The document provides an overview and status update on the ICD-11 revision process. It discusses the current status of the ICD-2013 beta version, issues with timelines, and plans for field trials, review processes, and implementation. Key points include: the beta is ready for review by technical advisory groups; scientific peer review of chapters will begin in September; remaining issues include finalizing the mortality linearization and ensuring sufficient time for translation and country implementation preparation.

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

2. Overview
1. ICD-11 progress
– Current status of progress
– Vol II  ICD knowledge base
– Review Process
– Field Trials
2. Issues and Solution Plans

3. 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
3

4. Outline
ICD2013 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
4

5. 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
5

6. ICD 2013 Beta
Infrastructure 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 6

7. Shoreline
Boundary 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
7

8. 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 8
ICD10 levels

9. 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…)
9

10. Digital Telescoping
(Russian Dolls)
10

11. Digital Telescoping
(Russian Dolls)
11

12. 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 Linearizations
Specialty - Research
Extensions 12

13. 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
13

14. 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
14

15. 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?”
15

16. Mortality Linearization
16

17. ICD 2013 Beta Mortality Linearization
as 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

18. 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
18

19. Morbidity Linearization(s)
1. International WHO Morbidity Linearization
2. National Morbidity Linearization(s)
3. Specialty Linearizations
19

20. 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
20
Pre-coord. Pre- or Post-coordination Post-coordination
1 - 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

21. 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 21

22. 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 22

23. 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
23

24. • 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

25. • 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

26. Age-adjusted death rates for
nephritis, nephrotic syndrome, and nephrosis:
United States, 1968-2005

27. 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

28. ICD-11 Timeline
• 2013 : Beta version & Field Trials Version
– +2 YR : Field trials
• 2015 : Final version for WHA Approval
– 2015+ implementation

29. 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

30. Transition Strategy
75 79 90 14 15 ??
ICD-9
ICD-10 ICD-11
4 24
2015
ICD-2016
ICD-2017
ICD-2018
ICD-2019

31. • TAG serving as an
Editorial Board
• Reviews
• Organizing Field testing
• Feasibility
• Quality assurance
• Reliability
Roadmap during Beta Phase

32. 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
• …

33. 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.

34. 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

35. 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

36. ICD-11
• International Public Good
– Openly Accessible
– Free for WHO Member States
• Available in multiple formats:
– Printed Book editions
– Internet-edition
– Various computerized tools