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

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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

100000

10000

1000

100

10

1

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

ICD-10 Medical Devices

associated with adverse incidents in diagnostic

Y70 Anaesthesiology

and therapeutic use

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

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

Births

Deaths

Diseases

Disability

Risk factors

Clinical

Decision Support

Integration of care

Outcome

Administration

Scheduling

Resources

Billing

Reporting

Cost

Needs

Outcome

Placing WHO Classifications in HIS

&

IT

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

Health Information Systems:

Analog to Digital

How do we optimize our health services

1.

ICD-11 Revision Goals

Evolve a

multi-purpose

and

coherent

classification

Mortality

,

morbidity

,

primary care

, clinical care, research,

health… public

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

SNOMED, GO, …)

(e.g.

ICD Categories

“defined”

associations and details by "logical operational rules" on their

Construction of ICD-

10

:

Revision Process in the 20

th

Century

• 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

• "

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

 understanding/exchange:

• among people among software agents

• a shared 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

CAT

• Open and collaborative process

– Users are empowered

– Web based

– Like WIKI – Trip Advisor

• But structured

• Editorial Oversight

iCAT

ICD11 Components

Foundation: ICD categories with

- 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

Why work together?

WHO & IHTSDO

– Coverage & Adequacy

– Quality – Reliability - Utility

– MultiLingual 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

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

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 independen

t formal concept representation

– Representation in multiple languages – more than translation

4. Utility:

– Is it beneficial for:

Care providers

Consumers

Policy/Decision Makers

: decision making, outcome evaluation

: participation

– ownership – evaluation – risk reduction

: informed decision making on costs, benefits, efficiency

5. Reliability:

– 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:

Process:

Annotation and Content

Use and Usability

10.Sustainability

Secured maintenance

: commitment to stability with earlier versions

– Openness to address

emerging technical issues

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