ICD-11 Robert Jakob, WHO 1
Timeline (Phase 2 consolidation) 2015 WHO Commissioned external review Focus on statistical classification Joint Task Force to consult with 2016 ICD-11 MMS for Member State Comment Revision conference Tokyo 12-14 October 2016 Field tests Editing 2017 Quality assurance Field tests Comments from Member States by Editing Proposals Maintenance structure 2
Overall picture 3
Why ICD-11? Improve usability Improve comparability of translations Improve index Improve incorporation in electronic problems Update scientific content Linkage to relevant other classifications and terminologies 4
Issues with ICD-10 - examples Antimicrobial resistance - essentially missing HIV subdivisions - outdated detail Skin cancer - melanoma types missing basalioma missing- other Valve diseases - outdated structure, need by valve, less rheumatic Chapters 1-18 versus Chapter 19 - clarify when use 19 and when not Regrouping necessary - Allergies and autoimmune diseases Problematic combination codes (e.g. alcoholic cardiomyopathy I42.6 <-> cause alcohol X45) External causes - Loosing detail in non-accidents; traffic accidents 5
Other ICD-10 issues Cystic Fibrosis Diabetes Lymphomas External Causes Mental Health Differences between dictionaries or indexes Different languages Mortality morbidity Different code ranges covered by indexes No standardized tooling for maintenance 6
ICD-11 - more standardization Scientific updates (look at maps) Solved known problems (look at 2007 meeting) Improves comparability nationally & internationally Translation of titles Translation/creation of index consistent All national additions in one place Maintenance of a single index (not IRIS and ICD separately) Saves money One central tooling and from that language versions are generated Maintenance of a single index (not IRIS and ICD separately) 7
ICD-11 Foundation - Links Index ICD-O Cancer Specialty versions Extension codes Tabular List for Mortality and Morbidity Statistics Content model ICF (Functioning) SNOMED CT Orphanet ICPC 8 Substances INN (=> ATC) External causes of injury ICHI dimensions (International Classification of ICECI Health Interventions)
ICD-11 - work 2016 6000 Proposals enacted: All received by 31-12-2015 Important input and error corrections received until 31-8-2016 Input from chapter reviews (JTF, others) Kind of work (Foundation has 53915 entities) Foundation has 42615 entities 35.000 index entries reviewed and many edited plus entity titles Spelling, language, pointing to correct entity 10900 parenting changes (mostly parent added) 6163 titles edited 4255 changes to shoreline 2200 changes to grouping Editing Reference Guide 9
Current work ICD-11 Mapping to ICD-10 => order, consistency User guidance Postcoordination Crossreferences (exclusion notes) Special tabulations Augmenting index From death certificates From clinical use Histopathology default tumour ICD-O integration Histopathology Anatomy Coding scheme and preparations for ICD-O-4 Substances INN integration Recommentations E.g. use URI for rare diseases 10
Alternative views Neurology linearization Specialties.. Priority to mortality /public health prevention Multiple parenting Revision electronic and science Phase 1 and phase 2 11
Timeline 2016 Release version for Member State comment 2017 Deadline Members State comments (31 May ) 2017 Deadline Field testing / quality assurance (30 June) 2017 Final round of editing 2018 Release of version for implementation 12
Problems Code hijacking Moving tumours into organ chapters (et idem) Using organ symptoms to link in the underlying diseases Level of detail Long lists without priority items Code explosion High coding depth Important ICD categories disappear in the depth Duplications Across chapters Within chapters 13
Coding Tool many refinements under the hood + Japanese version 14
Work now and 2017 Editing Complete the maps Check for terms or categories added to ICD-10 URC updates Review some shorelining (using maps and block level comparison reduce the number of primary codes Address the open proposals CSAC operational only 2017 Links to other classifications Address feedback from MS Address feedback from testing Tooling Add code collector feature to browser Mobile coding tool Improve print output Quality assurance Add terms from clinical modifications to the testing pool Line coding Work with MBRG on morbidity QA Case coding - morbidity rules Work with MRG on mortality rules Legal context IP regulations Contractual regulations Training materials Implementation planning 15
Important questions Verifying groupings and their place in the classification 1. Ch infectious Prion diseases (A81) Transmissible genetic component 2. Ch infectious Infections of central nervous system (Ch 1 and Ch 6) Viral infections of the central nervous system (A80 A89) Inflammatory diseases of the central nervous system (G00-G09) 3. Ch circulatory Cerebrovascular diseases Cerebrovascular diseases (I60-I90) Transient cerebral ischaemic attacks and related syndromes (G45) 16
ICD 11 start preparing now Give us your comments Try it and start translation tooling is ready 17