Transcript ICD Dr. T. Bedirhan Üstün Coordinator, Classifications, Terminologies, Standards. World Health Organization Background • WHO +International Standards  ICD • Classification – Common language for definitions: •

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
14,473
100000
ICD-10-M
ICD 10
8,173
1,967
1,164
ICD 9
10000
ICD-9-M
1,040
200
ICD 5
ICD 8
214
ICD 4
965
205
ICD 3
ICD 7
189
ICD 2
954
179
ICD 1
1000
ICD 6
161
1
Bertillon
10
139
100
Farr/d'Espine
ICD Revisions
1853 1893 1900 1909 1920 1929 1938 1948 1955 1968 1975 1979 1993 1993
ICD-10 Medical Devices
•
associated with adverse incidents in diagnostic
and therapeutic use
Y70 Anaesthesiology 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
DERIVED
Classifications
International Classification of
Diseases for Oncology, Third
Edition (ICD-O-3)
The ICD-10 Classification of
I nternational
C lassification of
F unctioning,
Disability & Health
I nternational
C lassification of
H ealth
I nterventions
(under development)
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 Clinical
•
•
•
•
•
Births
Deaths
Diseases
Disability
Risk factors
Administration
• Decision Support • Scheduling
• Integration of care • Resources
• Outcome
• Billing
Reporting
• Cost
• Needs
• Outcome
Placing WHO Classifications in HIS & IT
ICD
ICF
Linkages
KRs
e-Health Record
Systems
ICHI
Classifications
Terminologies
Population Health Clinical
•
•
•
•
•
Births
Deaths
Diseases
Disability
Risk factors
Administration
• Decision Support • Scheduling
• Integration of care • Resources
• Outcome
• Billing
Reporting
• Cost
• Needs
• Outcome
Health Information Systems:
Analog to Digital
How do we
optimize
our health
services
ICD-11 Revision Goals
Evolve a multi-purpose and coherent classification
1.
–
–
Mortality, morbidity, primary care, clinical care, research, public
health…
Consistency & interoperability across different uses
2.
Serve as an international and multilingual reference standard
for scientific comparability and communication purposes
3.
Ensure that ICD-11 will function in an electronic
health
records environment.
•
Link ICD logically to underpinning terminologies and ontologies (e.g.
SNOMED, GO, …)
•
ICD Categories “defined” by "logical operational rules" on their
associations and details
Construction of ICD-10:
Revision Process in the 20th Century
• 8 Annual Revision Conferences (1982
- 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 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
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  a shared
understanding/exchange:
• among people
• among software agents
• 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…
7.
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.
4.
Textual Definition(s)
Terms
4.1. Base Index Terms
4.2. Base Inclusion Terms
4.3. Base Exclusion Terms
5.
Body Structure Description
5.1.
5.2.
5.3.
6.
Body System(s)
Body Part(s) [Anatomical Site(s)]
Morphological Properties
Manifestation Properties
6.1. Signs & Symptoms
6.2. Investigation findings
7.1.
7.2.
7.3.
7.4.
7.5.
8.
Causal Properties
Etiology Type
Causal Properties - Agents
Causal Properties - Causal Mechanisms
Genomic Linkages
Risk Factors
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
iCAT
• 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
SNOMED-CT,
International Classification of Functioning,
Disability and Health (ICF)…
Primary Care
Linearizations
Morbidity
Mortality
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
– ‫التصنيف الدولي لألمراض‬
– 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 independent formal concept representation
– Representation in multiple languages – more than translation
4. Utility:
– Is it beneficial for:
• Care providers
• Consumers
• Policy/Decision Makers
5. Reliability:
: decision making, outcome evaluation
: participation – ownership – evaluation – risk
reduction
: informed decision making on costs, benefits,
efficiency
– 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: Annotation and Content
– Process: Use and Usability
10.Sustainability
– Secured maintenance: commitment to stability with earlier versions
– Openness to address emerging technical issues