ICD
Dr. T. Bedirhan Üstün
Coordinator, Classifications, Terminologies, Standards.
World Health Organization


– Common language for definitions:
• Mortality: Counting the dead
• Morbidity: Monitoring & Evaluation
• Primary Care: Diagnosis

Management
• Research: Epi, Genetics, Pharma…

1666  2011

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1853 1893 1900 1909 1920 1929 1938 1948 1955 1968 1975 1979 1993 1993

associated with adverse incidents in diagnostic and therapeutic use
• Y70 Anaesthesiology devices associated with adverse incidents
• Y71 Cardiovascular devices associated with adverse incidents
• Y72 Otorhinolaryngological devices associated with adverse incidents
• Y73 Gastroenterology and urology devices associated with adverse incidents
• Y74 General hospital and personal-use devices associated with adverse incidents
•
Y75 Neurological devices associated with adverse incidents
•
Y76 Obstetric and gynaecological devices associated with adverse incidents
•
Y77 Ophthalmic devices associated with adverse incidents
•
Y78 Radiological devices associated with adverse incidents
•
Y79 Orthopaedic devices associated with adverse incidents
•
Y80 Physical medicine devices associated with adverse incidents
•
Y81 General- and plastic-surgery devices associated with adverse incidents
•
Y82 Other and unspecified medical devices associated with adverse incidents

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)

ICD
ICF
ICHI
Classifications
Population Health
• Births
• Deaths
• Diseases
• Disability
• Risk factors
Clinical
• Decision Support
• Integration of care
• Outcome
Administration
• Scheduling
• Resources
• Billing
Reporting
• Cost
• Needs
• Outcome

&
e-Health Record
Systems
Linkages
KRs
Terminologies
ICD
ICF
ICHI
Classifications
Population Health
• Births
• Deaths
• Diseases
• Disability
• Risk factors
Clinical
• Decision Support
• Integration of care
• Outcome
Administration
• Scheduling
• Resources
• Billing
Reporting
• Cost
• Needs
• Outcome

How do we optimize our health services

1.
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 p urposes
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

10
th
• 8 Annual Revision Conferences (19 82
- 89 )
• 17 – 58 Countries participated
– 1- 5 person delegations
– mainly Health Statisticians
• Manual curation
– List exchange
– Index was done later
• "
" Method of discussion
• Output: Paper Copy
• Work in English only
• Limited testing in the field

11
st
• 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

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

• 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…
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. Textual Definition(s)
4. Terms
4.1. Base Index Terms
4.2. Base Inclusion Terms
4.3. Base Exclusion Terms
5. Body Structure Description
5.1. Body System(s)
5.2. Body Part(s) [Anatomical Site(s)]
5.3. Morphological Properties
6. Manifestation Properties
6.1. Signs & Symptoms
6.2. Investigation findings
7. Causal Properties
7.1. Etiology Type
7.2. Causal Properties - Agents
7.3. Causal Properties - Causal Mechanisms
7.4. Genomic Linkages
7.5. Risk Factors
8. 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
• Open and collaborative process
– Users are empowered
– Web based
– Like WIKI – Trip Advisor
• But structured
• Editorial Oversight

- Definitions, synonyms
- Clinical descriptions
- Diagnostic criteria
- Causal mechanism
- Functional Properties
Find Term
Linearizations
Mortality
Primary Care
Morbidity
SNOMED-CT,
International Classification of Functioning,
Disability and Health (ICF)…
18

– WHO & IHTSDO
– Coverage & Adequacy
– Quality – Reliability - Utility
– MultiLingual Applicability
– Interoperability
– Sustainability
– Member States :
Enable health care delivery and compile health information

– Openly Accessible
– Free for WHO Member States
– Printed Book editions
– Internet-edition
– Various computerized tools

– Simultaneous development in Multiple Languages
– ضارملأل يلودلا فينصتلا
– 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

– Primary Care
– Clinical Services
– Research
– Children and Youth
– Oncology
– Mental Health
– Neurology
– Musculoskeletal
– Dermatology
– Dentistry e.g. ICD-10 Diagnostic Guidelines for
Mental Health in Primary Care

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 independen t formal concept representation
– Representation in multiple languages – more than translation
4. Utility:
– Is it beneficial for:
• Care providers
• Consumers
: decision making, outcome evaluation
: participation – ownership – evaluation – risk reduction
•
Policy/Decision Makers : informed decision making on costs, benefits, efficiency
5. Reliability:
– does it give the same results in different users

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