Representation of ICD-10- AM/ACHI using Classification Markup - PowerPoint PPT Presentation

Representation of ICD-10- AM/ACHI using Classification Markup Language (ClaML) Robert Smith Western Sydney University

Who are We? • Australian Consortium for Classification Development (ACCD) • University of Sydney, National Centre for Classification in Health (NCCH) • Western Sydney University • Contracted by the Independent Hospital Pricing Authority (IHPA) for the development of the ICD-10-AM and ACHI Clinical Classifications

What is Clinical Classification? • International Statistical Classification of Diseases and Related Health Problems, 10 th Revision, Australian Modification (ICD-10-AM) • ICD-10-AM is the country specific version of the international standard ICD-10 • used for coding diagnosed diseases • Australian Classification of Health Interventions (ACHI) • Unique Australian classification for coding healthcare interventions • Uses • statistical tracking, funding, insurance claim processing and research

Classification Data Exchange • The vendors of ACCD • Software developers of Clinical Classification systems that use ICD-10-AM / ACHI • Needs access to ICD-10-AM / ACHI classification data • Current data exchange is through • Documents, text files, PDF files and database scripts / files • Documents and text files are far from suitable to be processed in an automated manner by IT Systems • Is this a problem?

Classification Data Exchange Problem • Database scripts / files • Can lead to misinterpretation of tables and data fields • Documents, PDF, Text Files • Not easy to be parsed by systems • Requires a programmer to create scripts • A standard method is needed that is: • machine consumable and human readable • structure classification data

Introduction to the Classification Markup Language (ClaML) • ClaML is an XML standard ISO 13120:2013, • Defines how to store clinical classification data • More easily processed by IT systems • Established international standard • Suitable for WHO Clinical Classifications • ICD-10 • ICF • ICHI

Short History of ClaML • First published in 2003 as Technical Specification DD CEN/TS 14463:2003 • Revised in 2008 as BS EN 14463:2007 • Replaced in 2013 with BS EN ISO 13120:2013 version 1 of the ISO standard • Currently under re-development as ISO/FDIS 13120 • Recommended by WHO-FIC (World Health Organization Family of International Classifications Network) for: • Maintenance • Publishing • Sharing

What is XML (eXtensible Markup Language) • XML is: • An independent tool for storing and transporting data • Designed to be self-descriptive • Simplifies data transports for systems • Simplifies platform changes • Uses for XML • A common use case is to exchange clinical classification data between different authorities i.e. Vendors of ACCD • Due to the self-describing nature of XML, it can be easily processed by different IT systems

Our Experience with ClaML • Workshop to understand the structures of ICD-10-AM, ACHI and ClaML • Analyse all documentation • ICD-10-AM and ACHI classification system mapping to ClaML tags • Propose changes and custom modifications • Manual transition of a few ICD-10-AM chapters into ClaML

Workshop Findings • Items modelled differently in our system needed changing. • Other additional information in ICD-10-AM • ACHI has a different structure to ICD-10-AM • ICD-10- AM / ACHI Indexes won’t fit in ClaML as -is

Structure of ClaML • ClaML is the root item • ClaML item can have many Classification items

Differences with ICD-10 ClaML from WHO and DIMDI • Modifiers - WHO applies Modifiers for 4-digit ICD-Classes to their superclasses (3- digit classes) whereas DIMDI applies them to the corresponding 4-digit classes to build the 5-digit sub-classifications. WHO DIMDI <Class kind="category" code="D18"> <Class kind="category" code="D18"> <ModifiedBy code="D18.0_5" position="5" /> <SuperClass code="D10 – D36 " /> <SuperClass code="D10 – D36 " /> <SubClass code="D18.0" /> <SubClass code="D18.0" /> <SubClass code="D18.1" /> <SubClass code="D18.1" /> </Class> </Class> <Class kind="category" code="D18.0"> <Class kind="category" code="D18.0"> <ModifiedBy code="D18.0_5" position="5" /> <SuperClass code="D18" /> <SuperClass code="D18" /> </Class> </Class> <Class kind="category" code="D18.1"> <Class kind="category" code="D18.1"> <ExcludeModifier code="D18.0_5" /> <SuperClass code="D18" /> <SuperClass code="D18" /> </Class> </Class>

Differences Between ICD-10-AM and ICD-10 with ClaML • Other Information in ICD-10-AM • Medicare Benefits Schedule (MBS) • Classification of Hospital Acquired Diagnoses (CHADx) • Australian Coding Standard (ACS) • Australian variant • More specific information that has different formatting • WHO has not provided an XML standard to store and exchange Clinical Classification Alphabetic Indexes

Adapting ClaML to Store Alphabetic Indexes • Alphabetic indexes have no unique identifier • Terms must contain their child terms in a consistent hierarchy • Tables – only in the Index

WHO Rubrics to ICD-10-AM Attributes ICD -10 ClaML ICD-10-AM Attribute • Mapping ICD-10-AM footnote -- not used -- text text Attributes to ICD-10 coding-hint code also code first Rubrics inclusional see • More specific types use additional of Information definition definition introduction introduction in ICD-10-AM modifierlink see note note styled note exclusion excludes inclusion includes preferredLong long code name preferred code name meta tag type range Range meta tag type ACS ACS No Modifiers code subdivision

WHO Rubrics to ACHI Attributes ClaML ACHI Attribute • Mapping ACHI coding-hint codeAlso Attributes to ICD-10 codeFirst Rubrics codeAlsoWhenPref inclusional • Similar types of see information in ACHI definition definition exclusion excludes • The following rubrics inclusion includes are not in ACHI note note styledNote • Footnote meta tag type ACS acsNo • Text preferredLong long code name Preferred code name • Introduction • Modiferlink • Meta tag type Range • modifiers

Validation of ClaML Export • Automatic generation of ClaML • After modifications to our application and database, the generation of ClaML files needs to go through quality assurance testing. • For quality assurance reasons, XSL was used to generate a graphical representation of ClaML • Validated the graphical representation against the publications • XSL (e X tensible S tylesheet L anguage) • Converts XML (i.e. ClaML) to a presentable web page • Provided a way to test the validity and consistency of the generated ClaML exports • Demonstrates the usability of ClaML, and the possibility of how it may be represented graphically

Validation of ClaML Export (Continued) <Class kind="category" code="D18"> <ModifiedBy code=" D18.0_5“ position ="5" /> <Meta name="Valid" value="False" /> <SuperClass code="D10 – D36 " /> <SubClass code="D18.0" /> <SubClass code="D18.1" /> <Rubric kind="preferred"> <Label> Into Haemangioma and lymphangioma </Label> </Rubric> <Rubric kind="inclusion"> <Label> morphology codes M912 – M917 with behaviour code/0 </Label> </Rubric> … </Class>

Future Directions • Still a work in progress! • Using the XSL to render tables for Alphabetic Indexes • Further quality assurance testing • Distribute ClaML to vendors for usage and feedback • Upgrade to upcoming ClaML 3.0 once it’s released

Thankyou. I hope you enjoyed the presentation