This is a presentation on ICD Revision current status in Internal Medicine TAG summarizing the latest developments in Beta Phase including the Review Process, Field Trials and next steps

1. ICD Revision Overview
Tevfik Bedirhan Üstün
Classifications, Terminologies, Standards Team
World Health Organization

2. Tokyo 2007 April  2013 February
ICD - Revision Journey
Thanks to:
• WHOFIC Network
• Japanese MHLW
• Japan Hospital Association
Table 1: Major Japanese academic societies
• Japanesesupporting Organizations
Medical ICD revision project
The Japanese Society of Internal Medicine
The Japanese Society of Gastroenterology
The Japanese Respiratory Society
Japanese Society of Nephrology
The Japan Endocrine Society
Japan Diabetes Society
Japanese Society of Hematology
The Japanese Circulation Society
Japanese Society of Neurology
Japan College of Rhumatology
Japan Association for Medical Informatics
The Japanese Society of Medical Record Administra

3. IM TAG Brazil Poster
Conclusions - Request
• Japanese government and academic societies have heavily involved
in the IM-TAG activities.
• As ICD is used in many countries with various ways it should be
supported financially by WHO and a number of governments.
• Also, it is essential to provide concrete and logical leadership by WHO
for conducting such a large international project effectively.

4. You can find the slides in…

6. Genealogy of ICD  1664

9. Age-adjusted death rates for
nephritis, nephrotic syndrome, and nephrosis:
United States, 1968-2005

13. ICD-11 Revision Goals
1. Evolve a multi-purpose and coherent classification
– 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 environment.
• ICD-11 will be a digital product
• Support electronic health records and information systems
• Link ICD logically to underpinning terminologies and ontologies (e.g. SNOMED, GO, …)
• ICD Categories “defined” by "logical operational rules" on their associations and details

14. ICD-11 Timeline
• 2012 : Beta version & Field Trials Version
– +2 YR : Field trials
• 2015 : Final version for WHA Approval
– 2015+ implementation
– Continuous Annual Cycles
• ICD 2015
• ICD 2016
• ICD 2017

15. How do we go
from Here to 21st Century?

16. • Open and Collaborative Platform
– Web based
– Like WIKIPEDIA
• But
– by the Content Model
• with
– by the TAGs , and scientific peers

17. ICD11 βeta
• http://www.who.int/classifications/icd/revision
• Beta – Browser & Print
10 look & feel + descriptions – code structure !
βeta
• ICD-11 Beta draft is NOT FINAL
• updated on a daily basis
•NOT TO BE USED for CODING
except for agreed FIELD TRIALS

18. The ICD Foundation Component
• is a collection of ALL
ICD entities like
diseases, disorders...
• It represents the whole
ICD universe.
• In a simple way, the foundation component is similar to a
“store” of books or songs.
• From these elements we build a selection as a
linearization.
• This analogy may however be misleading because there
are many links between the ICD entities (like parent-child
relations and other).
• The ICD entities in the Foundation Component:
• are not necessarily mutually exclusive
• allow multiple parenting ( i. e. an entity may be
in more than one branch, for example
tuberculosis meningitis is both an infection and
a brain disease)

19. The ICD Linearizations
• A linearization is a subset of the
foundation component, that is:
• Fit for a particular purpose: reporting
mortality, morbidity, or other uses
• Jointly Exhaustive of ICD Universe (Foundation
Component)
• Composed of entities that are Mutually Exclusive
of each other
• Each entity is given a single parent

20. Primary Care
Foundation: ICD
categories with Linearizations
- Definitions, synonyms
- Clinical descriptions Morbidity
- Diagnostic criteria
- Causal mechanism
- Functional Properties
Find Term Mortality
SNOMED-CT,
International Classification of
23
Functioning, Disability and Health (ICF)…

21. Linerization requirements
• Classical ICD
– Mutually Exclusive
MEJE priniciple
– Jointly Exhaustive
No double counting
All categories will be in
Residuals:
Other (*.8)
Unspecified (*.9)
should be generated for each linearization

22. Building Linearizations
• Multiple Parenting Allowed
– Pneumonia
• Lung Disease
• Sometimes Infectious Disease
• Permanence of meaning across different
linearizations
– Telescopic principle
• Zoom in – zoom out

23. Morbidity111
Morbidity112
Morbidity121
Morbidity131
Morbidity132
Morbidity133
Morbidity211
Morbidity221
Morbidity222
Morbidity311
Morbidity312
Morbidity321
Morbidity341
Morbidity342
Morbidity351
MORBIDITY
International

24. PC – Low 1
PC – Low 2
PC – Low 3
PRIMARY CARE Low Resource
(Verbal Autopsy ?)

25. Mort/PCHigh 11
PC – Low 1 Mort/PCHigh 12
Mort/PCHigh 13
Mort/PCHigh 21
PC – Low 2
Mort/PCHigh 22
Mort/PCHigh 31
PC – Low 3
Mort/PCHigh 32
Mort/PCHigh 33
Mort/PCHigh 34
Mort/PCHigh 35
PRIMARY CARE Low Resource PRIMARY CARE High Resource
(Verbal Autopsy ?) MORTALITY

26. Morbidity111
Mort/PCHigh 11
Morbidity112
PC – Low 1 Mort/PCHigh 12 Morbidity121
Morbidity131
Mort/PCHigh 13
Morbidity132
Morbidity133
Mort/PCHigh 21 Morbidity211
PC – Low 2
Morbidity221
Mort/PCHigh 22
Morbidity222
Morbidity311
Mort/PCHigh 31
PC – Low 3 Morbidity312
Mort/PCHigh 32
Morbidity321
Mort/PCHigh 33
Morbidity341
Mort/PCHigh 34
Morbidity342
Mort/PCHigh 35 Morbidity351
PRIMARY CARE Low Resource PRIMARY CARE High Resource MORBIDITY
(Verbal Autopsy ?) MORTALITY International

27. Morbidity111
Mort/PCHigh 11
Morbidity112
PC – Low 1 Mort/PCHigh 12 Morbidity121
Morbidity131
Mort/PCHigh 13
Morbidity132
Morbidity133
Mort/PCHigh 21 Morbidity211
PC – Low 2
Morbidity221
Mort/PCHigh 22
Morbidity222
Morbidity311
Mort/PCHigh 31
PC – Low 3 Morbidity312
Mort/PCHigh 32
Morbidity321
Mort/PCHigh 33
Morbidity341
Mort/PCHigh 34
Morbidity342
Mort/PCHigh 35 Morbidity351
PRIMARY CARE Low Resource PRIMARY CARE High Resource MORBIDITY Extensions
(Verbal Autopsy ?) MORTALITY International National Linearizations
Specialty - Research

28. X – Chapter:
Extension Codes
Type 1 Type 2 Type 3
Severity Main Condition (types) History of
Temporality Reason for Family History of
(course of the condition) encounter/admission
Temporality Main Resource Condition Screening/Evaluation
(Time in Life)
Etiology Present on Admission
Anatomic detail Provisional diagnosis
Topology
Specific Anatomic
Location
Histopathology Diagnosis confirmed by
Biological Indicators Rule out / Differential
Consciousness
External Causes (detail)
Injury Specific (detail)

29. Beta Phase
• Comments
• Proposals
• Review Mechanism
• Field Trials

30. Why a Review Process
• The review process will help WHO assure
the quality of the Beta Content
• Review focus:
– Scientific accuracy
– Completeness of each unit
– Internal consistency
– Utility / Relevance of each unit

31. Review Process
• The review process :
– the content
• Definitions
• Content model parameters
– The structure - of the linearization (s)
• Mortality
• Morbidity
• Primary Care
• The reviewers:
– scientific peers

32. Initial Review
• Initial Review of the current Beta draft:
– Linearization Structure(s) (e.g. Mortality and Morbidity or Primary
Care)
– Content
• Review Units: may include individual entities or groups of entities
at any level, such as:
 Structure Review Units  Content Review Units
– Entire Linearization – Chapter
– Chapter – Subchapter
– Subchapter – Clusters
– Clusters – Individual entities
– Use Cases – Other groups of entities, as selected
– Other structure groupings, as selected

33. Reviewers
• Content Reviewers: Pool of specialist
experts to review in their area of
expertise, similar to quality assessment in
peer-reviewed journals.
• Structure Reviewers: Morbidity TAG and
Mortality TAG
• TAG and WG members :
– will act as a scientific journal editorial board.
– should NOT be nominated as reviewers.

34. Call for Reviewers
• WHO Requests all TAGs and WGs to provide
nominations of reviewers for the next step in the Beta
Phase.
• Please send the following information to WHO
(robinsonm@who.int) and copy the message to Bedirhan
(ustunb@who.int) :
– Name of the nominee
– Email address
– Area(s) of expertise (content they are qualified to review)
– CV of the nominee (preferred)
– Linked-In or other professional profile link (if available)

35. Content Review – Schedule
1st Wave 3rd Wave
• GURM – Musculoskeletal
• TM (Disorders) – Mental Health
• Gastroenterology – Neurology
– Rare Diseases
• Nephrology
– Circulatory
• Hepato-pancreatobiliary
4th Wave
2nd Wave
– Dermatology
• External Causes and Injuries
– Hematology
• Ophthalmology – Respiratory
• Dentistry – Neoplasms
• Rheumatology – Infectious Diseases
• Endocrinology – Pediatrics

36. Transition Strategy
ICD-10 ICD-11
ICD-9
75 79 90 13 15 ??
4 23
ICD - 2016
ICD - 2018
ICD - 2019
ICD - 2017
2015

37. Roadmap during Beta Phase
• TAG serving as an
Editorial Board
• Reviews
• Organizing Field testing
• Feasibility
• Quality assurance
• Reliability

38. ICD11 βeta
A caterpillar,
This deep in fall-
Still not a butterfly
Basho