Dr. T. Bedirhan Üstün Coordinator, Classifications, Terminologies, Standards. World Health Organization

1. ICD Dr. T. Bedirhan ÜstünCoordinator, Classifications, Terminologies, Standards. World Health Organization

2. Background • WHO +International Standards  ICD • Classification • Common language for definitions: • Applications: • Mortality: Counting the dead • Morbidity: Monitoring & Evaluation • Primary Care: Diagnosis  Management • Research: Epi, Genetics, Pharma…

3. 1666  2011

4. ICD Revisions

5. ICD-10 Medical Devices associated with adverse incidents in diagnostic and therapeutic use • Y70Anaesthesiology devices associated with adverse incidents • Y71Cardiovascular devices associated with adverse incidents • Y72Otorhinolaryngological devices associated with adverse incidents • Y73Gastroenterology and urology devices associated with adverse incidents • Y74General hospital and personal-use devices associated with adverse incidents • Y75Neurological devices associated with adverse incidents • Y76Obstetric and gynaecological devices associated with adverse incidents • Y77Ophthalmic devices associated with adverse incidents • Y78Radiological devices associated with adverse incidents • Y79Orthopaedic devices associated with adverse incidents • Y80Physical medicine devices associated with adverse incidents • Y81General- and plastic-surgery devices associated with adverse incidents • Y82Other and unspecified medical devices associated with adverse incidents

6. I nternational C lassification of D iseases I nternational C lassification of F unctioning, Disability & Health I nternational C lassification of H ealth I nterventions (under development) WHO Family of Classifications REFERENCE Classifications DERIVED Classifications International Classification of Diseases for Oncology, Third Edition (ICD-O-3) The ICD-10 Classification of 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) 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 aidsfor persons with disabilities – Classification and Terminology

7. ICD ICF ICHI Classifications • Population Health • Births • Deaths • Diseases • Disability • Risk factors • Clinical • Decision Support • Integration of care • Outcome • Administration • Scheduling • Resources • Billing • Reporting • Cost • Needs • Outcome WHO Classifications in HIS

8. ICD ICF Linkages 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 Placing WHO Classifications in HIS & IT

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

10. ICD-11 Revision Goals Evolve a multi-purposeand coherent classification Mortality, morbidity, primary care, clinical care,research,public health… Consistency & interoperability across different uses Serve as an internationaland multilingual reference standard for scientific comparability and communication purposes Ensure that ICD-11 will function in an electronic health recordsenvironment. Link ICD logically to underpinning terminologies and ontologies(e.g. SNOMED, GO, …) ICD Categories “defined” by "logical operational rules" on their associations and details

11. 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

12. 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

13. 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

14. 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

15. THE CONTENT MODELAny Category in ICD is represented by: 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. Textual Definition(s) 4. Terms 4.1. Base Index Terms 4.2. Base Inclusion Terms 4.3. Base Exclusion Terms 5. Body Structure Description 5.1. Body System(s) 5.2. Body Part(s) [Anatomical Site(s)] 5.3. Morphological Properties 6. Manifestation Properties 6.1. Signs & Symptoms 6.2. Investigation findings TITLE of ENTITY: Name of disease, disorder, or syndrome… 7. Causal Properties 7.1. Etiology Type 7.2. Causal Properties - Agents 7.3. Causal Properties - Causal Mechanisms 7.4. Genomic Linkages 7.5. Risk Factors 8. 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

16. Open and collaborative process Users are empowered Web based Like WIKI – Trip Advisor But structured Editorial Oversight iCAT iCAT Collaborative Authoring Tool for ICD Revision

17. iCAT

18. ICD11 Components Foundation: ICD categories with - Definitions, synonyms - Clinical descriptions - Diagnostic criteria - Causal mechanism - Functional Properties Primary Care Linearizations Morbidity Find Term Mortality SNOMED-CT, International Classification of Functioning, Disability and Health (ICF)… 18

19. 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 aresynergisticandnot antagonistic

20. 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

21. ICD & WHO FIC • Simultaneous development in Multiple Languages • 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

22. 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

23. 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

24. 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