Icd 11 ppt

ICD11 Updates

1. GOOD AFTERNOON

2. SHORT TALK Dr. Megha Bhengra Junior Resident II Community Medicine GMC Miraj

3. CONTENTS Introduction Historical evolution of ICD Features of ICD-11 New elements of ICD-11 ICD-11 Revision updates References

4. INTRODUCTION The International Classification of Diseases is the international standard diagnostic tool for epidemiology, health management and clinical purposes. Its full official name is international statistical classification of diseases and related health problems . The is the global health information standard for morbidity and mortality statistics. ICD is increasingly used in clinical care and research to define diseases and study disease patterns as well as managing health care monitor outcomes and allocation of resources.

5. Continued ICD defines the universe of diseases, disorders, injuries and other related health conditions, listed in a comprehensive hierarchical fashion that allows for: 1. Easy storage , retrieval and analysis of health information for evidenced-based decision - making. 2. Sharing and comparing health information between hospitals, regions, settings and countries. 3. Data comparisons in the same location across different time periods.

6. HISTORICAL EVOLUTION OF ICD Francois Bossier de Lacroix better known as Sauvages is credited with the first attempt to classify diseases systematically, in his comprehensive treatise under the title Nosologia Methodica .

7. CONTINUED William Cullen of Edinburgh published the classification of disease in 1785 under the title Synopsis nosologiae methodica . However, the statistical study of disease began with the work of John Graunt on the London Bills of Mortality. He attempted to estimate the proportion of liveborn children who died before reaching the age of six years .

8. Continued In 1837, the General Register office of England and Wales, William Farr labored to perfect the classifications of diseases available at that time and tried to secure better classifications and international classifications and international uniformity in their use.

9. Continued However the first international classification edition , known as the International list of causes of death, was adopted by the International Statistical Institute in 1983 through a committee chaired by French man Jaques Bertillon.

10. Continued WHO was entrusted with the ICD at its creation in 1948 and published the 6 th version, ICD-6 that incorporated morbidity for the first time. The 6 th revision included morbidity and mortality conditions and its title was modified to reflect the changes: Manual of International Statistical Classification of Diseases, Injuries and Causes of Death. The WHO Nomenclature Regulations, adopted in 1967 , stipulated that member states use the most current ICD revision for mortality and morbidity statistics. The ICD has been revised and published in a series of editions to reflect advances in health and medical science over time.

11. ICD REVISIONS

12. A NEW WAY TO BUILD ICD

13. TIME LINE OF ICD 11 REVISION MAY 2011 JULY 2011 MAY 2012 MAY 2018 Open ICD-11 Alpha Browser to the Public for viewing. Open ICD-11 Alpha Browser to the Public for commenting. Open ICD-11 Beta To the Public. WHO is engaged with interested stakeholder for ICD revision. Individuals are able to make comments, make proposal, participate field trial and assist in translating. Present the ICD-11 to the World Health Assembly.

14. FEATURES OF ICD 11 1. Internet based platform 2. Input from all Stakeholders 3. Content Model

15. 4.Definitions 5. Field Trials for use cases

16. 6. Electronic Health Records 7. Multi Lingual Representations 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

17. 1. INTERNET BASED PLATFORM Open all year around with continuous updates. ICD-11 Browser is a website that allows the user see the current state of the development of the ICD 11 th Revision. The content on the site is updated daily with new content. It also allow it users to contribute to the ICD 11 development by writing comments, making change in proposals, help translation etc. Open to all interested people Health care providers, Health information managers, researchers, policy makers, insurers and National Health programmes managers. Also for structured review by experts ( TAG, RSG, JTF)

18. COUNTINUED Presented in a Structured Web Platform I CAT i.e. The Collaborative Authoring Tool for the 11 th Revision of International Classification Of Diseases. The access to iCAT is restricted to Topic Advisory Group (TAG) members only. Open and Collaborative platform. Web based. Like Wikipedia but structured by the Content Model. With editorial oversight by TAG and scientific peers. i CAT Collaborative Authoring Tool for ICD Revision

19. 2. INPUT FROM ALL STAKEHOLDERS Participation of interested stakeholders using a Collaborative Authoring Tool in which WHO aims to engage all experts and stakeholders to Make Comments. Make Proposals. Take part in Field Trials. Engage in translations for multilingual representations. Subjected to the scientific peer review process guided by experts groups such as TAG, RSG etc.

20. GOVERNANCE STRUCTURE OF ICD 11

21. Continued

22. ICD REVISION ORGANIZATIONAL STRUCTURE WHO R evision S teering G roup Health Informatics and Modeling TAG ( HIM TAG) iCAT Software Team Functioning TAG Mortality TAG Morbidity TAG Quality & Safety TAG Traditional Medicine TAG Dentistry TAG Musculoskeletal TAG Mental Health TAG Maternal , Neonatal and Urogenital TAG External Causes and Injuries TAG Dermatology TAG Internal Medicine TAG Neurology TAG Ophthalmology TAG Paediatrics TAG Gastroenterology WG Cardiovascular WG Hepatology & Pancreatobiliary WG Nephrology WG Endocrinology WG Rheumatology WG

23. 3. CONTENT MODEL The Content Model is a structured framework that captures the knowledge that underpins the definition of ICD entity. Represents ICD entities in a standard way. Allows Computerisation. Each ICD entity can be seen from different dimensions or “parameters”. There are currently 13 parameters. A parameters is expressed using standard terminologies known as value sets.

24. THE CONTENT MODEL PARAMETERS 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. Inclusion Terms 4.3. Exclusions 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 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 Treatment Properties 13. Diagnostic Criteria

25. 4. DEFINITIONS All ICD entities will have definitions : 1. Key descriptions of the meaning of the category. 2. In human readable forms to guide users. ( This is an advancement over ICD 10, which had only title Headings ) 3. Limited definition in print version. Definitions will be compatible with: 1. The Content Model. 2. Diagnostic Criteria. 3. Across the whole classification of ICD-11 version.

26. 5. FIELD TRIALS BETA PHASE FIELD TESTS: How TWO different users code the same case ? Measles Rubella Measles Rubella ?

27. CONTINUED Aims to test the “ Fitness to the ICD 11 for multiple purposes.” 1. Mortality Coding. 2. Morbidity Coding. To ensure the comparability between ICD-10 and ICD-11. To increase consistency, identify improvement paths and reduce errors. Use to assess applicability, feasibility, consistency and utility.

28. CONTINUED Different types of core studies and additional studies have been developed along with instruments and procedures to ascertain issues with ICD-11 or its implementation, to undertake: 1. Bridge coding . 2. Studies of inter coder reliability.

29. Bridge / Line Coding The information on a case ( live or medical record ) will be coded 1. In ICD -10 Version. 2. In ICD-11 Version. So, to assess whether both the system yield the same code.

30. INTER CODER RELIABILITY The information on a case ( live or medical record) will be coded by two different medical coder to assess whether they concur on the same code.

31. 6. ELECTRONIC HEALTH RECORDS The organisation or groups sees ICD -11 as representing the key strategic issues for current and future health information system, with its capabilities to open in an EHR and terminology environment. The theme for the ICD 11 R evision Conference held in October 2016, was “Health information in new era”. ICD-11 is regarded as future proofing to make classification acceptable for clinicians in an e-health environment.

32. 7. ICD 11 IN MUTIPLE LANGUAGES ICD has been translated into 43 languages so far. Built on the experience in previous ICD translations and using the Content Model and standard terminologies in ICD-11 revision process, the ICD-11 have the computerised assistance for its development in multiple languages with human experts verifying concept equivalence. 1. This is called a multilingual representation and not translation. 2. Aim is to represent equivocal concept rather than word by word translation.

33. CONTINUED The priority is on 6 official Languages. English French Spanish Russian Chinese Arabic Two WHO regional official Languages, German and Portuguese. Other language representations is done at the request of WHO Collaborating centres in different languages area.

34. ROLE OF SNOMED CT IN ICD-11 The International Health Terminology standards development organisation (IHTSDO), developers and owner of SNOMED CT i.e. Scientific Nomenclature of Medicine Clinical Terms, has a collaboration agreement with WHO to ensure linkages between SNOMED CT and WHO classification. IHTSDO is working to ensure alignment between SNOMED CT content and that proposed in ICD-11, so clinicians can globally use SNOMED CT in the electronic record for clinical information and users can then link across to ICD-11 for information related to healthcare statistics, billing ,public health , epidemiology etc.

35. CONTINUED The review focuses on identifying in SNOMED CT, such as specific classification terms. The IHTSDO is working through ICD-11 beta version chapter by chapter and preparing an initial assessment. This is followed by a review by clinical specialists – to review what SNOMET CT changes are being proposed, to ensure clinical relevant for international usage as well as ensuring that the clinical definitions are understandable in line with current clinical Practice.

36. CONTINUED 2017 Project Scope Deliverables Release 1. Alignment between SNOMED CT and ICD-11 Delivery of 1200 concepts to support MMS in the July 2017 SNOMED CT. Delivery of 1200 concepts to support MMS in the Jan 2018 SNOMED CT. Potential of 400 plus concepts that may be include in Jan 2018 release. In progress, July 2017. Jan 2018 3. Jan 2018 2. ICD11 Map 1. Create Map for ICD-11 alignment to scope of MMS. 1. In progress, 2017, multi release project. 3. Additional ICD-11 chapters. 1. Delivery of additional chapters 1.2018 - dependent on funding and priority.

37. WHY WORK TOGETHER ? WHO and IHTSDO i. Coverage and adequacy. ii. Quality, reliability and utility. iii. Multilingual acceptability iv. Interoperability. v. Sustainability.

38. NEW ELEMENTS OF ICD-11 New chapters: Chapter 3: Diseases of blood and blood forming Organs. Chapter 4: Disorder of immune system. Chapter 5: Conditions related to sexual health. Chapter 8: Sleep-wake disorder. Chapter 26: Extension code. Chapter 27: Traditional Medicine. Differences to ICD-10

39. New Concepts: i. Foundation: Everything in ICD. ii. Entity: Each element in the foundation. iii. Linearization: also known as classification. iv. Stem code: Category (includes former dagger codes). v. Extension Codes: additional information. vi. Linearization parents: Classification Hierarchy , chapters, blocks, category.

40. Content Model 1. ICD-11 categories have a short and long definitions. 2. All ICD-11 categories include separate information on anatomy, aetiology, and other aspects. 3. These can be assessed through searches, or when browsing the tabular list.

41. Example- In ICD 11 Beta draft version, in chapter 1 of infectious diseases Tuberculosis Tuberculosis of the respiratory system 1B30 Respiratory Tuberculosis, confirmed 1B31 Respiratory Tuberculosis, not confirmed. Tuberculosis of system other than respiratory system 1B40 Tuberculosis of nervous system. 1B40.1 Tuberculosis Meningitis. 1B40.3 Tuberculous meningo encephalitis.

42. New coding Scheme. 1. The chapter numbering: now Arabic , not roman numerals. 2. The coding scheme for categories: now minimum 4 characters, 2 levels of subcategories. 3. Asterisk codes become clinical forms and extension codes ..

43. Terminology 1. ICD-10 had a range of expressions to describe a causal relationship between conditions in a code title. In ICD-11, the preferred term is “due to ”. 2. ICD-10 had a range of expressions indicating the coincidence of two conditions in a code title (e.g. “in or with”).In ICD-11 preferred term is “ associated with ”.

44. ICD-11 RECENT UPDATES WHO publishes quarterly newspapers to inform key stakeholders and the public about the progress and advancements within the 11 th ICD revision progress. Latest newspaper on ICD-11 revision is published on January 2017. WHO organized a high level ICD-11 conference for member states, hosted by the collaborating centre WHO-FIC in Japan from 12-14 October 2016. The Theme for the conference was “ Health information in the new era “ and the opening session aimed to frame the ICD in the global health, the Sustainable D evelopment Goals (SDGs) 2016-2030 and country realities.

45. (A) ICD-11 : TAKING SHAPE Following the ICD-11 conference ,WHO team has been focussing on cross-cutting view of the classification with the help of TAG. The horizontal work is done to ensure the chapters work together and are consistent in their approach to classifying entities . There has also been work done on the index to confirm that term points to the correct location and are correctly written in the natural languages. The mapping of concepts between the ICD-10 and ICD-11 is in the review process. Movements of entities between chapters are verified and corrected where necessary.

46. ICD INFORMATICS UPDATE Currently, the ICD-11 browser is in the beta phase. ICD-11 Beta Draft ( Mortality and Morbidity Statistics) Search [ Advanced Search ] Last Update: [  Register  ]  |  [  Log In  ] ? ? ? Foundation Linearization Contributions Info 01Certain infectious and parasitic disease 02 Neoplasms 03 Diseases of blood or blood forming organ 04 Diseases of immune system 05 Endocrine, nutritional or metabolic diseases 06 Mental , behavioural or neurodevelopment disorders 07 Sleep-wake disorders 08 Diseases of nervous system 09 Diseases of visual system 10 Diseases of ear and mastoid process 11 Diseases of circulatory system 12 Diseases of respiratory system 13 Diseases of digestive system 14 Diseases of the skin 15 Diseases of musculo -skeletal system or connective tissue 16 Diseases of genitourinary system 17 Conditions related to sexual health 18 Pregnancy, childbirth and puerperium 19 Certain conditions originating in the perinatal period 20 Developmental anomalies 21 Symptoms, signs and clinical finding Foundation Id : http://id.who.int/icd/entity/1435254666 01 Certain infectious and parasitic diseases - Description This chapter includes certain conditions caused by a pathogenic organism, such as bacterium, virus, parasites Exclusions Infections of the foetus and new born *(KA40-KA4Z) Human prion diseases* (8C60-18C6Z) Pneumonia * (CA20) All Index Terms There are no index terms associated with this entity. ICD-11 Beta Draft-Morbidity and Mortality statistics

47. POST-COORDINATION IN ICD-11 BROWSER Post-coordination system allows adding more details to a category. Different types of information can be added to different entities. For example, additional histopathology information could be added to most part of the neoplasms categories. Displaying / searching value sets of post-coordination- 1. Some post-coordination axis can get values from a small set of possible values such as laterality. 2. Some axes can get values from a rather large value set such as histopathology.

48. Post -coordination ? 2D1Z Malignant neoplasm of breast , unspecified. Code: 2D1Z&XB32&XC56 Laterality XB32 Right Specific Anatomy XC56 Upper outer quadrant of breast Add detail to Malignant neoplasms of breast, unspecified Laterality (Use additional code, if desired) XB30 Bilateral XB31 Left XB32 Right XB33 Unilateral, unspecified XB34 Unspecified laterality Specific Anatomy (Use additional code, if desired) XC50 Nipple XC51 Lactiferous duct XC52 Areola XC53 Upper inner quadrant of breast XC54 Lower inner quadrant of breast XC55 Lower outer quadrant of breast XC56 Upper outer quadrant of breast XC57 Axillary tail of breast Histopathology (Use additional code, if desired) Search ? Histopathology - Acinar cell neoplasms - Adenomas and adenocarcinoma - Adnexal and skin appendages neoplasms - Basal cell neoplasms - Blood vessel tumour - Complex epithelial neoplasms - Complex mixed and stromal neoplasms - Cystic,mucinous and serous neoplasms.

49. BUILDING A CODE STRING Building a code string: click on the values that are displayed in the search results , in the hierarchy or in the shorter lists. The example shows malignant neoplasm of breast with detailed laterality and specific anatomy. The code generated at the right top area.

50. (B) ICD-11 FOUNDATION UPDATE Updates have been informed by proposals as well as the reviews conducted by medical societies and together with Joint Task Force. Proposals and review outputs received by 31 st December 2016 have become part of ICD-11 version for the extended quality assurance which has began in March 2017. Proposals that are received between 1 st January 2017 and 30 th March 2017 will be taken into account for the implementation of final version. Proposals received after that date will be considered in the context of ICD-11 maintenance after 2018.

51. Continued In addition to the changes in classification 1. Review of 35,000 Index entries, w hich were edited in terms of titles, spelling , languages and with appropriately guiding users to the correct entities. 2. An additional 4000 terms were added to the foundation from the review of national death certificate reporting. 3. At the structural level, 11000 parenting changes, 6163 entity titles were edited for completeness and accuracy. 4255 changes were made to the shoreline, 2200 changes to the different grouping in hierarchy.

52. ( C) Implementing line coding pilot testing in ICD-11-MMS Morbidity line coding pilot testing: 1. 22 countries are participating ,fifteen countries are conducting pilot testing in E nglish and seven in S panish. 2. The pilot testing started in august 2016 with coding of 308 diagnostic terms (1 st and 2 nd batch) uploaded to the web based data entry platform. 3. In the end of November 2016 ,a third batch with 88 diagnostic term was released for coding. 4. They included coding two or more stem codes with and without post-coordination, coding of stem codes with one or more extension codes and coding of “dagger” codes and “asterisk” codes.

53. continued Morbidity line coding pilot testing: 1. Initiated at the end of January 2017. 2. Fourteen countries are lined up to participate in the exercise 3. Compilation of list of terms most commonly found in Death certificates at national levels from selected countries. 4. A first batch with 100 Cause of death terms was identified and uploaded.

54. SUMMARY The ICD is the global health information standard for mortality and morbidity statistics. 117 countries use the system to report mortality data, a primary indicator of health status. ICD-11 has been aimed in the last conference to be the part of SDGs 2016-2030. It has been translated into 43 languages. About 70% of the World’s health expenditure (USD$ 3.5 billion) are allocated using ICD for reimbursement and resource allocation. The 11 th revision process is under way and the final ICD-11 version will be released in 2018.

55. REFERENCES WHO information sheet-Key facts of ICD ( 2017 ), http ://www.who.int/classifications/icd/factsheet/en/ Bhalwar R.et al, Classification of diseases, In: Text book of Public Health and community medicine, Department of community medicine, AFMC in collaboration with WHO, India office, New D elhi Publishers,1 st edition,Pune,2009,Page no:35-37 WHO ICD-11 Revision quarterly news paper (2017), www.who.int/classifications/icd/revision/en /

56. THANK YOU !