1. ICD Revision: A new way to build the ICD
Dr Robert Jakob, Medical Officer ICD
Dr Bedirhan Ustun, Coordinator Classifications, Terminologies, Standards World Health Organization

2. Death registration-causes of death reported to WHO
Of the reporting countries, half are developed providing 75% of the deaths included, but only 33% of estimated global deaths
WHO region
Number of Member States
Data reported for at least one of the years
Percentage of Member States reporting
AFR 46 4 9
AMR 35 32 91
EMR 21 6 29
EUR 53 87
SEAR 11 3 27
WPR 8 30
Global
193 99 51

3. Reporting 2009

4. ICD use in Morbidity DRAFT – To be edited
Morbidity use follows pattern similar to mortality use
Green=ICD-10 use
Light blue= ICD-9 use
Yellow= some use
Grey=some known users
Dark blue=unknown
DRAFT

5. WHO International Drug Monitoring Programme - Membership August 2005
Full members of the WHO programme
Associated members of the WHO programme
Non members of the WHO programme
Membership in programme

6. Cancer registration (ICD / ICD-O)

7. The International Classification of Diseases 11th Revision is due by 2015
ICD is the international standard to measure health & health services
Mortality Statistics
Morbidity Statistics
Health Care Costs
Progress towards MDGs
βeta

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

9. Construction of ICD-11: Revision Process in the 21st 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

10. ICD-11 International Classification = Global Participation
ICD-11 Revision Platform
is OPEN to ALL people
in a structured way

11. ICD Revision Organizational Structure
WHO
Revision Steering Group
Gastroenterology WG
Cardiovascular WG
Hepatology & Pancreatobiliary WG
Nephrology WG
Endocrinology WG
Rheumatology WG
Health Informatics and Modelling TAG
(HIM TAG)
iCAT Software Team
Dentistry TAG
Musculoskeletal TAG
Mental Health TAG
Maternal, Neonatal and
Urogenital TAG
External Causes and
Injuries TAG
Dermatology TAG
Internal Medicine TAG
Neurology TAG
Ophthalmology TAG
Paediatrics TAG
Rare Diseases TAG
Haematology WG
Functioning TAG
Mortality TAG
Morbidity TAG
Quality & Safety TAG
Respiratory WG
Working Groups
Neoplasms TAG
Cross-Sectional TAGs
Traditional Medicine TAG
Content-Specific TAGs

12. iCAT

13. ICD-11 Integrates standard definitions
Diseases
Disorders, syndromes …
Ready for electronic health records
Links with standard terminologies
SNOMED-CT
Gene Ontology

14. THE CONTENT MODEL Any Category in ICD is represented by:
TITLE of ENTITY: Name of disease, disorder, or syndrome…
Causal Properties
Etiology Type
Causal Properties - Agents
Causal Properties - Causal Mechanisms
Genomic Linkages
Risk Factors
Temporal Properties
Age of Occurrence & Occurrence Frequency
Development Course/Stage
Severity of Subtypes Properties
10. Functioning Properties
Impact on Activities and Participation
Contextual factors
Body functions
11. Specific Condition Properties
Biological Sex
Life-Cycle Properties
12. Treatment Properties
13. Diagnostic Criteria
ICD Concept Title
Fully Specified Name
Classification Properties
Parents
Type
Use and Linearization(s)
Textual Definition(s)
Terms
Base Index Terms
Inclusion Terms
Exclusions
Body Structure Description
Body System(s)
Body Part(s) [Anatomical Site(s)]
Morphological Properties
Manifestation Properties
Signs & Symptoms
Investigation findings
Green already exists in ICD-10 either explicitly or implicitly – Content model specifies them in a more systematic way
Orange rubrics are new – they exist in some specialty adaptations already such as oncology, mental health, neurology, dermatology,
Functioning Properties is also new – to allow joint use of ICD and ICF 14 14

15. ICD ~ SNOMED-CT Common Ontology
Core subset of ICD Foundation Component
& SNOMED CT
Shared concepts:
fully specified names; definitions; synonyms
Same parent-child relationships
Similar polyhierarchies
Similar grouping logic
Same content model parameters
ICD revision process is to have a “common ontology” shared (or at least coherent with) SNOMED CT.
The “common ontology” has two functions:
To provide an “ontological” – i.e. formal logically sound – framework for the Foundation Component of ICD-11.
To provide a common structure for interoperability with SNOMED CT.
What’s in the “Common Ontology”
Logical core
The logic-based definitions of concepts and additional universal logic assertions about those concepts – i.e. assertions to which any exception would be a “contradiction in terms”. Usefulness criteria determine whether assertions are included or not. (e.g. assertions about “things that are necessarily red” may be excluded if not useful)
The scope of concepts in the common ontology remains to be specified. It will include at least the “core subset” of concepts already in ICD (roughly 15,000).
Issues outstanding include:
Section headings from ICD
Terms from the ICD index.
In addition, it may be that a much smaller “mid level” subset needs to be defined in some sub-hierarchies.
(The first intended experiment is to develop a small “slice” of the Common Ontology around Cardiovascular Diseases.)
Hierarchies
Typically, the common ontology is displayed in a polyhierarchy. The polyhierarchy is inferred logically from the definitions and universal assertions (some of which may state simply that one concept is a kind of another).
Text definitions
The common ontology is to be annotated with “Text Definitions” which explain the meaning and intent. As text, they play no part in the logical structure of the ontology, but should be kept aligned with it.
Curation of the text definitions is a major challenge. The goal is to assure that they are:
a) Correct
b) Understandable
c) Coherent with the logical definitions.
There are several different sub-elements of text definitions, and agreement is needed on the desired element(s) to be developed. These elements might include: (1) statements of genus-differentia (appendicitis is an inflammatory disorder that is located in the vermiform appendix), (2) statements of archetypal examples or lists of instances (instances of body organ include heart, lung, liver, and kidney), (3) statements explaining how to recognize/identify archetypal instances (myocardial infarction is typically accompanied by chest pain and ST segment elevation on EKG), (4) other clarifying statements such as exclusions, literature references, etc.
Names / labels / terms
Each concept in the “Common Ontology” should have:
A fully defined name in English (need to decide spelling/dialect: en-US or en-GB, or both)
In each language and dialect:
A preferred term that is unique within the “Common Ontology” (not necessarily unique across all of SNOMED CT. For example “immunosuppression” might be a disorder or a procedure.)
Any number of synonyms that need not be unique (but implementers must provide means of disambiguation where terms are not unique.)
Any number of “hidden” synonyms that can be used for search but are not normally displayed. (Acronyms, Eponyms, abbreviations, etc.)
Except for English, a  fully defined name (unless the national coordinating centre prefers to use the English.)
Identifiers
Each concept in the “Common Ontology” will be identified by an IRI. Details of the IRI scheme to be discussed separately.
Note: SNOMED CT has a draft IRI scheme that makes use of SNOMED CT Identifiers. We should take advantage of opportunities for re-use and coordination. Also need to discuss whether there is value in using SCTIDs in the “common ontology” IRI. The WHO-IHTSDO agreement intended to allow this, as one way to implement linkages.

16. Smooth transiton to ICD-11
Seamless evolution from ICD-10
Backwards compatible
βeta

17. Stability Analysis Types & Methodology
Mortality
Morbidity
ICD-10-WHO with ICD-11-WHO
ICD-10&11-WHO with ICD-10-GM
ICD-10&11-WHO with ICD-10-CA
ICD-10&11-WHO with ICD-10-AM
ICD-10&11-WHO with ICD-10-CM

18. PC – Low 1 PC – Low 2 PC – Low 3 MORBIDITY MORTALITY Extensions
Mort/PCHigh 11
Mort/PCHigh 12
Mort/PCHigh 13
Mort/PCHigh 21
Mort/PCHigh 22
Mort/PCHigh 31
Mort/PCHigh 33
Mort/PCHigh 34
Mort/PCHigh 32
Mort/PCHigh 35
Extensions
PC – Low 1
PC – Low 2
PC – Low 3
PRIMARY CARE Low Resource
(Verbal Autopsy ?)
PRIMARY CARE High Resource
MORBIDITY
MORTALITY
International
National Linearizations
Specialty - Research

19. ICD-11 Simultaneous development in Multiple Languages 國際疾病與相關健康問題統計分類
التصنيف الدولي للأمراض
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

20. Translation platform

21. Information Notes ICD Revision Communication ICD Revision Timelines
TAG Allocation
Content Model
Foundation Component and Linearizations
Legacy Linearizations
Code Structure
Multidimensional Coding
Index
Diagnosis Type
Main Condition
Review Process
Mirror Coding
Modifiers and Qualifiers
Field Trials
Stability Analysis
Multilingual ICD Platform
Dagger and Asterisk resolution
Multisystem Chapter

22. Overview ICD-11 progress Issues and Solution Plans
Volume I: Current status of Content
Stability Analysis: ICD10 in 11
Review Process
Field Trials
Volume II:  ICD knowledge base
Volume III: Index
Issues and Solution Plans

23. Current Status as of 30 April 2013
Some Chapters need further work
Signs & Symptoms
Factors influencing health status and contact with health services
Other chapters’ structure reported to be complete
Mental Health, Sexual Health, GURM sections…
Definitions
Top level > 50 %
Overall > 35 %

24. Proposal mechanism Browser functionality the same including searching
List of existing proposals visible with a summary
Proposals attached to descendant entities can be viewed
Creation of proposals

25. Review Process
The review process will help WHO assure the quality of the Beta Content
Review focus:
Scientific accuracy
Completeness of each unit
Internal consistency
Utility / Relevance of each unit
There is currently great diversity in the level of work completed in the Beta draft

26. ICD-11 Field Trials Mortality coding Morbidity coding Other use cases
To test the “fitness of ICD-11 for multiple purposes”
Mortality coding
Morbidity coding
Other use cases
To ensure the comparability between ICD-10 and ICD-11

27. Field Trial Studies Additional Studies Core Studies Study One:
Basic Questions – consistency, errors
Study Two:
Reliability & Feasibility
Study Three:
Bridge Coding
Additional Studies

28. Roadmap Collaborative Authoring Tools Review Mechanisms Field testing
Multilingual Production
USE CASES
Linking Classifications

29. ICD-11 International Public Good Available in multiple formats:
Openly Accessible
Free for WHO Member States
Available in multiple formats:
Printed Book editions
Internet-edition
Various computerized tools
e.g. Mobile phones…

30. ICD-11 Timeline 2013 : Beta version: Field Trials Version
+2 YR : Field trials
: Final version for WHA Approval
implementation
BETA: is not same as computer usage. 30