This is the current status of ICD Revision Process. A stable computer infrastructure is built; 24 Expert Advisory Groups in different segments have given their proposals. Crosswalks between ICD 10 and ICD 11 have been built using 5 different sources. Proposals can NOW be made by interested stakeholders and the PUBLIC. A scientific peer review for the current and future proposals is set up. YOU can comment, make proposals, review or translate the ICD11 BETA NOW...

1. ICD Revision: Where Are We?
World Health Organization Classifications, Terminologies, Standards

2. Overview
• ICD Revision progress
– Current status
– Stability: how similar to ICD10 – ICD10AM
– Next Steps:
• Collaborative Authoring Tool improvements
• Proposals
• Peer Review
• Field Trials
• Other Products
• …

3. 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

4. Current Status
• Frozen September 30
– iCAT continues real time
– JLMMS is frozen for review
– A new freeze is expected in Dec 2014.
• Definitions
– Top level > 75 % > 10,000 definitions
• Linearization errors < 465 (from 10K)
• Duplicates < 105 (from 3K)

5. 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 or songs.

6. 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

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

11. Linearizations:
Zoom-in Zoom-Out

12. Example of Telescope
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

15. ICD Organization
• 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
• Post- Coordination - extensions
• Bicycle Accident
• Hit
• Role
• Context
• Activity

16. 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
Topology
Specific Anatomic
Location
Provisional diagnosis
Histopathology Diagnosis confirmed by
Biological Indicators Rule out / Differential
Consciousness
External Causes (detail)
Injury Specific (detail)

17. POST COORDINATION MECHANISM
• Extension codes are implemented in iCAT
• Sanctioning tables are being generated
– REQUIRED
– ALLOWED
– DISALLOWED
• First target group is the REQUIRED
a. ICD-10 categories which have equivalence with
ICD11 STEM + X codes (around 1000 codes)
b. other

18. • 2014 : Beta version & Field Trials Version
– +2 YR : Field trials
• 2017 : Final version for WHA Approval
– 2018+ implementation
– Continuous Annual Cycles
• ICD 2018
• ICD 2019
• ICD 2020
ICD-11 Timeline

19. ICD11 βeta
http://www.who.int/classifications/icd/revision
Beta – Browser & Print
10 look & feel
+ descriptions – code structure !
• ICD-11 Beta draft is NOT FINAL
• updated on a daily basis
•NOT TO BE USED for CODING
except for agreed FIELD TRIALS
βeta

20. ICD-11 Browser

21. Visualization

22. Print Versions

23. ICD 2014 September release
• Print version release includes:
• Frozen “Joint Linearization for Mortality and
Morbidity Statistics” ( Vol. 1 Equivalent).
• The ongoing work on iCAT will go ahead in further
completing the ICD definitions and improvements.
• A future release is also planned in December.
Thereafter the releases will be made whenever
necessary.
• Incremental changes from August Release are given
in a separate document to enable tracking which
parts remained stable – which parts changed.

24. Diff Files

25. Diff Files

26. Taxonomic Check
• Taxonomic check includes the aggregation equivalence:
• with the Primary Care versions
– PC Intermediate Resource version  renamed: Intermediate Version
– PC Low Resource version  renamed: Short Version
• With Specialty Versions
– see whether the specialty extensions roll up to JLMMS ( if this was the chosen option)

27. Annotation Document & Reviews
• An updated Annotation Document identifies the architecture,
principles and known issues.
• Reviews by Mortality and Morbidity TAGs included for
common reference and guiding future work

28. STABILITY ANALYSIS
• A Foundation based equivalence programme
identifies equivalences between ICD-10 and ICD-11.
• a TRANSCODING table between ICD-10 and ICD-11 in
excel format
• A CROSSWALK gives the detailed output in excel
format
• The ICD11 Beta Browser will display the ICD-10
equivalents accordingly.

29. Mapping Tool

30. Transcoding tables ICD-10 to ICD-11
in excel

31. 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 - 6635
– 4343 Equivalent
– 2207 mapped to a larger entity in 11
• with post coordination many have equivalent maps
– 85 not mapped

32. ICD Index
• Print Index is about 1900 pages with some lead
terms running several pages.
• About 3000 ICD10 Index terms are “missing”. A
human judgement is being made as to whether
they are necessary and once included they point
to the right code.
• Sublead terms missing
• Improvements planned

33. Translation Platform

34. ICD Revision: Where Are We?
World Health Organization Classifications, Terminologies, Standards