Digital Health and Electronic Medical Records: Aligning the EU and UK Agendas 15th July 2010, RCP London, UK

WHO Agenda: Classifications – Terminologies - Standards

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

The desiderata for a WHO FIC in 21st Century

 Evolve a

multi-purpose

– and

coherent

WHO classification which are

consistent

• • • yet

adaptable

and different uses (public health, service management, research) the spectrum of health care (Primary, Secondary, Tertiary) in developing and developed countries

interoperable

across – compatible with other

WHO classifications

 Serve as an

international

scientific

comparability

and

multilingual

and

communication

reference standard for purposes  Ensure that WHO classification will function in an

electronic health records

– – environment.

Link WHO FIC logically

SNOMED, GO, …) to underpinning

terminologies

and

ontologies

WHO FIC categories “

defined

” by "

logical operational rules

" on their associations and details (e.g.

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

ICD 11 is no longer just lists…it is based on a content model

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: syndrome Name of disease, disorder, or 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

ICD 11 Foundation Component and Linearizations

ICD-11 content model parameters

- 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

Web based collaborative authoring tool (iCAT)



display

&

browse

model rubrics taxonomy with its content  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

technology tooling interface with description logic

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

Making WHO FIC

ontology

based

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

Construction of ICD-10 & ICF:

        ICD: 8 Annual

Revision Conferences

(19

82 - 89

) ICF: 7 int. & 38 nat.

Revision Conferences

(19

94 - 2001

)

ICD: 17 – 58 Countries

– –

1- 5 person

mainly participated delegations

Health Statisticians ICF: 61 Countries

–

1- 5 person

– participated 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

What is the answer? ... what is the question?

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