Current Status of ICD-11 and

Expectations for Education of

Health Information in

JapanDr. T. Bedirhan Üstün

Coordinator, Classifications, Terminologies, Standards.

World Health Organization

Health Information Management in the 21st Century

• The 21st century ≡ CHANGE

• Change 2000 – 10 > Change 1900 - 2000

last 10years last century

Countries

managers

professions are not ready for this change

ICD - Revision Journey Tokyo: 2007 April 2010 December

Thanks to:

• WHOFIC Network

• Japanese MHLW

• Japan Hospital Association

• Japanese Society for Health Information

Management

• Japanese Medical Organizations

ICD-11 Timeline

• 2010 : Alpha version ( ICD 11 alpha draft) – +1 YR : Commentaries and consultations

• 2011 : Beta version & Field Trials Version – +2 YR : Field trials

• 2013 : Final version for public viewing–2014 : WHA Approval

• 2015+ implementation

ICD11 αlpha PRODUCTS

• Alpha - Print VOL I: 10 look & feel + descriptions – code

structure !

VOL II: move from patchwork to coherent guide

VOL III : digital index instead of manual curation

• iCAT

Good News • “Alpha” has proven feasible

– Continuity: respectful to ICD traditions – break with non-essential features– Content Model proves useful & relevant -- (despite discussions on its size)

• Computerization is feasible

• Unprecedented linkage possibilities to:– SNOMED CT– ICF– other WHOFIC– other ontology, terminology and standard sources (QSM, TM, ICPS…)

• Better Multilingual Production opportunities

NOT so-good News

• Below expected targets yet < 80% definitions

< 20% content model

• Not all TAGs are at similar development stage

• Not all parameters of Content Model is implemented yet

• Beta Plans are less than desired level

Continuous Quality Improvement

• 6 months to Beta !!! • 43 months to Final version

• what might be achieved?• how can we make it happen?

Never ending story:• Perpetual Beta

1666 2010

ICD Revisions139

161

179

189

205

200

954

965

1,0

40

1,1

64

8,1

73

1,9

67

14,4

73

214

1

10

100

1000

10000

100000

Farr

/d'E

spin

e

Bert

illo

n

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

1853 1893 1900 1909 1920 1929 1938 1948 1955 1968 1975 1979 1993 1993

Placing WHO Classifications in HIS & IT

Population Health• Births • Deaths • Diseases• Disability • Risk factors

ICD

ICF

ICHI

Classifications

Clinical• Decision Support• Integration of care• Outcome

Administration• Scheduling• Resources • Billing

Reporting• Cost• Needs• Outcome

Start-l-ing Point

Placing WHO Classifications in HIS & IT

Population Health• Births • Deaths • Diseases• Disability • Risk factors

e-Health RecordSystems

ICD

ICF

ICHI

Classifications

LinkagesKRs

Terminologies

Clinical• Decision Support• Integration of care• Outcome

Administration• Scheduling• Resources • Billing

Reporting• Cost• Needs• Outcome

How do we optimize

our health services

Health Information Systems:Analog to Digital

Digital Models

New business models

Existing business models

New products

Existing products

e-bay e-trade

e-banking e-media (music/video)

e-health

Interoperability

How do we go from Here to 21st Century?

Definition of Diseasea set of dysfunction(s) in any of the body systems

including:• with a known pattern of signs, symptoms & findings

» symptomatology - manifestations

• probably with an underlying explanatory mechanism» etiology

• a distinct pattern of development over time» course and outcome

• a known pattern of response to interventions » treatment response

• with linkage to underlying genetic factors » genotypes, phenotypes and endophenotypes

• with linkage to interacting environmental factors

• Ontology (philosophy)– the Organization of Reality !!!

• Ontology (computer science) – the explicit – operational description of

the conceptualization of a domain:• Concepts: entity and quality

(properties and attributes)

• 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

What is Ontology?

Ontology

THE CONTENT MODELAny Category in ICD is represented by:

Descriptive characteristics1. Type

Disease, disorder, syndrome, injury, sign/symptom, external cause, reason for encounter;

2. Body System(s) / Part(s) 3. Manifestation Properties

a. Signs & Symptomsb. Investigation Findings

4. Causal Properties (etiology) a. Causal Mechanisms /Agentsb. Genomic characteristics

5. Temporal Properties6. Severity Properties 7. Functional Properties 8. Treatment Properties

TITLE of ENTITY: Name of disease, disorder, or syndrome…1. Textual definition2. Synonyms - Inclusion – Exclusion - Index terms

iCAT• Open and collaborative process

– Users are empowered– Web based– Like WIKI – Trip Advisor

• But structured • Editorial Oversight

iCATCollaborative Authoring Tool

for ICD Revision

Creating ICD

I say a word

You say a word

Autumn comes

I say a word

You say a word

ICD is built

SNOMED : Old and Current

Open Market Activity

Open Market Activity

FormerSNOMED

Enterprise

SNOMEDSDO National

Centre

NationalCentre

NationalCentre

NationalCentre

NationalCentre

NationalCentre

NationalCentre

NationalCentre

NationalCentre

NationalCentre

College

American

Pathologists

Open Enterprise

Multi-county

MedicineGlobal

Network

Overall Health Care

Why work together?– WHO & IHTSDO

– Coverage & Adequacy– Quality – Reliability - Utility– MultiLingual Applicability– Interoperability– Sustainability

– Member States: Enable health care delivery

and compile health information

SNOMED & WHO Classifications are synergistic and not antagonistic

Primary Care Use Case: Exploration of Cough

Fever

386661006

COUGH

49727002

WET COUGHsputum

28743005

Hemoptisia

Blood in Sputum

207069003

• X-ray : Tbc? • Culture

399208008

104184002

• Diagnosis: Tuberculosis 154283005A 15.0

• Treatment: DOTs { 324453004 }

WHO FIC Network: APN

WHO FIC Network: IFHIMA (IFHRO)

ICD Revision

"Genchi genbutsu"Learn about pines from the pine, and about bamboo from the bamboo.松は松に聞け、竹は竹に聞け

Don’t follow in the footsteps of the old poets, seek what they sought先人言葉に盲従せず、その考え方に学べ

Basho 　松尾芭蕉

• Active Participation in the ICD Revision• Joint Authoring• Review• Field testing• Japanese version• USE CASES

• BUSINESS Applications • Electronic Health Records • Education

Post Tokyo: