ICD Dr. T. Bedirhan Üstün Coordinator, Classifications, Terminologies, Standards. World Health Organization
Background • WHO +International Standards ICD • Classification – Common language for definitions: • Applications: • • Mortality: Morbidity: Primary Care: Research: Counting the dead Monitoring & Evaluation Diagnosis Management Epi, Genetics, Pharma…
1666 2011
ICD Revisions
ICD-10 Medical Devices associated with adverse incidents in diagnostic and therapeutic use • Y 70 Anaesthesiology devices associated with adverse incidents • Y 71 Cardiovascular devices associated with adverse incidents • Y 72 Otorhinolaryngological devices associated with adverse incidents • Y 73 Gastroenterology and urology devices associated with adverse incidents • Y 74 General hospital and personal-use devices associated with adverse incidents • Y 75 Neurological devices associated with adverse incidents • Y 76 Obstetric and gynaecological devices associated with adverse incidents • Y 77 Ophthalmic devices associated with adverse incidents • Y 78 Radiological devices associated with adverse incidents • Y 79 Orthopaedic devices associated with adverse incidents • Y 80 Physical medicine devices associated with adverse incidents • Y 81 General- and plastic-surgery devices associated with adverse incidents • Y 82 Other and unspecified medical devices associated with adverse incidents
WHO Family of Classifications RELATED Classifications International Classification of Primary Care (ICPC) International Classification of External Causes of Injury (ICECI) The Anatomical, Therapeutic, Chemical (ATC) classification system with Defined Daily Doses (DDD) ISO 9999 Technical aids for persons with disabilities – Classification and Terminology REFERENCE Classifications I nternational C lassification of D iseases I nternational C lassification of F unctioning, Disability & Health I nternational C lassification of H ealth I nterventions (under development) DERIVED Classifications International Classification of Diseases for Oncology, Third Edition (ICD-O-3) The ICD-10 Classification of Mental and Behavioural Disorders Application of the International Classification of Diseases to Dentistry and Stomatology, Third Edition (ICD-DA) Application of the International Classification of Diseases to Neurology (ICD-10 -NA) ICF, Children & Youth Version (ICF -CY)
WHO Classifications in HIS ICD ICF ICHI Classifications Population Health Clinical • • • Births Deaths Diseases Disability Risk factors Administration • Decision Support • Scheduling • Integration of care • Resources • Outcome • Billing Reporting • Cost • Needs • Outcome
Placing WHO Classifications in HIS & IT ICD ICF Linkages KRs e-Health Record Systems ICHI Classifications Terminologies Population Health Clinical • • • Births Deaths Diseases Disability Risk factors Administration • Decision Support • Scheduling • Integration of care • Resources • Outcome • Billing Reporting • Cost • Needs • Outcome
Health Information Systems: Analog to Digital How do we optimize our health services
ICD-11 Revision Goals Evolve a multi-purpose and coherent classification 1. – – 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 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
Construction of ICD-10: Revision Process in the 20 th 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
Construction of ICD-11: Revision Process in the 21 st 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
Definition of Disease a set of dysfunction(s) in any of the body systems including: • with a known pattern of signs, symptoms & findings » symptomatology - manifestations • probably with an underlying explanatory mechanism » etiology • a distinct pattern of development over time » course and outcome • a known pattern of response to interventions » treatment response • with linkage to underlying genetic factors » genotypes, phenotypes and endophenotypes • with linkage to interacting environmental factors
What is Ontology? • Ontology (philosophy) – the Organization of Reality • !!! Ontology (computer science) – the explicit – operational description of the conceptualization of a domain: • Concepts: entity and quality (properties and attributes) • An ontology defines: – a common vocabulary a shared understanding/exchange: • among people • among software agents • between people and software – to reuse data - information – to introduce standards to allow interoperability
THE CONTENT MODEL Any Category in ICD is represented by: TITLE of ENTITY: Name of disease, disorder, or syndrome… 7. 1. ICD Concept Title 1. 1. Fully Specified Name 2. Classification Properties 2. 1. Parents 2. 2 Type 2. 3. Use and Linearization(s) 3. 4. Textual Definition(s) Terms 4. 1. Base Index Terms 4. 2. Base Inclusion Terms 4. 3. Base Exclusion Terms 5. Body Structure Description 5. 1. 5. 2. 5. 3. 6. Body System(s) Body Part(s) [Anatomical Site(s)] Morphological Properties Manifestation Properties 6. 1. Signs & Symptoms 6. 2. Investigation findings 7. 1. 7. 2. 7. 3. 7. 4. 7. 5. 8. Causal Properties Etiology Type Causal Properties - Agents Causal Properties - Causal Mechanisms Genomic Linkages Risk Factors Temporal Properties 8. 1. Age of Occurrence & Occurrence Frequency 8. 2. Development Course/Stage 9. Severity of Subtypes Properties 10. Functioning Properties 10. 1. Impact on Activities and Participation 10. 2. Contextual factors 10. 3. Body functions 11. Specific Condition Properties 11. 1 Biological Sex 11. 2. Life-Cycle Properties 12. Treatment Properties 13. Diagnostic Criteria
i. CAT • Open and collaborative process – Users are empowered – Web based – Like WIKI – Trip Advisor • But structured • Editorial Oversight i. CAT Collaborative Authoring Tool for ICD Revision
i. CAT
ICD 11 Components 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)… Primary Care Linearizations Morbidity Mortality 18
Why work together? – WHO & IHTSDO – – – Coverage & Adequacy Quality – Reliability - Utility Multi. Lingual Applicability Interoperability Sustainability – Member States: Enable health care delivery and compile health information SNOMED & WHO Classifications are synergistic and not antagonistic
ICD & WHO FIC • International Public Good – Openly Accessible – Free for WHO Member States • Available in multiple formats: – Printed Book editions – Internet-edition – Various computerized tools
ICD & WHO FIC – Simultaneous development in Multiple Languages – ﺍﻟﺘﺼﻨﻴﻒ ﺍﻟﺪﻭﻟﻲ ﻟﻸﻤﺮﺍﺽ – 國際疾病與相關健康問題統計分類 – International Classification of Diseases – Classification internationale des maladies – Международная классификация болезней – Clasificación internacional de enfermedades
ICD & WHOFIC • Multiple Settings: – Primary Care – Clinical Services – Research • Specialty Adaptations: – Children and Youth – – – Oncology Mental Health Neurology Musculoskeletal Dermatology Dentistry e. g. ICD-10 Diagnostic Guidelines for Mental Health in Primary Care
Desiderata for a global terminology (1) 1. Comprehensiveness: – Coverage for all aspects of health care 2. Adequacy: – Is it fit or purpose – multiple purposes? – Does it have a good information model and ontological basis? 3. Multilingual applicability – language independent formal concept representation – Representation in multiple languages – more than translation 4. Utility: – Is it beneficial for: • Care providers • Consumers • Policy/Decision Makers 5. Reliability: : decision making, outcome evaluation : participation – ownership – evaluation – risk reduction : informed decision making on costs, benefits, efficiency – does it give the same results in different users
Desiderata for a global terminology (2) 6. Validity: – Does it indicate the right things – and does the indication make sense 7. Comparability • Does the data in different context have same properties to be compared? 8. Interoperability – Technical: Can information systems exchange information and use it? – Semantic: Can information systems interpret the data with the same meaning? 9. Quality Assurance – Product: Annotation and Content – Process: Use and Usability 10. Sustainability – Secured maintenance: commitment to stability with earlier versions – Openness to address emerging technical issues
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