icd revision beta 2013 - internal medicine
DESCRIPTION
This is a presentation on ICD Revision current status in Internal Medicine TAG summarizing the latest developments in Beta Phase including the Review Process, Field Trials and next stepsTRANSCRIPT
ICD Revision Overview
Tevfik Bedirhan Üstün
Classifications, Terminologies, Standards Team World Health Organization
Tokyo 2007 April 2013 February ICD - Revision Journey
Thanks to: • WHOFIC Network• Japanese MHLW• Japan Hospital Association• Japanese Medical Organizations
IM TAG Brazil PosterConclusions - Request
• Japanese government and academic societies have heavily involved
in the IM-TAG activities.
• As ICD is used in many countries with various ways it should be
supported financially by WHO and a number of governments.
• Also, it is essential to provide concrete and logical leadership by WHO
for conducting such a large international project effectively.
You can find the slides in…
Genealogy of ICD 1664
y195
0
y195
2
y195
4
y195
6
y195
8
y196
0
y196
2
y196
4
y196
6
y196
8
y197
0
y197
2
y197
4
y197
6
y197
8
y198
0
y198
2
y198
4
y198
6
y198
8
y199
0
y199
2
y199
4
y199
6
y199
8
y200
0
y200
2
y200
4
y200
6
-
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
14,000,000
16,000,000
18,000,000
20,000,000
Number of deaths reported to WHO with ICD codes 1950 - 2007
Reference year of data
Ab
so
lute
nu
mb
er
of
de
ath
s
Source: WHO Mortality Data base as of 19 Oct 2012
ICD-7 ICD-8 ICD-9 ICD-10
Age-adjusted death rates for nephritis, nephrotic syndrome, and nephrosis:
United States, 1968-2005
ICD-11 Revision Goals1. 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
ICD-11 Timeline
• 2012 : Beta version & Field Trials Version – +2 YR : Field trials
• 2015 : Final version for WHA Approval– 2015+ implementation– Continuous Annual Cycles
• ICD 2015 • ICD 2016• ICD 2017
How do we go from Here to 21st Century?
iCAT• Open and Collaborative Platform
– Web based
– Like WIKIPEDIA• But
– by the Content Model • with
– by the TAGs , and scientific peers
iCATCollaborative Authoring Tool
for ICD Revision
structured
Editorial Oversight
ICD11 βetahttp://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
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)
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
Skin
Neoplasms
ICD11 Components: Linearizations
23
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
Linerization requirements
• Classical ICD– Mutually Exclusive– Jointly Exhaustive
No double countingAll categories will be in
Residuals: Other (*.8) Unspecified (*.9)
should be generated for each linearization
MEJE priniciple
Building Linearizations
• Multiple Parenting Allowed– Pneumonia
• Lung Disease• Sometimes Infectious Disease
• Permanence of meaning across different linearizations– Telescopic principle
• Zoom in – zoom out
Morbidity111
Morbidity112
Morbidity121
Morbidity133
Morbidity131
Morbidity132
Morbidity221
Morbidity222
Morbidity211
Morbidity311
Morbidity312
Morbidity321
Morbidity341
Morbidity342
Morbidity351
MORBIDITYInternational
PC – Low 1
PC – Low 2
PC – Low 3
PRIMARY CARE Low Resource
(Verbal Autopsy ?)
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
PRIMARY CARE High Resource
PC – Low 1
PC – Low 2
PC – Low 3
PRIMARY CARE Low Resource
(Verbal Autopsy ?) MORTALITY
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
PRIMARY CARE High Resource MORBIDITY
PC – Low 1
PC – Low 2
PC – Low 3
PRIMARY CARE Low Resource
(Verbal Autopsy ?) MORTALITY International
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
PRIMARY CARE High Resource MORBIDITY
PC – Low 1
PC – Low 2
PC – Low 3
PRIMARY CARE Low Resource
(Verbal Autopsy ?) MORTALITY International National LinearizationsSpecialty - Research
Extensions
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 TopologySpecific Anatomic Location
Provisional diagnosis
Histopathology Diagnosis confirmed by
Biological Indicators Rule out / Differential
Consciousness
External Causes (detail)
Injury Specific (detail)
Beta Phase
• Comments
• Proposals
• Review Mechanism
• Field Trials
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
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
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– Entire Linearization– Chapter– Subchapter– Clusters– Use Cases– Other structure groupings, as selected
Content Review Units
– Chapter– Subchapter– Clusters– Individual entities– Other groups of entities, as selected
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.
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 ([email protected]) and copy the message to Bedirhan ([email protected]) :– 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)
Content Review – Schedule
3rd Wave– Musculoskeletal– Mental Health– Neurology– Rare Diseases– Circulatory
4th Wave– Dermatology– Hematology– Respiratory– Neoplasms– Infectious Diseases– Pediatrics
1st Wave• GURM• TM (Disorders)• Gastroenterology• Nephrology• Hepato-pancreatobiliary
2nd Wave• External Causes and Injuries• Ophthalmology• Dentistry• Rheumatology• Endocrinology
Transition Strategy
75 79 90 13 15 ??
ICD-9 ICD-10 ICD-11
4 23
2015
ICD
- 2016
ICD
- 2017
ICD
- 2018
ICD
- 2019
• TAG serving as an Editorial Board• Reviews
• Organizing Field testing• Feasibility• Quality assurance• Reliability
Roadmap during Beta Phase
A caterpillar,
This deep in fall-
Still not a butterfly
Basho
ICD11 βeta