ICD-11 2018 version: Part 2 – The ICD-11 Menu Hierarchy

The ICD-11 Homepage at https://icd.who.int/ (opens in a new tab of this same open window) of the World Health Organisation (WHO) website is a specific point in time when you “Discover” the ICD-11 interface to then “Explore” to both the whole time you are looking for something about ICD-11 and the time you discovered something about ICD-11.

From this Homepage, the reader discovers a top-level menu that brings you to various “places” within the ICD-11 Homepage. Below is a chart (you can view a larger image of this chart by clicking on this chart which will open in a new tab of this same open window) from my discovery of these various “places” and what I found from my exploration.  This chart shows the ICD-11 Menu Hierarchy as I had discovered and explored. In future posts, I shall write more on each individual menu item.

WHO-FIC Network Annual Meeting 2013 – Beijing, People’s Republic of China

A Health Information Management (HIM) / Medical Records (MR) practitioner reader of this website-blog will surely be familiar and knowledgeable of The International Classification of Diseases (ICD) that covers death and disease, two main parameters of health and the health system.

Perhaps many  HIM / MR practitioners may still not know that the ICD is one other reference classification which belongs to the World Health Organization Family of International Classifications (WHO-FIC)  Likewise, ICF (the International Classification of Functioning and Disability) and ICHI (International Classification of Health Interventions) are also reference classifications which belong to the WHO-FIC.

I think it is appropriate for any HIM / MR practitioner to be aware of developments of WHO classifications such as the ICD.  In this post, I like to share in this post of what is already available at the WHO website about the 2013 Annual Meeting of the International Network of WHO-FIC Collaborating Centres (WHO-FIC 2013) which will be held at the Empark Grand Hotel, in Beijing, China, from 12 to 18 October 2013. This year’s theme is: “Universal Health Coverage: Information and Innovation”. The reader can view detailed information about the meeting venue, accommodation and registration available on the meeting website at this link (this link will open in a new tab of your current browser window).

Since participation to this meeting is by invitation only, I like to suggest – since HIM / MR practitioner readers will already be familiar with ICD-10 but need to be aware of the ICD-11 revision, to focus and follow the progress and developments in ICD-10 and ICD-11 to be presented when the WHO-FIC Council meets in Beijing soon to review progress in relation to the strategic work plan of the WHO-FIC network and plan for the future. Please click on these links below (each of these links will open in a new tab of your current browser window) to know and learn the progress and developments in ICD-10 and ICD-11 :

progress and developments in ICD-10

progress and developments in ICD-11

References:

  1. WHO-FIC Network Annual Meeting 2013 – Beijing, People’s Republic of China, Classifications, The World Health Organisation (WHO), viewed 3 October 2013, <http://apps.who.int/classifications/network/meeting2013/en/>
  2. WHO-FIC Network Annual Meeting 2013, 2013 WHO-FIC Network, The World Health Organisation (WHO), viewed 3 October 2013, <http://www.whofic2013.org/register/toFrontPage.do>

ICD 11 – The Content Model, Part 2

ICD 11 book coverIn this second part of the ICD 11 Content Model posts, I will aim to provide an insight into the basic structure of the model.

As you can read from the post ICD 11 – The Content Model, Part 1 (this link will open in a new tab of your current window), the revision process of the The 11th revision of the International Classification of Diseases and Related Health Problems (ICD ) is a broad participatory Webbased development process by the World Health Organisation (WHO).

This collaborative development of new content and proposed changes for ICD 11 is the responsibility of a Revision Steering Group (RSG) within the WHO ICD Revision Organisation Structure, which serves as the planning and steering authority in the update and the run-up to the revision process of ICD 11.

Today the Beta Draft of ICD 11 is available as the culmination of an information infrastructure and workflow processes started initially by Topic Advisory Groups (TAGs) for various specialty areas. The Webbased development of ICD 11 which is still open for comments and suggestions by interested parties in a social process on the Web, is integrated with knowledge of (i) diseases and health conditions, the eotiology and the anatomical and physiological aspects of the disease, (ii) input of all chapters and codes from existing clinical modifications of the ICD, and (iii) mappings to other terminologies and ontologies from other WHO-FIC (Family of International Classifications) members into computer systems, thus creating draft classifications for field testing as it is available in the Beta Draft of ICD 11.

I can prefigure the complex problems of developing ICD 11, which surely was undertaken and managed by using systematic approaches to deal with its development in a prescribed way and by using analytical techniques to identify and dissect the orderly arrangement of the mass of data already in a confused state into logical patterns thus promoting understanding and pointing the way to an appropriate decision within a clearly defined framework and a concrete context, the ICD 11 Content Model.

Thus, the Health Informatics and Modeling Topic Advisory Group (HIM-TAG) – also a part of the WHO ICD Revision Organisation Structure,  was entrusted to develop the ICD-11 Its task was to ensure that the Content Model remains the critical component of ICD 11 that specifies the structure and details of the information that should be maintained for each ICD category in the revision process.

The WHO (2013) describes the Content Model as a structured framework that captures the knowledge that underpins the definition of an ICD entity in the following ways:

  • includes the full scope of health care diseases and related health conditions (such as traditional medicine entries) so as to be as congruent with the overall structure 
  • ICD 11 entities are represented in a standard way from the currently set of different 13 defined dimensions or  main “parameters”, each parameter expressed using standard terminologies known as “value sets” by observing basic taxonomic and ontological principles including:
    1. key definitions: disease, disorder, syndrome, sign, symptom, trauma, external cause,
    2. separation of disability and joint use with the International Classification of Functioning, Disability, and Health (ICF),
    3. attributes  – etiology, pathophysiology, intervention response, genetic base, and

    4. linkages to other classifications and ontologies, including that of for Primary Care, Clinical Care and Research
  • the Content Model enables content experts to view and curate i.e to pull together and sift through and select for presentation its contents using software tools that allows automatic error checking and enforces constraint enforcement thus maintaining the correctness or validity of the stored data (integrity ). 

Each category ICD 11 entity in the Content Model will be described by 13 different, defined dimensions or main “parameters” as can be seen below.

ICD-11-content-model

More in the next post on the ICD 11 Content Model.

References:

  1. World Health Organisation, 2012, Content Model, viewed 18 March 2013, < http://www.who.int/classifications/icd/revision/contentmodel/en/index.html >

ICD 11 – The Content Model, Part 1

ICD 11 book coverThe Content Model of an ICD entity in the 11th revision of the International Classification of Diseases and Related Health Problems (ICD) forms the basis of this succeeding post to the earlier post ICD 10 & ICD 11 Development – How, What, Why & When (this link will open in a new tab of your current window).

It is not my intention to write volumes on Content Model, rather I shall attempt to share the basics of this model in its simplest form that I have understood as compared to ICD 10.

We know that ICD 10  had evolved to include morbidity classification from its original design to record causes of death. We are aware that ICD is also used for reimbursement (in countries like in the US), and also used in specialty areas such as oncology and primary care.

Then we also know that from the ICD-10 tabular list found in Volume 1, ICD 10 is organised as a monohierarchy. Monohierarchy is a top-down classification. Perhaps the following example of a monohierarchy among Felidae, the biological family of the cats will make things clearer of what I wish to write  about how ICD 10 codes are organised.

Monohierarchy

ICD 10 uses letters for an initial broad categorisation (e.g., I for diseases of the circulatory system) and combined with digits (e.g. I00 to I02) for each successive level of child codes. Sibling codes (e.g. I01.0 and I01.1) are considered to be exhaustive and mutually exclusive, requiring the use of residual categories—“unspecified” and “other”—at each level, (e.g. I01.9 Acute rheumatic heart disease, unspecified).

A code may have associated inclusions (I10 Essential (primary) hypertension Incl: High blood pressure) and exclusions (e.g. I01.0, Excl: when not specified as rheumatic [I130.-]).

Inclusions are exemplary terms or phrases that are synonymous with the title of the code or terms representing more specific conditions (e.g. I21 Acute myocardial infarction Incl.:myocardial infarction specified as acute or with a stated duration of 4 weeks (28 days) or less from onset).

Most exclusions are either conditions that might be thought to be children of a given condition but, because they occur elsewhere in the classification, must be excluded from appearing under it (e.g. I25.2 for old myocardial infarction); others are codes representing possible co-occurring conditions that should be distinguished from the condition (e.g.I23 Certain current complications following acute myocardial infarction i.e to say co-occuring or concurrent with acute myocardial infarction (I21-I22).

As I have posted in the posts ICD 11 – history of the development of the ICD from 1853 to 2015 (this link will open in a new tab of your current window), ICD 11 is been developed as a participatory Web-based process.

The development of ICD-11 is aimed to create an information infrastructure and workflow processes that utilises knowledge from existing hierarchies of codes and titles found in ICD 10 Volume 1 as I have elaborated above, and supplementary volumes of rules (found in ICD 10 Volume 2) and indices (found in ICD 10 Volume 3).

This new ICD 11 information infrastructure captures the knowledge that underpins the definition of an ICD entity as we know of it today – again as I have elaborated above, which will thus aid the review of best scientific evidences to enable the definition of diseases and health conditions, encoding of the eotiology and the anatomical and physiological aspects of the disease, and mappings to other terminologies and ontologies.

Initially the workflow of the collaborative development of new content and proposed changes, review and approval processes, and the creation of draft classifications for field testing was undertaken by Topic Advisory Groups (TAGs) for various specialty areas.

The workflow continued with the Alpha Draft of ICD-11 revision process with comments and suggestions by interested parties collected in a social process on the Web and  ended by May 2010, and continued with the Beta Draft with field trials of draft standards.

The Alpha and Beta drafts have produced the new ICD 11 information infrastructure based on the Content Model for ICD 11 which represents ICD entities in a standard way, each ICD entity defined by “parameters” representing different dimensions – a parameter expressed using standard terminologies known as “value sets” that specifies the structure and details of the information that should be maintained for each ICD category in the revision process and which thus allows for computerisation.

In the next post, I shall post about the basic structure of the Content Model.

References:

  1. International Statistical Classification of Diseases and Related Health Problems, The Tabular List Volume 1 Version 2010, 2010 edn, World Health Organisation, Geneva, Switzerland
  2. World Health Organisation, 2012, Content Model, viewed 18 March 2013, < http://www.who.int/classifications/icd/revision/contentmodel/en/index.html >

ICD 11 – history of the development of the ICD from 1853 to 2015

The classification of disease began as a statistical study of disease.

This post looks back to the past from 1853 when William Farr (1807–1883) who was a medical statistician of the the General Register Office of England and Wales, laboured to use this imperfect classifications of disease available at the time. With the progress of preventive medicine and to embody the advances of medical science, Farr worked to secure better classifications and international uniformity in their use. Farr’s model survived as the basis of the International List of Causes of Death.

In 1983, The Bertillon Classification of Causes of Death by Jacques Bertillon (1851–1922), Chief of Statistical Services of the City of Paris was adopted as the revision to the International List of Causes of Death.

Revisions to The Bertillon or International List of Causes of Death were carried out in 1900 (ICD 1), 1910 (ICD 2) and 1920 (ICD 3).

With the lack of leadership after Bertillon’s death in 1922 and in preparation for subsequent revisions, the International Statistical Institute and the Health Organization of the League of Nations – which had taken an active interest in vital statistics, cooperated and prepared the expansion in the rubrics of the 1920 International List of Causes of Death into the Fourth (1929) and the Fifth (1938) revisions of the International List of Causes of Death.

The classification of disease remained almost wholly in relation to cause-of-death statistics.

But there was a growing need for a corresponding list of diseases, a classification of diseases for morbidity statistics.

Farr had actually recognised back in 1855 that it was also desirable to extend the cause-of-death statistics system for morbidity. It is interesting to note that 5 years later in 1860, Florence Nightingale urged the adoption of Farr’s classification of diseases for the tabulation of hospital morbidity in the paper, “Proposals for a uniform plan of hospital statistics”. Subsequently, all three revisions of ICD 1, ICD 2 and ICD 3 had adopted a parallel classification of diseases for use in statistics of sickness, however this parallel classification failed to receive general acceptance.

The International Classification of Diseases, Injuries, and Causes of Death as a single list was endorsed by the First World Health Assembly in 1948 as ICD 6. This list provided for the first time a common base for comparison of morbidity and mortality statistics that greatly facilitates coding operations.

The Seventh Revision (ICD 7) and The Eighth Revision (ICD 8) of the International Classification of Diseases were revised under the auspices of WHO in 1955 and 1965 respectively.

The Ninth Revision (ICD 9) was accepted in 1975 and included the dagger and asterisk system as an optional alternative method of classifying diagnostic statements, including information about both an underlying general disease and a manifestation in a particular organ or site.

The Tenth Revision (ICD 10) was originally scheduled for 1985, following the established 10 year interval between revisions

The WHO decided to delay ICD 10 until 1993 as it then realised the great expansion in the use of the ICD which necessitated a thorough rethinking of its structure. The WHO needed to devise a stable and flexible classification, which should not require fundamental revision for many years to come.

ICD 11 is not due until May 2015 when it is due to be presented to the World Health Assembly. As of May 2011. the Open ICD-11 Alpha Browser was open to the public for viewing and for commenting in July 2011. The ICD-11 Beta version was open to the public in the ICD revision process to make comments, make proposals, to change ICD categories, participate in field trials and assist in translating.

Below is an infographic (you can view a larger image by first clicking on the image below which will open in a new tab of your current window and then clicking again on the image in the new tab) I have designed as a display in a showcase way of all the past revisions of ICD leading to ICD 11 expected in 2015.

icd-revisions

With the historical background of ICD and the run-up to ICD 11, I present this post as a pre-cursor to the previous post ICD 10 & ICD 11 Development – How, What, Why & When (this link will open in a new tab of your current window) and for my coming posts on ICD 11.

References:
International Statistical Classification of Diseases and Related Health Problems, Volume 2 Instruction manual 2011, 2010 edn, World Health Organization, Geneva, Switzerland

World Health Organization, 2012, Classifications, viewed 18 December 2012, < http://www.who.int/classifications/icd/revision/timeline/en/index.html >