Digital Health and Electronic Medical Records:
Aligning the EU and UK Agendas
15th July 2010, RCP London, UK
Nenad Kostanjsek
World Health Organization
1 |
WHO agenda: Classifications, Terminologies, Standards |
RCP Conference on Digital Health & EMR, 15 July 2010, London, UK

Placing WHO Classifications in HIS & IT of the
21 st Century e-Health Record
Systems
KRs
Mappings
Terminologies
ICD
ICF
ICHI
Classifications
ICPS
ICTM
2 |
Population Health
• Births
• Deaths
• Diseases
• Disability
• Risk factors
Clinical
• Decision Support
• Integration of care
• Outcome
Administration
• Scheduling
• Resources
• Billing
Reporting
• Cost
• Needs
• Outcome
WHO agenda: Classifications, Terminologies, Standards |
RCP Conference on Digital Health & EMR, 15 July 2010, London, UK

 Evolve a multi-purpose and coherent WHO classification which are
– consistent yet adaptable and interoperable across
• different uses (public health, service management, research)
• the spectrum of health care (Primary, Secondary, Tertiary)
• in developing and developed countries
– compatible with other WHO classifications
 Serve as an international and multilingual reference standard for scientific comparability and communication purposes
 Ensure that WHO classification will function in an electronic health records environment.
– Link WHO FIC logically to underpinning terminologies and ontologies (e.g.
SNOMED, GO, …)
– WHO FIC categories “ defined
” by " logical operational rules " on their associations and details
3 |
WHO agenda: Classifications, Terminologies, Standards |
RCP Conference on Digital Health & EMR, 15 July 2010, London, UK

Key workstreams & elements for developing WHO FIC
 Use cases
 Content model (parameter & value set)
 Population & peer review of content model
 Web based collaborative authoring tool (iCAT)
 Ontology development
4 |
WHO agenda: Classifications, Terminologies, Standards |
RCP Conference on Digital Health & EMR, 15 July 2010, London, UK

5 |
WHO agenda: Classifications, Terminologies, Standards |
RCP Conference on Digital Health & EMR, 15 July 2010, London, UK

THE CONTENT MODEL
Any Category in ICD is represented by:
2.
3.
4.
5.
1.
6.
7.
8.
9.
10.
11.
12.
13.
6 |
14.
ICD Concept Title: Name of disease, disorder, or syndrome
Classification Properties : Parents, Type, Use
Textual Definition(s) : Fully Specified Name
Terms : synonyms, Index, inclusion, exclusion
Clinical Description: Body System(s), Body Part(s),
[Anatomical Site(s), Histopathology
Manifestation Properties: Signs & Symptoms,
Findings
Causal Properties: etiology type, agents, mechanisms, genomic characteristics; risk factors
Temporal Properties: age of occurrence & occurrence
Frequency, development course
Severity Properties
Functioning Properties
Specific Condition Properties
Treatment Properties
Diagnostic Criteria
WHO agenda: Classifications, Terminologies, Standards |
External Causes
Maintenance attributes
A.
Unique identifier
B.
C.
Mapping relationships
Linkages to other systems like
SNOMED etc.
Other rules

- Definitions, synonyms
- Clinical descriptions
- Manifestation properties
- Causal properties
- Functional properties
Linearizations
Specialty
Adaptation
Primary Care
Morbidity
Mortality
Value Set
SNOMED-CT, International Classification of
Functioning, Disability and Health (ICF), International
Classification of External Causes of Injury (ICECI)…
7 |
WHO agenda: Classifications, Terminologies, Standards |
RCP Conference on Digital Health & EMR, 15 July 2010, London, UK

 display & browse taxonomy with its content model rubrics
 allow user to comment on the content
 allow users editing the content and facilitate the use of value sets derived from other classifications and terminologies
 allow user restructuring the classification
 Incorporates multiple level of user access
 supports multilingual representation
 ontology tooling interface with description logic technology
8 |
WHO agenda: Classifications, Terminologies, Standards |
RCP Conference on Digital Health & EMR, 15 July 2010, London, UK

Example: ICPS ontology development has cause
Incident type has type
Hazard
Incident has consequence has circumstances has impact
Contextual
Factors
Harm Action is a
Patient outcome Org. outcome is a
Injury
Adverse Reaction
Disease
Disability is a
Managing action Preven. action
9 |
WHO agenda: Classifications, Terminologies, Standards |
RCP Conference on Digital Health & EMR, 15 July 2010, London, UK

WHO classification development in the 20 th Century
 ICD: 8 Annual Revision Conferences (19 82 - 89 )
ICF: 7 int. & 38 nat. Revision Conferences (19 94 - 2001 )
 ICD: 17 – 58 Countries participated
– 1- 5 person delegations
– mainly Health Statisticians
ICF: 61 Countries participated
–
1- 5 person delegations
– Multi-disciplinary
 Manual curation
– List exchange
– Index was done later
 "Decibel" ? Method of discussion
 ICF: Concept driven
 Output: Paper Copy
 Work in English only

ICD: Limited testing in the field
ICF: drafts translated into / tested in 27 languages
 post-coordinated development of linkages to related classification, terminologies and assessment instruments
10 |
WHO agenda: Classifications, Terminologies, Standards |
RCP Conference on Digital Health & EMR, 15 July 2010, London, UK

WHO classification development in the 21 th Century
 Internet-based permanent platform
– All year round
– Open to all people in a structured way
– Linkages to related classification, terminologies and assessment instruments
– Content experts & users are empowered
 Digital curation
– Wiki enabled collaboration
– Ontology
 Enhanced discussion & peer review
 Electronic copy  print version
 Work in multiple languages
 field tests
– based on Use Cases
11 |
WHO agenda: Classifications, Terminologies, Standards |
RCP Conference on Digital Health & EMR, 15 July 2010, London, UK

Computers are useless. They can only give you answers.
Pablo Picasso (1881-1973)
12 |
WHO agenda: Classifications, Terminologies, Standards |
RCP Conference on Digital Health & EMR, 15 July 2010, London, UK