Tokyo jha ustun (show)
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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: