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

CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH INFORMATION … WHO Family of 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) (under development) 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 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)

CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH INFORMATION … ICD Revisions

CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH INFORMATION … Key Drivers WHA and EBMandated by WHA and EB consumer-needsRespond to consumer-needs –Prevention, Primary Care, Secondary Care, Administration, Patients, Families; Data-users Keep up with new scientific knowledge –New Diseases –New Diseases, Measures, Treatments, Terminology… –Corrections: pruning and grafting, deletions –Change in rules, guidelines, conventions… the WHO-FIC membersCompatibility within the WHO-FIC members –ICPC, ICF,ICHI, ICECIICD-O –ICPC, ICF, ICHI, 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 Population Health Births Deaths Diseases Disability Risk factors e-Health Record Systems ICD ICF ICHI Classifications Mappings Terminologies Clinical Decision Support Integration of care Outcome Administration Scheduling Resources Billing Reporting Cost Needs Outcome

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

Sources for Revision of Chapter XX

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

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

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 4th character ~ 400 codes never used – “Bitten or struck by crocodile or alligator, residential institution”

CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH INFORMATION … 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  WHA Approval

CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH INFORMATION … ICD Revision Work Streams 1.Scientific Stream Evidence Based Reviews Surveys Validation Studies Add-on protocols for existing studies Meta analyses 2.Clinical Stream Primary care utility Secondary care utility Linkage to patient reports Treatment Response Phenotypes: gene to behaviour specs 3.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…  Personalized selections in an interconnected electronic environment  Actionable information – alerting, planning, query, reporting & analysis  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 WHO FIC Update & Revision Committee Coordinating Group Scientific Stream Clinical Stream Public Health Stream Treatment Response Phenotypes Terminology Payment Groups Topical Groups Disorder Groups FIELD TRIALS K M S P O R TA L

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

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