ICD Revision Process: ICD Revision Process: Building the Building the infrastructure of ICD - infrastructure of ICD -11 11 … building blocks of health information … building blocks of health information … … Dr. T. Bedirhan Ü Üst stü ün n Dr. T. Bedirhan Classifications, Terminologies, Standards Classifications, Terminologies, Standards CLASSIFICATIONS, Terminologies, Standards … BUILDING BLOCKS OF HEALTH INFORMATION … BUILDING BLOCKS OF HEALTH INFORMATION … … Aggregated Statistics 1665 Aggregated Statistics 1665 CLASSIFICATIONS, Terminologies, Standards … BUILDING BLOCKS OF HEALTH INFORMATION … BUILDING BLOCKS OF HEALTH INFORMATION … …
ICD Revisions ICD Revisions 100000 14 ,47 3 1 2,96 7 8,173 10000 1,164 1,040 954 965 1000 2 14 1 89 205 200 179 16 1 139 100 10 1 IC D -9-M IC D -1 0-M Farr/d'Esp ine Bertillon IC D 1 IC D 2 IC D 3 IC D 4 IC D 5 IC D 6 IC D 7 IC D 8 IC D 9 IC D 10 1853 1893 1900 1909 1920 1929 1938 1948 1955 1968 1975 1979 1993 1993 CLASSIFICATIONS, Terminologies, Standards … BUILDING BLOCKS OF HEALTH INFORMATION … BUILDING BLOCKS OF HEALTH INFORMATION … … WHO Family of Classifications WHO Family of Classifications REFERENCE Classifications I I nternational nternational C C lassification lassification of of D iseases D iseases I nternational I nternational C lassification C lassification of of F F unctioning unctioning, , Disability & Health Disability & Health I nternational I nternational C lassification C lassification of of H ealth ealth H I I nterventions nterventions (under development) (under development) CLASSIFICATIONS, Terminologies, Standards … BUILDING BLOCKS OF HEALTH INFORMATION … BUILDING BLOCKS OF HEALTH INFORMATION … …
WHO Family of Classifications WHO Family of Classifications DERIVED REFERENCE Classifications Classifications International Classification of Diseases for Oncology , Third I nternational nternational I Edition (ICD-O-3) C lassification lassification of of C D D iseases iseases The ICD-10 Classification of Mental and Behavioural Disorders I nternational nternational I C C lassification lassification of of Application of the International F F unctioning unctioning, , Classification of Diseases to Dentistry and Stomatology, Disability & Health Disability & Health Third Edition (ICD-DA) Application of the International I I nternational nternational Classification of Diseases to C C lassification lassification of of Neurology H ealth H ealth (ICD-10-NA) I nterventions nterventions I ICF, Children & Youth (under development) (under development) Version (ICF -CY) CLASSIFICATIONS, Terminologies, Standards … BUILDING BLOCKS OF HEALTH INFORMATION … BUILDING BLOCKS OF HEALTH INFORMATION … … WHO Family of Classifications WHO Family of Classifications REFERENCE DERIVED RELATED Classifications Classifications Classifications International Classification of International Classification I I nternational nternational Diseases for Oncology , Third of Primary Care (ICPC) Edition (ICD-O-3) C C lassification lassification of of D D iseases iseases International Classification The ICD-10 Classification of of External Causes of Mental and Behavioural Disorders Injury (ICECI) I nternational I nternational C C lassification lassification of of Application of the International F F unctioning unctioning, , The Anatomical, Classification of Diseases to Therapeutic, Chemical (ATC) Disability & Health Disability & Health Dentistry and Stomatology, classification system with Third Edition Defined Daily Doses (DDD) (ICD-DA) I nternational I nternational Application of the International Classification of Diseases to C lassification C lassification of of ISO 9999 Technical aids Neurology H ealth ealth for persons with disabilities H (ICD-10-NA) – Classification and I nterventions nterventions I Terminology ICF, Children & Youth Version (under development) (under development) (ICF -CY) CLASSIFICATIONS, Terminologies, Standards … BUILDING BLOCKS OF HEALTH INFORMATION … BUILDING BLOCKS OF HEALTH INFORMATION … …
Placing WHO Classifications in HIS & IT Placing WHO Classifications in HIS & IT ICD ICD ICF ICF KRs ICHI ICHI Mappings Classifications e-Health Record Terminologies Systems Population Health Clinical Administration Reporting • Births • Decision Support • Scheduling • Cost • Deaths • Integration of care • Resources • Needs • Diseases • Outcome • Billing • Outcome • Disability • Risk factors CLASSIFICATIONS, Terminologies, Standards … BUILDING BLOCKS OF HEALTH INFORMATION … BUILDING BLOCKS OF HEALTH INFORMATION … … ICD ≈ ≈ Common Language ? Common Language ? ICD Pseudoconsensus ? ? Pseudoconsensus • Communication : ↑ ↑ ↓ ↓ Mutual data exchange ↔ ↔ Confusion – – Mutual data exchange Confusion • Research & Science : ↑ ↑ ↓ ↓ ↔ Straitjacket Common framework ↔ – – Common framework Straitjacket • Clinical utility : ↑ ↑ ↓ ↓ Reliable assessment ↔ ↔ Reductionism – Reliable assessment Reductionism – • Public Health : ↑ ↑ ↓ ↓ ↔ Conformism Guides decision making ↔ – – Guides decision making Conformism • Human Rights : ↑ ↑ ↓ ↓ Protection ↔ ↔ Discrimination & Stigma – – Protection Discrimination & Stigma CLASSIFICATIONS, Terminologies, Standards … BUILDING BLOCKS OF HEALTH INFORMATION … BUILDING BLOCKS OF HEALTH INFORMATION … …
Problems with ICD Problems with ICD 1. No standard of knowledge representation 2. No linkages with health terminology and ontologies 3. Driven by billing and mortality use cases 4. Does not interoperate with eHR 5. Used in 117 out of 193 countries for official statistics 6. Limited web presence – utility for masses CLASSIFICATIONS, Terminologies, Standards … BUILDING BLOCKS OF HEALTH INFORMATION … BUILDING BLOCKS OF HEALTH INFORMATION … … Construction of ICD- -10: 10: Construction of ICD Revision Process Revision Process • 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 CLASSIFICATIONS, Terminologies, Standards … BUILDING BLOCKS OF HEALTH INFORMATION … BUILDING BLOCKS OF HEALTH INFORMATION … …
Construction of ICD- Construction of ICD -11: 11: Revision Process Revision Process • 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 CLASSIFICATIONS, Terminologies, Standards … BUILDING BLOCKS OF HEALTH INFORMATION … BUILDING BLOCKS OF HEALTH INFORMATION … … Tentative Timeline Tentative Timeline • 2010 : Alpha version ( ICD 11 alpha draft) – +1 YR : Commentaries and consultations • 2011 : Beta version & Field Trials Version – +2 YR : Field trials • 2013 : Final version for public viewing – 2014 : WHA Approval • 2015+ implementation CLASSIFICATIONS, Terminologies, Standards … BUILDING BLOCKS OF HEALTH INFORMATION … BUILDING BLOCKS OF HEALTH INFORMATION … …
ICD- -11 Revision Goals 11 Revision Goals ICD Evolve a multi-purpose and coherent classification 1. – Mortality , morbidity , primary care , clinical care, research , public health… – Consistency & interoperability across different uses Serve as an international and multilingual reference standard 2. for scientific comparability and communication p urposes Ensure that ICD-11 will seamlessly function in an electronic 3. health records environment. • Link ICD logically to underpinning terminologies and ontologies (e.g. SNOMED, GO, …) • ICD Categories “defined” by " logical operational rules" on their associations and details CLASSIFICATIONS, Terminologies, Standards … BUILDING BLOCKS OF HEALTH INFORMATION … BUILDING BLOCKS OF HEALTH INFORMATION … … ICD- ICD -11 Revision 11 Revision Organization Structure Organization Structure WHO WHO WHO FIC Update & Revision Committee Topic Advisory Group: Revision Steering Group Health Informatics and Modelling External Internal Rare New TAGs Mental Health Neoplasms Causes Medicine Diseases Neurology Musculoskeletal Work Work Work Work Work Work Work Work Work Ophthalmology Group Group Group Group Group Group Group Group Group Maternal – Gender Dermatology Dentistry CLASSIFICATIONS, Terminologies, Standards … BUILDING BLOCKS OF HEALTH INFORMATION … BUILDING BLOCKS OF HEALTH INFORMATION … …
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