Frequent Criticisms

1. Frequent Criticisms • too ambitious • recreation of a Textbook of Medicine • competing with SNOMED-CT  • replicates the work done elsewhere: DSM, ICPC, • too academic – far from what ICD is needed for • will overhaul national statistics • The Content model is too big • You are killing the ICF  • Public commenting does not apply to ICD: Disease classification is a science

2. Frequent Criticisms • This is too ambitious • Ambitious but commensurate with the international information needs: • Use in public health: mortality, morbidity, … • from primary care to research • Coherent and comparable results • Available in multiple languages • Be ready for electronic health records • Links with standard terminologies such as SNOMED-CT, Gene Ontology

3. Frequent Criticisms • This is recreation of a textbook of medicine • NO - limits of information included is mainly for diagnostic and classification purposes • It is essential to formalize the classification knowledge using standard terms to enable use in electronic health records and other research

4. Frequent Criticisms • This is competing with SNOMED-CT • NO - ICD 11 clearly will not create a clinical terminology of its own • On the contrary, ICD11 will use SNOMED CT subsets wherever applicable as a value set for its parameters

5. Frequent Criticisms • This replicates the work done elsewhere: e.g. ICPC, DSM • NO - ICD does not replace either ICPC or DSM or other input classification. On the other hand, it references them as necessary to enable cross-utilization. • In particular, there is an agreement to make ICD11 and ICPC3 fully harmonized. • Similar agreement is in the works for DSM 5 & ICD 11 chapter V.

6. Frequent Criticisms • This will overhaul national statistics • NO - ICD11 will be produced with backward compatibility • It will provide cross-tabulation to ICD-10 • Migration will be tested by bridge-coding exercises between ICD-10 and 11. • Similar agreement is in the works for DSM 5 & ICD 11 chapter V.

7. ICD11 alpha - DIFF • Shows the change from ICD-10 • Backwards compatible

8. Frequent Criticisms • The Content Model is too big • Content Model captures different dimensions to represent a classification entity for ontological purposes. It is not necessary to capture all the dimensions for each entity. • Some experts still suggest to add new parameters to the CM • Each group may use a set of parameters which they find useful – but do not have the right to kick-out any parameter

9. Frequent Criticisms • You are killing the ICF - “functioning properties” is a caricature of the ICF • Functioning Properties represent only a high level entry items from the Activities and Participation Component of the ICF. It is to enable quick orientation to ICF for the ICD users. It does not cover Jthe full ICF. Users are suggested to use the full ICD when they have a larger need. • This will enable to align ICD and ICF. It will be useful to increase their utility in public health reporting.

10. Frequent Criticisms • Public Commenting does not apply to ICD – Disease classification is a science • Disseminated development process of ICD11 will enable structured input from interested parties. We will be addressing mainly content experts from health sciences. But anyone willing to make an input is able to do so. All proposals will be scientifically peer-reviewed. • It is important to get beyond the limited expert input thanks to the technological opportunities.

11. Frequent Criticisms • too academic • far from what ICD is needed for • Large scale mortality coding would certainly need simple systems: arriving at a reliable, comparable and consistent simple coding system requires a scientific undertaking with quality assurance. • Systematic definitions and computerized applications will increase ease of use and better implementation.