# Presentation: 404119

## ICD Revision Process:towards ICD -11

- Classification, Assessment, Terminology Team
- WHO

## WHO Family of Classifications

**WHO Family of Classifications**

**REFERENCE 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*

**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)

## ICD Revisions

## Key Drivers

**Mandated by ****WHA and EB**
**Respond to ****consumer-needs**
- Prevention, Primary Care, Secondary Care, Administration, Patients, Families; Data-users
**Keep up with new scientific knowledge**
- New Diseases, Measures, Treatments, Terminology...
- Corrections: pruning and grafting, deletions
- Change in rules, guidelines, conventions...
**Compatibility within ****the WHO-FIC members**
- ICPC, ICF, ICHI, ICECI, ICD-O...
**Creation of an improved network and dissemination**
**Better implementation within Health Information Systems**
- Electronic Health Record,  Clinical Terminologies, Mortality Database

**Notes:**
Identification of new diseases
SARS,HIV subtypes...
Gene markers 
Change in clinical knowledge
Treatment response
Change in clinical terminology
Compatibility within the WHO FIC

Increase specificity, granularity

## Placing WHO Classifications in  HIS & IT

## Linking Classifications  to eHealth Records

- e-Health Record
- Systems

- Mappings

- Classifications

- Terminologies

- Diagnosis / Assessment
*  **Diseases*
*  **Disability *

- Management / Interventions

## Sources for Revision of Chapter XX

**Sources for Revision of Chapter XX**

## Sources for Revision of Chapter XX

**Sources for Revision of Chapter XX**

## ICD Chapter XX- International Statistical Use -

**ICD Chapter XX****- International Statistical Use -**

- Chapters

- Blocks

- 4 Ch. Categories

- ICD

- Child Mortality

- ICD Morbidity

- ISHMTHospital Morbidity

- General Mortality

- Verb. Autopsy

- Use (Epidemiology)

- Accidental poisoning

- Intentional self harm

- Medical devices associated with adverse incidents

- Traffic accidents

## Revision Chapter XXMortality

-  Use of Chapter XX
-   (Doris Ma Fat, Dejan Loncar, WHO)
-  1/3 of all deaths reported to WHO
-  ~ 7 % Chapter XX
-  Transport: 45 % “unspecified”
-  13/~70 countries do not use 4th character
-  ~ 400 codes never used
-  “Bitten or struck by crocodile or alligator, residential institution”

## ICD Revision Process

- Drafting Rules
**Taxonomic Guidelines**
**Definition, Diagnosis and Indexing / mapping** guidelines
- Drafting **Overall Structure**
- Drafting **Individual Chapters**
- Overseeing the **TOTAL ICD**
**ALPHA Draft** – structured comments
**BETA Draft** – field testing
- Final Draft
**WHA Approval**

## ICD Revision Work Streams

**Scientific Stream**
- Evidence Based Reviews
- Surveys
- Validation Studies
- Add-on protocols for existing studies
- Meta analyses
**Clinical Stream**
- Primary care utility
- Secondary care utility
- Linkage to patient reports
- Treatment Response
- Phenotypes: gene to behaviour specs
**Public Health Stream**
- Impact on Health Systems –society –service delivery
- Impact on statistics
- Resource management -reimbursement - accounting
- IT applications - terminology

## Knowledge  PortalWeb of ICD Revision

**Evidence based systematic reviews**
- Clinical Use: Primary Care, Secondary Care
- Epidemiology, demography and public health
**Knowledge Sharing**
**All ICD Chapters**:
- Disease Definitions and Criteria
- comment threads
- Structured Discussion Forums
- Field Trials:  Global Practice Networks to test the proposed codes, definitions...
***Personalized selections ****in an interconnected electronic environment*
*Actionable information – alerting, planning, query, reporting & analysis*
*Collaboration (Executive, Knowledge worker, User)*

## Slide 14

**Notes:**
Screen example shows  how the application works
The WEB Application:
 lists all ICD-10 items. 
It collects and displays 
comments and revision proposals 
from the WHO FIC Centers 
and Experts. 
It covers the Standard WHO-ICD-10 
 and (if there are no copyright restrictions) all the ICD-Clinical Modifications. 

When clicked on a code, the application displays the list of existing proposals that relate to this item. From here one may either add a new proposal or click on an existing proposal to see the details.

## Slide 15

**Notes:**
Addition of a new proposal/comment is filling in a form that collects information about the proposal that is made. In addition to writing, the user may hyperlink to resources that already exist on the web or upload documents.

## Slide 16

**Notes:**
Filling in a proposal. 

## Tentative Timeline

**Tentative Timeline**

- ICD-11 by ...
- 2006   : International Consultations for blueprint
- 2007   : Start of multiple streams of workplan
- 2008   : Alpha version
- 2008   : Commentaries and  consultations
- 2009   : Beta version & Field Version
- 2010   : Field trials
- 2011   : Final version for public viewing
**2012 **  : **WHA Approval**
- 2014+   implementation

## Involvement Strategy

**International: **
- Multiple countries
- Multiple languages
- Multiple health care systems
**Multiple Parties & Professionals**
- Different clinical specialties, nursing & midwifery; other professionals
- Different health care aspects:
- Prevention
- Primary care
- Secondary care
- Home care
- Rehabilitation
- Long term care
- Consumers from different sectors

## Structure of Revision Process

## One Classification – Multiple Projections  (samples)

**I**
**C**
**D**

**ICD**

- head

- thorax

- abdom.
- cavity

- foot

**ICD**

- infectious

- immune

- work

- iatrogen

**ICD**

- mortality

- Primary
- care

- billing

- Verbal
- Autopsy

- The One

- Anatomy

- Ethiology

- Use

## ICD-11

- Easy to use and implement
- To reflect spectrum of needs of multiple
- cultures
- levels of development
- health sectors
- Compatibility with existing Classifications
- Statistical comparability and continuity

## Structure of Revision Process

**Structure of Revision Process**

**External causes and injuries**

**Accidents**

**Drugs**

- Patient safety

**Work**

**Factors**