ICD Revision Process towards ICD -11 Classification Assessment

ICD Revision Process: towards ICD -11 Classification, Assessment, Terminology Team WHO

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 CLASSIFICATIONS 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) … BUILDING BLOCKS OF HEALTH INFORMATION …

ICD Revisions CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH INFORMATION …

Key Drivers • Mandated by WHA and EB • Respond to consumer-needs – Prevention, Primary Care, Secondary Care, Administration, Patients, Families; Data-users • Keep up with new scientific knowledge – – – New Diseases, Measures, Treatments, Terminology… Diseases Corrections: pruning and grafting, deletions Change in rules, guidelines, conventions… • Compatibility within the WHO-FIC members – ICPC, ICF, ICHI, ICECI, ICD-O… ICECI ICD-O • Creation of an improved network and dissemination • Better implementation within Health Information Systems – Electronic Health Record, Clinical Terminologies, Mortality Database CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH INFORMATION …

Placing WHO Classifications in HIS & IT ICD ICF Mappings e-Health Record Systems ICHI Classifications Terminologies Population Health Clinical CLASSIFICATIONS • • • Births Deaths Diseases Disability Risk factors Administration • Decision Support • Scheduling • Integration of care • Resources • Outcome • Billing Reporting • Cost • Needs • Outcome … BUILDING BLOCKS OF HEALTH INFORMATION …

Linking Classifications to e. Health Records ICD ICF Mappings e-Health Record Systems Terminologies Diagnosis / Assessment • Diseases • Disability CLASSIFICATIONS ICHI Classifications Management / Interventions … BUILDING BLOCKS OF HEALTH INFORMATION …

Sources for Revision of Chapter XX

Sources for Revision of Chapter XX CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH INFORMATION …

ICD Chapter XX - International Statistical Use Intentional self harm Chapters Blocks 3 Ch. Categories ICD 4 Ch. Categories Verb. Autopsy General Mortality Child Mortality Traffic accidents ICD Morbidity ISHMT Hospital Morbidity Accidental poisoning Medical devices associated with adverse incidents Use (Epidemiology)

Revision Chapter XX Mortality • Use of Chapter XX (Doris Ma Fat, Dejan Loncar, WHO) • 1/3 of all deaths reported to WHO • ~ 7 % Chapter XX • Transport: 45 % “unspecified” • 13/~70 countries do not use 4 th character • ~ 400 codes never used – “Bitten or struck by crocodile or alligator, residential institution”

ICD Revision Process • Drafting Rules – Taxonomic Guidelines – Definition, Diagnosis and Indexing / mapping guidelines • Drafting Overall Structure • Drafting Individual Chapters • Overseeing the TOTAL ICD – ALPHA Draft – structured comments – BETA Draft – field testing • Final Draft ØWHA Approval CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH INFORMATION …

ICD Revision Work Streams 1. Scientific Stream • • • 2. Clinical Stream • • • 3. Evidence Based Reviews Surveys Validation Studies Add-on protocols for existing studies Meta analyses Primary care utility Secondary care utility Linkage to patient reports Treatment Response Phenotypes: gene to behaviour specs Public Health Stream • • Impact on Health Systems –society –service delivery Impact on statistics Resource management -reimbursement - accounting IT applications - terminology CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH INFORMATION …

Knowledge Portal Web of ICD Revision • Evidence based systematic reviews – Clinical Use: Primary Care, Secondary Care – Epidemiology, demography and public health • Knowledge Sharing – All ICD Chapters: • Disease Definitions and Criteria • comment threads – Structured Discussion Forums – Field Trials: Global Practice Networks to test the proposed codes, definitions… Ø Personalized selections in an interconnected electronic environment Ø Actionable information – alerting, planning, query, reporting & analysis Ø Collaboration (Executive, Knowledge worker, User) CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH INFORMATION …

CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH INFORMATION …

CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH INFORMATION …

Tentative Timeline • ICD-11 by … – – – – – 2006 : International Consultations for blueprint 2007 : Start of multiple streams of workplan 2008 : Alpha version 2008 : Commentaries and consultations 2009 : Beta version & Field Version 2010 : Field trials 2011 : Final version for public viewing 2012 : WHA Approval 2014+ implementation CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH INFORMATION …

Involvement Strategy • International: – Multiple countries – Multiple languages – Multiple health care systems • Multiple Parties & Professionals – Different clinical specialties, nursing & midwifery; other professionals – Different health care aspects: • • • Prevention Primary care Secondary care Home care Rehabilitation Long term care – Consumers from different sectors CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH INFORMATION …

Structure of Revision Process WHO Classifications Team K M S Coordinating Group Clinical Stream Scientific Stream FIELD TRIALS WHO FIC Update & Revision Committee Treatment Response Disorder Groups CLASSIFICATIONS Public Health Stream Phenotypes Terminology Payment Groups P O R T AL Topical Groups … BUILDING BLOCKS OF HEALTH INFORMATION …

One Classification – Multiple Projections (samples) The One Anatomy I C D CLASSIFICATIONS Ethiology Use ICD ICD head infectious mortality thorax immune Primary care abdom. cavity work billing foot iatrogen Verbal Autopsy … BUILDING BLOCKS OF HEALTH INFORMATION …

ICD-11 • Easy to use and implement • To reflect spectrum of needs of multiple – cultures – levels of development – health sectors • Compatibility with existing Classifications • Statistical comparability and continuity CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH INFORMATION …

Structure of Revision Process WHO Classifications Team K M S Coordinating Group Clinical Stream Scientific Stream FIELD TRIALS WHO FIC Update & Revision Committee Treatment Response Patient safety Public Health Stream Accidents Phenotypes Terminology Payment Groups P O R T AL External causes and injuries Disorder Groups CLASSIFICATIONS Work Factors Topical Groups Drugs … BUILDING BLOCKS OF HEALTH INFORMATION …