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WHO Classifications & Terminologies:

WHO Classifications & Terminologies:. What should WHO do?. What should WE do?. T. Bedirhan Üstün MD World Health Organization Classifications & Terminology www.who.int/classifications. Outline. WHO's vision for Health Information Systems

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WHO Classifications & Terminologies:

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  1. WHO Classifications & Terminologies: What should WHO do? What should WE do? T. Bedirhan Üstün MD World Health Organization Classifications & Terminology www.who.int/classifications

  2. Outline • WHO's vision for Health Information Systems • Vision for a global health terminology standard • Possible Options for WHO involvement • Organizational Issues towards as an international public good • Summary: • Desiderata for a global terminology • Future Steps

  3. How do we optimize our health services Health Systems & Information Systems:Analog to Digital

  4. ICD ICF Mappings KRs ICHI Classifications e-Health Record Systems Terminologies • Population Health • Births • Deaths • Diseases • Disability • Risk factors • Clinical • Decision Support • Integration of care • Outcome • Administration • Scheduling • Resources • Billing • Reporting • Cost • Needs • Outcome WHO Vision for Classifications and Terminology in HIS

  5. SNOMED-CT • SNOMED-CT is currently the most advanced system of clinical care terminology • Centrally maintained and updated by CAP and UK NHS • About 414,808 terms (about 10% have definitions) and 1.465 million (and counting) relations defined which supports consistency in communication • Gaps in some areas & questions about underlying ontology • Key to computerization of health information: electronic health records for coding, retrieval and analysis • Increased benefits for Health Information Systems: • Mainly ICD and potential to link to ICF, ICHIthrough adequate mapping and knowledge representation • Potential Use for: • Decision support for clinical users  Knowledge Map of Medicine • error reduction & patient safety  Reduced prescription errors • Administrative support  Payment by results

  6. WHO and Proposed SNOMED SDOPossible Options: Degrees of Collaboration • -1: WHO leads opposite development – competing terminology/(ies) • 0: WHO remains inert / ignores SNOMED SDO • +1: WHO watches/regulates the health terminology space • Establishes HIS needs, application rules that SNOMED applies • +2: WHO takes part in the SNOMED SDO • Representing 104/192 Countries • Takes part in "Harmonization Board" for Classifications –Terminology link • Takes part in R&D • Includes SNOMED in WHO e-Health Projects • Translation platform – Multilingual representation • +3 WHO owns the IPR of SNOMED CT • Runs the Executive Secretariat • Management operations

  7. WHO and Proposed SNOMED SDOOption 4: WHO takes part in SD Activities • Pro's: • Opportunity to represent Member States' overall concerns • Harmonization with Classifications and other HIS elements • Mapping to ICD-10 • ICF • ICHI and others • Work towards global multilingual health care terminology • Multi-lingual platform • Include WHO ART, Drug Dictionary Traditional Medicine,…others • Development of ICD-11 • Con's: • May seem as undue preference declaration • Will require substantive resources • Reduce competition • …

  8. Health Information Granularity • ~ 700 groups • Economic classification • ICD 12,000 categories • Higher order abstraction • SNOMED 400,000 concepts • Identification of clinical picture and activities

  9. ICD-11 Using SNOMED an example: F32.0 Depressive Disorder • Low mood {41006004} Loss of interest {417523004 } Low energy {248274002} • Appetite (decrease, increase){64379006, 72405004} • Body weight (decrease, increase) {89362005, 8943002} • Sleep (decrease, increase) {59050008, 77692006} • Psychomotor (decrease, increase) {398991009, 47295007} • Libido loss {8357008} • Low self esteem {286647002, 162220005} • Guilt, self blame {7571003} • Thoughts of death … • Suicide Ideation {102911000, 6471006} B.

  10. ICD-11 Terminology Tools ICD-10 Plus ICD-11 draft Experts/Workgroup Members that draft ICD-11 Using the joint-authoring web application the experts draft and share portions of ICD-11. ICD-10 + WEB Revision application Protege/OWL OpenGALEN Hi-Ki Joint-authoring WIKI like application • WHO EDITORS • Taxonomic rules • Definitions • Diagnostic criteria 1.Proposals, 2.Comments3.Discussions are all stored in a central searchable database ANY USER can connect to the web application and send their revision proposals or comments. Also review other proposals and discuss them SNOMED and/or any other terminology WHO and Clinical Modification Owners enter their Codes to represent the Standard and CM versions. ALL USERS can see drafts and comment. • Mappings • Algorithms • Clinical Interface/ Decision support system for diagnosis Use of SNOMED in ICD-11 Development

  11. Definition of Diseasea 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

  12. WHO "Collaborating Centers" Joint Workplan Policy Tools, Products Standards Quality Assurance Distributed development Linkage to other terminologies/ontologies Partnership for resource mobilization and sharing Cooperate with developing countries WHO Network of Terminology Centers

  13. Desiderata for a global terminology (1) • Comprehensiveness: • Coverage for all aspects of health care • Adequacy: • Is it fit or purpose – multiple purposes? • Does it have a good information model and ontological basis? • Multilingual applicability • language independent formal concept representation • Representation in multiple languages – more than translation • Utility: • Is it beneficial for: • Care providers : decision making, outcome evaluation • Consumers : participation – ownership – evaluation – risk reduction • Policy/Decision Makers : informed decision making on costs, benefits, efficiency • Reliability: • does it give the same results in different users

  14. Desiderata for a global terminology (2) • Validity: • Does it indicate the right things – and does the indication make sense • Comparability • Does the data in different context have same properties to be compared? • Interoperability • Technical: Can information systems exchange information and use it? • Semantic: Can information systems interpret the data with the same meaning? • Quality Assurance • Product: Annotation and Content • Process: Use and Usability • Sustainability • Secured maintenance: commitment to stability with earlier versions • Openness to address emerging technical issues

  15. Noting potential impact of ICT Applicability for low- and high-income countries... Urges Member States to consider…. strategy, infrastructure, public/private partnership, centres of excellence, public health information… Requests WHO to promote collaboration on compatibility and ethics use ICT solutions create model solutions and provide technical support WHA 58.28 Resolution on eHealth

  16. Public Health, Epi & Surveillance Clinical Information Reimbursement Resource Management Real Time Public HealthRule-based Aggregation @ Individual, Facility, Population levels Interventions Events Findings

  17. Semantic Interoperability for Public Health • to understand exactly what that data means • what constitutes a valid interpretation of the data • Search using Concepts above Words in eHRs • Extraction of Concepts from eHRs/compilations • Statistical Index on Community Collections • Concept Navigation across Collections

  18. Mergingtrafficahead Mergingtrafficahead StandardOrg. G StandardOrg. H StandardOrg. I No Forward-Looking Standards StandardOrg. F StandardOrg. E StandardOrg. D StandardOrg. C StandardOrg. B StandardOrg. A The Convergent Health Care Terminology ISO Dead End

  19. SummaryNetwork Development of an International Public Good • Overall Health Information Systems • Reporting frameworks: Clinical, Admin, Public Health • Think joint use of classifications and terminologies • Linguistic, cultural adaptation know-how • Linguistic Knowledge Representation & better ontology • Measures for Digital Development: Bridging Gaps • Action plan formulation and implementation • Proactive Support for a Global Standard system • ISO, eHSCG, CEN, EC…

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