A caterpillar,

This deep in fall-

Still not a butterfly

Basho

ICD11 βeta

Beta Phase

• Comments

• Proposals

• Review Mechanism

• Field Trials

How to deal with the TAG proposals after locking iCAT

• All TAG proposals should be send to Bedirhan Ustun (ustunb@who.int) and Eva Foust (fouste@who.int)

• WHO will post the TAG proposal(s) on Redmine:

http://informatics.mayo.edu/WHO/ICD11/collaboratory/projects/icatbetaproposal

and will give identified editors TEMPORARY PASS

• All TAG Chairs/WG Chairs and Managing Editors will be alerted AUTOMATICALLY every time a new proposal is posted on Redmine.

• TAGs will have 1 week to make comments on proposals. – If there are NO evidence-based objections, the proposal(s) will be

entered in iCAT.– If there are major issues raised, WHO will contact the involved

parties and will facilitate discussions to sort out these issues.

Information Notes

1. ICD Revision Communication

2. ICD Revision Timelines

3. TAG Allocation

4. Content Model

5. Foundation Component and Linearizations

6. Legacy Linearizations

7. Code Structure

8. Multidimensional Coding

9. Index

10.Diagnosis Type

11.Main Condition

12.Review Process

13.Mirror Coding

14.Modifiers and Qualifiers

15.Field Trials

16.Stability Analysis

17.Multilingual ICD Platform

18.Dagger and Asterisk resolution

19.Multisystem Chapter

Information Notes under development

20. Cross-cutting TAG Rolesa. Mortality

b. Morbidity

c. Functioning

d. Quality & Safety

21. Post-Coordination Principles and Rules

22. Residual Categories

23. Common Ontology with SCT

24. Coding Rules

25. National Linearizations in ICD-11

26. ICD-11 Definitions

• Pre-coordination - fixed names

V12.24 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities

ICD Organization

• Post- Coordination - extensions• Bicycle Accident

• Hit • Role• Context• Activity

X – Chapter:

Extension Codes Type 1 Type 2 Type 3

Severity Main Condition (types) History of

Temporality (course of the condition)

Reason for encounter/admission

Family History of

Temporality (Time in Life)

Main Resource Condition Screening/Evaluation

Etiology Present on Admission

Anatomic detail TopologySpecific Anatomic Location

Provisional diagnosis

Histopathology  Diagnosis confirmed by

Biological Indicators Rule out / Differential

Consciousness

External Causes (detail)

Injury Specific (detail)   

Multiple CodingEquivalent Expressions

Cluster Style

– Code1*– Code2*– Code3*– ..– * CLUSTERING IND.

Chain / String Style

– Code1/Code2/Code3

Multiple CodingEquivalent Expressions

Chain / String Style

JH6.100/ XT0.???/ XD0.100

STEMI - posterior wall – confirmed by EKG

Cluster Style

• JH6.1001 Myocardial Infarction with ST Elevation

• XT0.???1 Posterior wall of heart

• XD0.1001 Diagnosis Confirmed by EKG

• 1 CLUSTERING indicator.

• Ensure a seamless transition between ICD-10 and ICD-11 – national – international levels

• Represent knowledge gained from national clinical modifications in the revised ICD.

• CrossCutting TAGs review and confirm continuity between ICD-10 and ICD-11

Stability AnalysisObjectives

• Mortality• Morbidity

– ICD-10-WHO with ICD-11-WHO– ICD-10&11-WHO with ICD-10-GM– ICD-10&11-WHO with ICD-10-AM– ICD-10&11-WHO with ICD-10-CM– ICD-10&11-WHO with ICD-10-CA

Stability Analysis

Types & Methodology

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

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

Initial Review

1. Linearization Review

2. Content Review

Linearization Review

1. Mortality Linearization Review

2. Morbidity Linearization Review

3. Primary Care Linearization Review

4. Mirror-Coding Review

Linearization Review

1. Review Unit is the whole linearization in question– e.g. Four-character Codes in MORTALITY– Review the results of Stability Analysis– Mark-up in iCAT– Review restricted to the relevant TAG only

• e.g. M TAG for Mortality Linearization

Morbidity Linearization

1. Review of Five or more character codes

2. Results of the Stability Analysis

3. Results of the resolution of Dagger-Asterisk resolution

Primary Care Linearization(s)

• Expect to produce two different linearizations– Low resource PC linearization

• Fewer categories – large groupings

– High resource PC linearization• Frequent health conditions in PC with high

resources (same as Morbidity linearization in resolution, but representing only PC relevant cases)

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– Entire Linearization– Chapter– Subchapter– Clusters– Use Cases– Other structure groupings, as selected

Content Review Units

– Chapter– Subchapter– Clusters– Individual entities– Other groups of entities, as selected

Content Review

1. Initial review:– Selected sections of ICD-11 where

• work has been completed

– specific review is needed– there is special interest

• Accuracy• Scientific quality• Completeness• Clinical or Public Health Utility

Content Review

• Proposal Generation Phase– When proposals are mature (decide how) – Submit to 5 reviewers – Obtain 3 complete reviews– Generate combined statement– Submit to TAG in a combined list– Implement results– Submit conflicts to RSG

Review Units

1. Linearizations

2. Chapters – Sub Chapters – Code clusters

3. Single categories– Initial selection from:

• Completed content• Hot Categories – with differential aspects in XMs.• Public Health Importance

4. Set of Content Model parameters across multiple categories– e.g. Lab findings , genomics, etc.

Review Software

A. Process manager– Identify Review Units– Identify Reviewers– Send invitations

• Letter• Review questions

– Send reminders, if necessary– Compile results

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.

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)

Reviewers

1. WHO search– From PUBMed, Google Scholar– WHO expert database

2. TAG Nominations

3. ICD-11 Web-site– Self-nomination

4. Solicited Reviews– NGOs ( e.g. WONCA etc ) – Genetics institutions

Contributor - Reviewer Acknowledgement

• WHO is currently creating a list to acknowledge all participants:

– ICD website– Print version of the ICD-11.

• Please include all with participant contact information.

The following individuals will be acknowledged:

– RSG– RSG-SEG– TAG– TAG WGs

– Managing Editors

– NGOs– Other Contributors – WHO-FIC Collaborating Centres– WHO Staff

Incentives for Reviewers

Content Review – Schedule

3rd Wave– Musculoskeletal– Mental Health– Neurology– Rare Diseases– Circulatory

4th Wave– Dermatology– Hematology– Respiratory– Neoplasms– Infectious Diseases– Pediatrics

1st Wave• GURM• TM (Disorders)• Gastroenterology• Nephrology• Hepato-pancreatobiliary

2nd Wave• External Causes and Injuries• Ophthalmology• Dentistry• Rheumatology• Endocrinology

ICD11 Field Trials

• Basic aims– To test the “fitness of ICD-11 for multiple purposes”

• Mortality coding• Morbidity coding• Other use cases

– To ensure the comparability between ICD-10 and ICD-11– To increase consistency, identify improvement paths, and reduce errors

.

• Key Assessments:

• Applicability – feasibility easy to use

• Reliability - consistency gives same results in the hands of all

• Utility - added value renders useful information

ICD11 Field Trials

• Applicability (Feasibility) – – Is the classification easy to implement in the hands of the real life users (coders, doctors etc.) ?

• Utility – – What is the value of the classification to enhancing data capture and its uses?– Does it improve recognition? – Does it serve for better documentation? – Does it enable re-use? – Does it guide better diagnosis? – Does it allow better resource allocation?

• Reliability – – Is the classification used in the same manner by different users? – Do two different users code the same case with the same code? – What are the sources of discrepancy? – What are the factors to improve comparability and consistency?

Field Trials• KEY USES:

– Mortality: cause of death coding, verbal autopsy – Morbidity: various morbidity codings – hospital discharge, DRG etc.– Other uses 

• DIFFERENT SETTINGS: – Primary Care

• High-resource settings• Low-resource settings

– General Health Care• Specialty settings

– Research settings• Use in population studies - epidemiology• Use in clinical research

Core Studies

• Study One: – Feasibility and Reliability for live Cases and Case

Summaries coding with • ICD-11 Chapters (double coding)

• Study Two: – Basic Questions

Study 1 Components

• Feasibility in evaluations: The rater will administer the ICD and assign codes for the case and record some other pertinent information on the Form A.

• Inter-rater reliability in evaluations: This component will assess the agreement between two of more raters rating the same case evaluation. Data for all the raters will be collected on Form A, one for each rater.

After finishing the data collection for all the two components, each interviewer will be asked to respond to a short post-study questionnaire provided in the protocol (Form B). Data for all two components and the post-study questionnaire will be submitted as electronic spread sheets to WHO Geneva.

Study 2 Components

Consensus Conference ApproachEach field trial centre will conduct at least one consensus conference to discuss the basic questions. The results of the consensus conference will be summarised in a report and forwarded to WHO Geneva.

Individual Response ApproachResponses to the basic questions should be collected by each field trial centre from multiple individuals who have expertise in the area of TM coding. Each person should provide a written response to the basic questions on the Response Form provided in the protocol. The field trial centre will collect these responses and provide a summary using the same format as for the Consensus Conference.

– Plan for field trials• Essential components• Additional components

– Methodology– Timelines

– Possible Participants

– Data collection – Analysis - Publications

Field Trials Work Plans

Inter-rater reliability

• The Case information• live • medical record

• Coded using ICD11 by at least two different people

• Agreement rates measured

Bridge Coding

• The Case information• live • medical record

• Coded using • ICD10• ICD11

• Agreement rates measured

Transition Strategy

75 79 90 13 15 ??

ICD-9 ICD-10 ICD-11

4 23

2015

ICD

- 2016

ICD

- 2017

ICD

- 2018

ICD

- 2019

• TAG serving as an Editorial Board• Reviews

• Organizing Field testing• Feasibility• Quality assurance• Reliability

Roadmap during Beta Phase

Common Ontology with SNOMEDCVD Use Case

• Nearly 1200 entries in ICD for matching• Nearly 5000 entries in SCT for matching• Caveats:

– Updates • CVD TAG is pending• pre-coordination / post coordination selection to be

made

SCT Disorders of CardioVascular System

Top-Level• Acute disease of cardiovascular system• Aneurysm• Cardiovascular injury• Cardiovascular system hereditary disorder• Chronic disease of cardiovascular system• Congenital anomaly of cardiovascular system• Disease affecting entire cardiovascular system• Disorder of cardiovascular prostheses and implants• Disorder of pericardium• Disorder of portal venous system• Eclampsia in pregnancy• Fetal cardiovascular disorder• Foreign body of cardiovascular structure• Heart disease• Infectious disease of cardiovascular system• Inflammatory disorder of the cardiovascular system• Near syncope• Neonatal cardiovascular disorder• Neoplasm of heart AND/OR pericardium• Perinatal cardiovascular disorders• Peripheral vascular disease• Pseudoaneurysm• Syncope• Thrombosis• Vascular disorder• Vasovagal attack

Current ICD Key Groups – Heart

1. Rheumatic Disease

2. Hypertensive Disease

3. Ischemic Heart Disease

4. Pulmonary Heart Disease

5. Arrhythmia

6. Pericard Disease

7. Myocarditis

8. Heart Failure

Current ICD Key Groups - Heart

1. Rheumatic Disease– acute-chronic– With heart involvement- chorea– With valve involvement

2. Hypertensive Disease– Heart – Renal

3. Ischemic Heart Disease– Angina– MI– MI complications

4. Pulmonary Heart Disease

5. Arrythmia

6. Pericard Disease

7. Myocarditis

8. Heart Failure

Current ICD Key Groups – Vascular

1. Arterial – Systemic arterial ( non-coronary)

• Aorta • Peripheral Arteries• Exclusions: cerebrovascular ( brain attack )

2. Venous – Systemic– Portal

3. Lymphatic

Current ICD Key Groups – Congenital

1. Developmental – Intrauterine / At birth / later in life

2. Structural – Anatomical – Functional

Poly hierarchies in ICD and SCT

• Tree visualization– Tree- stem- brach – subbranch – leaf…– Essential top layers 1-2-3-4 harmonization

Sorting out conceptual equivalence

– Angina Pectoris• Syndrome ? : Acute Coronary Syndrome• Clinical sign : Chest pain

Shared etiological grouping

• Ischemia• Hemorrhage• Thrombosis• Abnormal heart rate• Gangrene• Rupture• Vascular complications

– Plaque, stenosis, … aneursym, dissection/splitting • Procedural – post-operative…

Time equivalence

• Myocardial Infarction: – ACUTE up to 28 days

• arbitrary ICD-10 definition

• CVD TAG to define– subacute, chronic, old MI

» OLD MI >28 day

Remaining Work

• Complete entries– TAG – Work Groups ( temporary pass)

– Harmonization between TAGs• Mortality• Morbidity• Other Overlap Areas (Rare Diseases, etc)

Checks of linearizations

– Check with Infectious Diseases• e.g. Broncopnuemonia Respiratory

– Check with Neoplasms

• e.g. Lung Ca Respiratory

– Check with CLINICAL FORMS ( R Chapter)• e.g. with bleeding ( extension code – R

chapter)

Pre- or Post- coordination

• Check the existing pre-coordination whether it can be post coordinated ( “unbundling” )– V12.24 Pedal cyclist injured in collision with two- or

three-wheeled motor vehicle, unspecified pedal cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities• Hit • roles• Context• Activity

• Compatibility with the NEW code structure

Harmonization

– Stability Analysis • ICD-10 ICD-11 -explanation of change

– Linearization decisions• Mortality• Morbidity• Primary Care

– Consistency with ontology – SNOMED/ GO other• Common Ontology

Telescoping – Zoom in/out

Current Status as of end Jan.2013

• Some Chapters need further work– Infectious Disease A– Neoplasms B,C– Sign & Symptoms R– Z codes

• Other chapters’ structure reported to be complete

• Definitions > 50% – Top level > 70 %

Remaining Content Model Parameters

• Laboratory Tests• Genetic Linkages• Treatment Properties