:
1. TITLE of ENTITY: Name of disease, disorder, syndrome…
2. Classification Properties
3. Textual definition
4. Terms: Synonyms - Inclusion – Exclusion - Index terms
5. Body System(s) / Part(s)
6. Temporal Properties
7. Severity Properties

12. Optional Parameters:
8. Manifestation Properties
9. Causal Properties
10. Functioning Properties
11. Specific Condition Properties
12. Treatment Properties
13. Diagnostic Criteria

13. Browsing ICD Entities

14. Advanced Search

15. OpenID Logon

16. User Profile

17. Threaded Comments

18. Single Assessment Questions

21. Suggesting Definitions

22. Comments

23. Dashboard (Foundation)

24. 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 French
Multi Lingual Representations
Русский язык Russian
Español Spanish
Deutsch German
Português Portuguese

25. Information Notes:
1. Communication &
Dissemination
2. Revision Timelines
3. TAG Allocations
4. Content Model
5. Foundation Component &
Linearizations
6. Legacy Linearizations
7. Code Structure
8. Multidimensional Coding
9. Index
10. < …>

26. Primary Care
Foundation: ICD
categories with Linearizations
- Definitions, synonyms
- Clinical descriptions Morbidity
- Diagnostic criteria
- Causal mechanism
- Functional Properties
Find Term Mortality
SNOMED-CT,
International Classification of
26
Functioning, Disability and Health (ICF)…

27. 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)

28. 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

29. ICD Multi-dimensional Coding
Information 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

30. 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

31. 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

32. 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 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

33. Conceptual Lego… it could be...
Post-coordinated
Structured Data Entry
File Edit Help
Cycling Accident
What you hit
Your Role
Activity
Location

35. Managing Expectations
March 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

36. 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 %

37. ICD-11 Features
Internet Based
Input from
Platform
all Stakeholders
Content Model Definitions
Translations
Field Trials for Electronic Health Record
Use Cases Ready

38. 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.

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

40. Stability Analysis
of ICD-11 key linearizations
• Categories remain constant vs changed
• Mortality
• ICD Morbidity - DRGs
changed 11
10
constant

41. ICD11 alpha - DIFF
• Shows the change from ICD-10
– Backwards compatible

42. “DIFF”
Tracking incremental changes from ICD

43. The curious case of …

44. Transition Strategy
ICD-10 ICD-11
ICD-9
75 79 90 13 15 ??
4 23
ICD - 2016
ICD - 2018
ICD - 2019
ICD - 2017
2015

45. 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

46. ICD Revision Overview
Internal Medicine TAG 2012
Dr. T. Bedirhan Üstün
Coordinator, Classifications, Terminologies, Standards.
World Health Organization