ICD Revision: Quality Safety Meeting 2013 September 9-10
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Transcript of ICD Revision: Quality Safety Meeting 2013 September 9-10
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World Health Organization Classifications, Terminologies, Standards
ICD Revision: Where Are We?
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Overview1. ICD-11 progress
– Current status of progress
– Vol II ICD knowledge base
– Review Process– Field Trials
2. Issues and Solution Plans
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Current Status:
• All input from Vertical TAGs received– Minor exceptions: sexual disorders, some GURM, Mental Health, Neurology…
• ICD 2013 Beta for Review
Mortality Linearization
Morbidity Linearization• Linearizations relatively stable
– constant updates– Together with Stability Analyses
» For review by mTAG and MbTAG» Q&S TAG – PS Indicators» fTAG – mirror codes
– Sept Review Process started– Sept Community Proposals started
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OutlineICD2013 Beta for Review
• Mortality Package: 1. Mortality Linearization
2. Mortality Stability Tables
3. Annotation Document
4. Other documentation ( Electronic/Print Index files; updated rules )
• Morbidity Package: 1. Morbidity Linearization
2. Morbidity Stability Tables
3. Annotation Document
4. Other documentation ( Electronic/Print Index files; updated rules )
• Other TAGs– Shoreline Documents for each chapter – Current Status for Definitions, Content Model and Residuals
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Critical Timelines
• Current Packages mTAG, MbTAG– Updates in September
• Webex or Live Meetings with vertical TAGs to resolve issues– August - September
• First review results of mTAG, MbTAG – in Beijing WHOFIC Annual Network Meeting October 2013– Discussion of future steps
• Scientific Peer Review of Vertical Chapters starting in September
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ICD 2013 BetaInfrastructure is ready for:
1. Linearization generation• Index Generation (Print + Electronic)• Post Coordination modeling + sanctioning tables
2. NEW PROPOSAL GENERATION • by public
3. REVIEW mechanism • by selected Scientific Peers
4. Multi-lingual presentation
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ShorelineBoundary between Pre- and Post-Coordination
– Mortality Linearization is always Pre-coordinated
– Morbidity Linearization is both Pre- and Post-Coordinated
Post-Coordination : uses X- R- and Other Chapters
» Specialty Linearizations may use:
» Post-Coordination and other extensions
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General Rules for (Pre- and Post-) Coordination
• Items at ICD-10 three-character level would be pre-coordinated – unless there is compelling reason in the contrary
• Items at ICD-10 four character level and higher will be mostly post-coordinated – unless evidence or use case requirement indicate otherwise
Pre-coord. Pre- or Post-coordination Post-coordination
1 2 3 4 5 6
STEM Code
Mostly Post–coordination;Can be Pre-Coordinated depending on evidence
Post-coordination space (X, R, other chapters..) PRE COORDINATION by Exception
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ICD10 levels
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General criteria for determining pre-coordination
• What to keep in the “Mortality – Morbidity” Linearizations?
1. Legacy (esp. if used previously in Mortality linearization)
2. Scientific evidence
3. Consistency according to Taxonomical and ontological rules
4. Utility
a) Clinical – treatment grouping etc
b) Public Health - reportable disease etc
5. “Use Case specific”:
A. Frequency in practice setting for a given linearization
( e.g. Primary Care, Verbal Autopsy…)
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Digital Telescoping (Russian Dolls)
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Digital Telescoping (Russian Dolls)
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Mort/PCHigh 11
Mort/PCHigh 12
Mort/PCHigh 13
Mort/PCHigh 21
Mort/PCHigh 22
Mort/PCHigh 31
Mort/PCHigh 33
Mort/PCHigh 34
Mort/PCHigh 32
Mort/PCHigh 35
Morbidity111
Morbidity112
Morbidity121
Morbidity133
Morbidity131
Morbidity132
Morbidity221
Morbidity222
Morbidity211
Morbidity311
Morbidity312
Morbidity321
Morbidity341
Morbidity342
Morbidity351
MORBIDITY
PC – Low 1
PC – Low 2
PC – Low 3
PRIMARY CARE Low Resource
(Verbal Autopsy ?) MORTALITY National LinearizationsSpecialty - Research
Extensions 12
1 234
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Mortality Linearization
– Will include all ICD-10 entities have legacy for appropriate time series analysis:• Infant & Child Mortality• Maternal Mortality• General Mortality• Global Burden of Disease • Other major sources - e.g. Verbal Autopsy
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Mortality Linearization
• Mortality Linearization is a proper subset of Morbidity Linearization
• There should not be any items that are in the mortality and are not expressed in the morbidity linearization
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Mortality Linearization
• Mortality Linearization should only contain items relevant causes of death
• Each entity to be examined for its relevance in mortality statistics (internationally and nationally) – “Is it used?” – “What is the frequency among its parent category
and its children?”
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Mortality Linearization
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ICD 2013 Beta Mortality Linearizationas of 29 August
• 1,039 categories at ICD10 3 Character-equivalent level
• 3,892 categories at all levels (up to 7 ICD-10 Character level)
Problems
1. Final Verification ongoing – Some 100 are not directly included out of a total of about
1000 codes either: • relevant part of major tabulations• frequent 95% of cases
– They need to be explained in stability analysis
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Morbidity Linearization(s)
• The main international reference for reporting and data exchange:– hospital discharge summaries – case mix groupings– reimbursement – …
• Morbidity Linearization– comprehensive enough – avoid unnecessary detail
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Morbidity Linearization(s)
1. International WHO Morbidity Linearization
2. National Morbidity Linearization(s)
3. Specialty Linearizations
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STEM CODES• Precoordinated ICD-11 codes are called ‘STEM CODES’
• STEM CODES give the basic classification tree structure
• Additional details are added to STEM CODES by EXTENSION CODES
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Pre-coord. Pre- or Post-coordination Post-coordination1 - 4 5 6
STEM Code
Mostly Post–coordination;Can be Pre-Coordinated depending on evidence
Post-coordination space (X, R, other chapters..) PRE COORDINATION by Exception
ICD11 levels
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Sanctioning Tables
• Not all extension codes could be used for a given STEM CODE
• Applicable extensions for a stem code will be specified in SANCTIONING TABLES
• Sanctioning tables will identify each relevant item as:– Applicable– Required – Non-applicable
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National Linearizations• Countries who adopt ICD-11
– Use as is: ICD WHO version– May generate their own “National Linearizations”
• National Linearizations will require:– extension items are in the foundation component
(drawn from or if absent will be added to foundation)– Identify the mechanism of how they are linearized
• Foundation – National Linearizations:– provides an enhanced coordination mechanism – avoids non-standard development– ensures comparability
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Specialty Linearizations
• Further detail for specialty care could be done in two ways:
1. Extensions of the Morbidity Linearization
2. New groupings from the Foundation Component (Research Linearizations ?)
• Both methods would use by post-coordination & sanctioning rules
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• Ensure a seamless transition between ICD-10 and ICD-11 – national – international levels
• CrossCutting TAGs review and confirm continuity between ICD-10 and ICD-11
• Represent knowledge gained from national clinical modifications in the revised ICD.
Stability Analysis
Objectives
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• Mortality
• Morbidity– ICD-10-WHO with ICD-11-WHO– ICD-10&11-WHO with ICD-10-GM– ICD-10&11-WHO with ICD-10-CA– ICD-10&11-WHO with ICD-10-AM– ICD-10&11-WHO with ICD-10-CM
Stability Analysis
Types & Methodology
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Age-adjusted death rates for nephritis, nephrotic syndrome, and nephrosis:
United States, 1968-2005
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Overall Evaluation
+• Solid Digitalization
– iCAT– Browser– Proposal Mechanism– Linkage to SNOMED– URIs
• Engagement of Partners– TAGs
• Review Mechanism• Field Trials
- / ?• Project Management• Remaining Time • Communication
• Funding– Japan, EU, TM – PS
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ICD-11 Timeline
• 2013 : Beta version & Field Trials Version – +2 YR : Field trials
• 2015 : Final version for WHA Approval– 2015+ implementation
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ICD-11 Timeline
• WHA Adoption and Implementation dates are separate – Member States adopt ICD at their own
convenience – WHA adoption enables official use for
countries who wish to switch
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Transition Strategy
75 79 90 14 15 ??
ICD-9 ICD-10 ICD-11
4 24
2015
ICD
- 2016
ICD
- 2017
ICD
- 2018
ICD
- 2019
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• TAG serving as an Editorial Board• Reviews
• Organizing Field testing• Feasibility• Quality assurance• Reliability
Roadmap during Beta Phase
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ICD-11 administrative data use case:
• Quality - Patient Safety indicators • Case-mix groupings• Data – Meta data standards, documentation
• Diagnostic algorithms • Chart-Database comparison studies• "True" gold standards• International Morbidity comparisons• …
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ICD Revision use cases
Advanced computerised safety systems:
– Identification of common patterns in safety-relevant events.
– New tools for prediction, detection and monitoring of adverse
events and other relevant information.
– Use ICD in innovative data mining and integration techniques of
existing databases and specific applications
• like electronic health record systems,
• decision support systems,
• adverse event reporting systems.
– Include validation leading to quantitative benefits.
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Issues
• Is the remaining time sufficient for 2015– Translations No– Implementation Preparation No– Proper wide scale testing No– Completing Reviews Yes– Producing a better usable ICD Yes
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ICD-11 Timeline
• 2015 : Final version for WHA Approval– 2015+ implementation
• 2016 : WHA Approval– More time for Review and FT
• 2017 : WHA Approval– More time for Review , Field Trial and
Translations
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ICD-11
• International Public Good– Openly Accessible– Free for WHO Member States
• Available in multiple formats:– Printed Book editions– Internet-edition – Various computerized tools