Dr. T. Bedirhan Üstün World Health Organization Classifications, Terminologies, Standards

Transcription

1 WHO on ICD and Health Information Dr. T. Bedirhan Üstün World Health Organization Classifications, Terminologies, Standards

2 KEY MESSAGES: 1. ICD-11 should be simplified 2. ICD-11 should be computerized 3. ICD-11 should be fit for purpose 4. ICD-11 should be easy to teach, implement 5. ICD-11 should speak the same language in PC and Specialty All efforts on ICD-10 and ICD-11 should converge

3 SIMPLICITY Is the Ultimate Sophistication

4 Shepherding simple requirements 1. Count your sheep How many born? How many dead?

5 Source WHO 2014 Reporting of Mortality in the World

6 Information Paradox Burden of Mortality YLLs VR countries vs No VR

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9 Carpet burnt

10 Shepherding simple requirements 1. Count your sheep How many born? How many dead? 2. Don t cry wolf!

11 Genealogy of ICD years

12 ICD Revisions ,040 1,164 8,173 1,967 14, Farr/d'Espine Bertillon ICD 1 ICD 2 ICD 3 ICD 4 ICD 5 ICD 6 ICD 7 ICD 8 ICD 9 ICD-9-M ICD 10 ICD-10-M

13 Placing WHO Classifications in HIS & IT ICD e-health Record Systems Terminologies Linkages KRs ICF ICHI Classifications Population Health Births Deaths Diseases Disability Risk factors Clinical Decision Support Integration of care Outcome Administration Scheduling Resources Billing Reporting Cost Needs Outcome

14 ICD-11 Revision Goals 1. Evolve a multi-purpose and coherent classification Mortality, morbidity, primary care, clinical care, research, public health Consistency & interoperability across different uses 2. Serve as an international and multilingual reference standard for scientific comparability and communication purposes 3. Ensure that ICD-11 will function in an electronic environment. ICD-11 will be a digital product Support electronic health records and information systems Link ICD logically to underpinning terminologies and ontologies (e.g. SNOMED, GO, ) ICD Categories defined by "logical operational rules" on their associations and details

15 Construction of ICD-10: Revision Process in 20 th Century 8 Annual Revision Conferences ( ) Countries participated 1-5 person delegation Manual curation List exchange Index was done later "Decibel"? Method of discussion Output: Paper Copy Work in English only Limited testing in the field

16 Construction of ICD-11: Revision Process in the 21 st Century Internet-based permanent platform All year round Open to all people in a structured way Content experts focus Digital curation Wiki enabled collaboration Ontology based Enhanced discussion & peer review TAGs serve as the editorial group Electronic copy print version Work in multiple languages Planned field tests Based on Use Cases

17 How do we go from Here to 21 st Century?

18 Sharing Meaning YOU Think wish to express think you have just expressed you expressed OTHER ONE wants to hear Actually hears wishes to understand understands

19 APPLE TERM Knowledge Representation the triad of things, thoughts and words (Ogden & Richards, 1923 )

20 What is Ontology? Ontology (philosophy) the Organization of Reality Ontology (computer science) the explicit operational description of the conceptualization of a domain: An ontology defines: a common vocabulary a shared understanding/exchange: among people among software agents between people and software to reuse data - information to introduce standards to allow interoperability

21 Open and Collaborative Platform Web based Like WIKI But by the Content Model with by the TAGs, and scientific peers

22 ICD11 βeta Beta Browser & Print 10 look & feel + descriptions code structure! βeta ICD-11 Beta draft is NOT FINAL updated on a daily basis NOT TO BE USED for CODING except for agreed FIELD TRIALS

23 The ICD Foundation Component is a collection of ALL ICD entities like diseases, disorders... It represents the whole ICD universe. In a simple way, the foundation component is similar to a store of books, songs, lego pieces.

24 The ICD Linearizations A linearization is a subset of the foundation component, that is: Fit for a particular purpose: reporting mortality, morbidity, or other uses Jointly Exhaustive of ICD Universe (Foundation Component) Composed of entities that are Mutually Exclusive of each other Each entity is given a single parent

25 Foundation: ICD categories with - Definitions, synonyms - Clinical descriptions - Diagnostic criteria - Causal mechanism - Functional Properties Linearizations Morbidity Primary Care Find Term Mortality SNOMED-CT, International Classification of Functioning, Disability and Health (ICF)

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29 Linearizations: Zoom-in Zoom-Out

30 Linearizations: PC short PC Intermediate JLMMS

31 DIGITAL ZOOMING Title Primary C. Joint Lin. Ophthalm. Cataract code code code Age-related cataract code code code Cortical age-related cataract other other code Nuclear age-related cataract other other code Cataracta brunescens other other code Nuclear sclerosis cataract other other code Capsular and Subcapsular age-related cataract other other code Capsular age-related cataract other other code Anterior subcapsular polar age-related cataract other other code Posterior subcapsular polar age-related cataract other other code Incipient age-related cataract other other code Coronary age-related cataract other code code Punctate age-related cataract other code code Water clefts other other code Advanced or mature age-related cataract other other code Mature age-related cataract other code code Subtotal advanced or mature age-related cataract other other code Advanced or mature age-related cataract, total cataract other other code Morgagnian age-related cataract other other code Calcified age-related cataract other other code Combined forms of age-related cataract other other code

32 APN Hamamatsu Meeting A Primary Care classification must be short and simple. 2. There should be no redundancy between coding systems. ICD-11 and ICPC should be compatible. 3. Classification rubrics in primary care are heterogeneous ranging from ; there may be many different factors important to each case. There needs to be a proper decision of what factors are to be defined in classification. 4. Primary care does not exist on its own, but within an overall health system. Primary care should not be approached as if there is no secondary or tertiary care. This must be considered when designing the PC Classifications and appropriate collaboration systems built between primary, secondary and tertiary care systems. 5. It is important that Primary Care Classification revision be well coordinated for different types of providers and consumers. There needs to be efficient sharing of information between all stakeholders. 6. The Primary Care Classifications should be based on established terminologies/ontologies. This will be the basis for linking with health records and assuring quality assurance. This underpinning systems will enlight how different coding systems interact with each other. 7. There must be incentives for the users of Primary Care Classification. Primary Care Practitioners will classify if they are given reasons to do so, and classification systems should be developed with this in mind. One incentive for use of the system may be the management guidance. 8. In many countries it is not possible to have a second layer of coders in addition to the practitioners. Methods should be developed for primary care providers allowing code themselves. 9. PC classifications should be tested in the real world to identify issues of feasibility, reliability and these tests should be used to improve their user-friendliness. 10. PC classifications should be of at least two levels of complexity: (a) resource poor settings; (b) resource rich settings.. PC Classification systems should be usable electronically and on paper.

33 Where Do People Seek Help? Inpatients Outpatients PHC - Recognized PHC - Attenders The Community

34 Data Collected But Not Used

35 Finagle's Law of Information need have the information YOU - want have is not what you want want is not what you need need is not what you can have In other words there is always a gap between what you have, need or want

36 ICD can only be a door stopper in Primary Care Halfdan Mahler WHO Director General

37 WHO-FIC in Primary Care WHO FIC elements are not currently suitable for use in primary care: They are complex, Too detailed No reward to the user. WHOFIC for Primary Care should be Concise Focused on frequent and important conditions in Primary Care Should be treatable in Primary Care Providers should be able to code the information. PHC RENEWAL NEW WAYS

38 ICD-10 PC

39 ICD-10 PC for Mental Health Diagnostic Guidelines Presenting Complaints Diagnostic Criteria Differential Diagnosis Management Guidelines What to say to patient and family What sort of psychological counseling Prescription: what, when, how...? When and how to refer a specialist

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41 Future work Selection criteria for ICD categories ICF-PC disability categories ICHI-PC intervention categories Signs - symptoms (Chapter R) Contextual factors (Chapter Z) Reason for Encounter use Other

42 EVALUATION: Do Classifications increase... recognition? diagnosis? accuracy of diagnosis? treatment? prescription? compliance? referral? outcome? patient satisfaction? CLASSIFICATIONS BUILDING BLOCKS OF HEALTH INFORMATION

43 Primary Care Classifications Comprehensive - not a single chapter-oriented Brief - yet covering all common disorders User-friendly and flexible with different modules Emphasis on Doctor-Patient relationship Management-oriented Treatment Guidelines? Dual function: used both for training and in daily practice Culture-oriented: can be applied in many different cultures extensive implementation and evaluation process endorsed by WHO, WONCA, APN and multiple parties Creating a network (or integrating into existing ones) between primary care physicians and psychiatrists.

44 Real Time Public Health Rule-based Individual, Facility, Population levels Public Health, Epi & Surveillance Reimbursement Resource Management Clinical Information Findings Events Interventions

45 Need for Integration Every programme, project, partner has a separate M&E plan Every M&E plan focuses on indicators but not on the system for generating them PHC RENEWAL NEW WAYS

46 Clinical Use Case: Exploration of Cough Hemoptisia Blood in Sputum Fever WET COUGH sputum X-ray : Tbc? Culture COUGH Diagnosis: Tuberculosis A 15.0 Treatment: DOTs { }

47 The Power of ORS From David Werner and David Sanders. Questioning the Solution. The Politics of Primary Health Care and Child Survival with an in-depth critique of Oral Rehydratation Therapy. Palo Alto: Health Rights, 1997.

48 Why is this Sooooo important?

49 GIGO: Garbage In Out?

50 Beyond Search using Concepts above Words How many patients do have diabetes mellitus type II? Extraction of Concepts from Health Records Automated extraction of HbA1c results of selected patients with DM type II from lab reports within last year Statistical Index on Community Collections Calculation of coverage gap for treatment need for diabetes mellitus Concept Navigation across Collections Comparison of region A with region B etc 50

51 Knowledge Representation Grade 3 hypertension Grade 2 hypertension 172 Diastolic pressure Grade 1 hypertension High normal normal optimal Systolic pressure 51

52 Uniform Resource Identifiers URI: //id.who.int/. enable links to other established terminology, ontologies allow impact analysis possible via W3C e.g. where on the world these are used or not used Useful for translations: the concepts will indicate a language-independent construct and translations will refer to the unique source concept.

53 Current Status Frozen June 2015 icat continues real time BROWSER JLMMS is frozen for review Definitions Top level > 75 % ~ 10,000 definitions Linearization errors < 344 (from 10K) Duplicates < 651 (from 3K)

54 ICD-11 Timeline 2015 : Beta version & Field Trials Version (June /September 15) 2016 : World Health Assembly Information Presentation Field trials 2018 : Final version for WHA Approval implementation Continuous Annual Cycles ICD 2019 ICD 2020 ICD 2021

55 Coding Tool

56 Coding Tool

57 Print Versions

58 Transcoding tables ICD-10 to ICD-11 in excel

59 ICD-10 ICD-11 correspondence 3 character 1183 (w/o ECI & Residuals) 951 Equivalent 191 mapped to a larger entity in 11 with post coordination many have equivalent maps 41 not mapped 4 character Equivalent 2207 mapped to a larger entity in 11 with post coordination many have equivalent maps 85 not mapped

60 ICD Translation Tool: French

61 ICD Translation Tool: Japanese

62 ICD11 Translation Tool: Chinese

63 Millenium Development Goals

64 What do we do with our time?

65 Global Village It takes a village It takes the whole globe to share data

66 Questions & bedirhan-ustun