International Classification of Diseases, 10th & 11th review.pptx

International Statistical Classification of
Diseases and Related Health Problems (ICD)
Alaa Fadhel Hassan
(M.Sc. Pharmacology)
Al-Mahmoudiya General Hospital

Entrance
• In order to understand diseases in ways that enable prevention,
treatment, and the allocation of resources, we need a useful &
reliable measurement, that allow valid comparisons to be made
between places and over time, and enable coherent summarization
of large volumes of data.
• WHO farmed family of International Health Related
Classifications (WHOFIC). Including ICD, the International
Classification for Health Interventions (ICHI) and the
International Classification for Functioning, Disability and Health
(ICF) [core classifications], which are complemented by
Classifications for Nursing, Primary Care or Medicaments
(ATC/DDD) for such purposes.

ICD 10th and 11th Revision
• Clinical modifications of ICD are the main basis for statistics on
disease, particularly cases treated by hospitals, that underlie
crucial functions such as payment systems, service planning,
administration of quality and safety and health services research.
• The 10th revision (ICD-10) was developed about 30 years ago. It
serves a variety of functions in much of the world—(least 120
countries & translated to 43 languages). It has long been used in
digital forms, that have enabled differences of structure and
meaning to creep into translations and modifications.
• Next revision is, the 11th revision (ICD-11); was adopted by the
World Health Assembly in May 2019.

ICD 11th Revision, Importance
• It is the international standard for systematic recording, reporting,
analysis, interpretation and comparison of mortality and morbidity
data [a document of all kind of clinical detail in combination with the
simplified coding]; produced by unprecedented collaboration with
clinicians, statisticians, classification and IT experts worldwide.
• It allows the world to compare and share data in a consistent and
standard way – between hospitals, regions and countries, facilitates
the collection and storage of data for analysis and evidence-based
decision-making [easy to install & use online or offline, free
'container' software, with access to 17 000 diagnostic categories, over
100 000 medical diagnostic index terms & index-based search
algorithm interprets more than 1.6 million terms].

Framework for ICD-11 has three integrated parts:
• A database referred to as the Foundation.
• Classifications derived from the foundation.
• Common biomedical ontology linked to the Foundation.

The Foundation & Its Classification
• It has about 80,000 entries complemented by 40,000 synonyms,
each characterizing a disease, syndrome, or health-related
phenomenon authored in English in a descriptive & other entities
relationships specific way, [each entry include a unique,
unchanging identifier, preferred name, fully specified name,
synonyms, human language translations of names and synonyms
to the other standard languages of the WHO, like Arabic, French,
Mandarin, Russian, and Spanish, a description notes, details of
severity grades or stages, parent relationships, child relationship,
genomic associations, etiology, clinical criteria and
manifestations].

ICD – 11th Revision, Framework

Common Ontology
• While the Foundation is a semantic knowledge base, the entities
used in the knowledge base, and how they are represented, are
referred to by the information science term ’ontology’.
• The Foundation can be anchored to external ontology sources by
inclusion and reconciliation of terms and definitions, with
attribution of current & future sources like :
 SNOMED (Systemized Nomenclature of Medicine-Clinical
Terms).
 MedDRA (Medical Dictionary for Regulatory Activities).
 The Open Biomedical Terminologies (OBO) community.

International Classification of Diseases, 10th & 11th review.pptx

ICD – 11th Revision, (WHO) Classifications
Certification and reporting of
Causes of Death
Provide information on what people
die of is recorded on standard forms,
analyzed and reported following ICD
standards.
The information reliably provides a
long-term trend of the health of a
population. It also can serve short-
term monitoring of epidemiological
information, like in an epidemic or
pandemic.
Morbidity coding and reporting
including Primary care
Provide accurate and precise
information on what people fall sick
from and are treated for is recorded
and reported with ICD.
This includes all levels of health from
primary to secondary and tertiary
care. This information further serves
policy design, planning and
monitoring of all aspects of the
health of a population.

Case mix and Diagnosis-
Related Grouping (DRG)
ICD-coded information is used
for resource allocation or
lumpsum payments of
statistically equal groups.
Cancer registries
Cancer registration provides
detailed information over time
on cancer patients.
Information on the type of
cancer, its location, spread
and behavior is coded with
ICD.

Antimicrobial resistance
(AMR)
ICD provides the details
recommended by the Global
Antimicrobial Resistance and Use
Surveillance System (GLASS).
This enables the recording and
reporting of the infection, the
specific agent, and the level and
type of resistance to specific
drugs.
Researching and performing
clinical trials and
epidemiological studies
Comparability of coded information in
multiple languages and with common
diagnostic approaches allows the pooling
of information from different sites, both
globally and locally, for research and
trials. ICD provides all levels of detail
required for complete clinical and
research documentation across
languages, borders and settings.

Assessing and monitoring the
safety, efficacy, & quality of care
Quality of care uses ICD-coded
information to describe the situation of
the patient, outcome of treatment and
incidents or near-incidents including
mechanisms and involved objects such
as the failure of an infusion pump or the
accidental wrong dosage of medicament
by the patient in line with the WHO
recommendations for patient safety
incident reporting and learning systems.
Assessing functioning
The ability to carry out tasks by
oneself and participate in daily life
are means by which to describe, in
summary, the overall functioning of
a person. It can be used to track the
situation in general or before & after
treatment. [Includeing a set of
functioning categories based on the
WHO disability assessment scheme
(WHODAS2) that allow users to
calculate a functioning score].

Coding traditional medicine conditions
To better reflect this reality, ICD-11 includes a supplementary
chapter for optional dual coding use, entitled ‘Traditional medicine
conditions’. ICD-11 enables the counting of traditional medicine
services and encounters; the measurement of their form, frequency,
effectiveness, safety, quality, outcomes, and cost; comparison with
mainstream medicine; and research, due to standardized terms and
definitions nationally and internationally.
This supplementary chapter is a sub-classification for optional use, is
not intended for mortality reporting. Coding should always include
also a category from the chapters 1-24 of ICD.

Interoperability standards in WHO Digital Guidelines and
for Digital Documentation of COVID-19 Certificates
(DDCC)
ICD-11 has combined the updated classification structure with what
was formerly the index of ICD, redesigned the additional information
included in ICD-10 and its derivatives in addition to other WHO
nomenclatures and terminologies. As a result, ICD-11 has a broad
terminological basis that allows users to code clinical terms in
records as well as in other documents, such as COVID-19 vaccine
certificates. Due to its multilingual design and the controlled
translation environment, it is a reliable tool for communication
across settings, borders and languages.

List of Official ICD-10 Updates
The Official Updates to the published volumes of ICD-10 are
available as annual lists of changes.
The lists indicate the source of recommendation and implementation
date. Date of approval has been indicated for all changes except the
corrigenda.
These updates are approved annually at the October meeting of
Heads of WHO Collaborating Centres for the Family of International
Classifications.

The International Classification of Functioning, Disability
and Health (ICF)
It is a classification of health and health-related domains.
As the functioning and disability of an individual occurs in a context,
ICF also includes a list of environmental factors [the WHO
framework for measuring health and disability at both individual and
population levels].
ICF was officially endorsed by all 191 WHO Member States in the
Fifty-fourth World Health Assembly on 22 May 2001(resolution
WHA 54.21) as the international standard to describe and measure
health and disability [based on ICD & ICHI foundation & coding
system].

The International Classification of Functioning,
Disability and Health

International Classification of Health Interventions (ICHI)
ICHI is a common tool for reporting and analyzing health interventions for
clinical and statistical purposes. ICHI covers interventions carried out by a
broad range of providers across the full scope of health systems and
includes interventions on: diagnostic, medical, surgical, mental health,
primary care, allied health, functioning support, rehabilitation, traditional
medicine and public health.
The classification is built around three axes: Target (the entity on which
the Action is carried out), Action (a deed done by an actor to a target) and
Means (the processes and methods by which the Action is carried out).
Extension codes are shared with ICD and ICF in the common foundation
and allow users to describe additional detail about the intervention in
addition to the relevant ICHI code.

International Classification of Health Interventions
(ICHI)

International Classification of Diseases for Oncology, 3rd
Edition (ICD-O-3)
ICD-O is a multi-axial classification of the site, morphology, behaviour,
and grading of neoplasms. Used principally in tumour or cancer registries
for coding the site (topography) and the histology (morphology) of
neoplasms, usually obtained from a pathology report. The topography axis
uses the classification of malignant neoplasms for all types of tumours
while the morphology axis provides five-digit codes ranging from M-
8000/0 to M-9989/3 [The first 4 digits indicate the specific histological
term,5th digit after the slash (/) is the behaviour code, indicates whether a
tumour is malignant, benign, in situ, or uncertain, and a separate one-digit
code is provided for histologic grading (differentiation)].

International Classification of Primary Care, 2nd edition (ICPC-
2)
ICPC-2 classifies patient data and clinical activity in the domains of
General/Family Practice and primary care. It allows classification of the
patient’s reason for encounter (RFE), the problems/diagnosis managed,
interventions, and the ordering of these data in an episode of care
structure.
It has a biaxial structure consists of 17 chapters, each divided to 7
components dealing with symptoms and complaints (comp. 1), diagnostic,
screening & preventive procedures (comp. 2), medication, treatment and
procedures (comp. 3), test results (comp. 4), administrative (comp. 5),
referrals & other reasons for encounter (comp. 6) & diseases (comp. 7).

CD – 11th Revision, (WHO) Classifications
International Classification of External Causes of Injury (ICECI)
The ICECI is no longer maintained (last change 2003), & its different
elements have been included as extension codes in the ICD-11. It was
designed to help researchers and prevention practitioners describe,
measure and monitor the occurrence of injuries and to investigate their
circumstances of occurrence.
ICECI had a multi-axial and hierarchical structure: core module including
seven items (mechanism of injury, objects/substances producing injury,
place of occurrence, activity when injured, the role of human intent, use of
alcohol, use of (other) psycho-active drugs) and five additional modules to
enable the collection of additional data on special topics (violence,
transport, place, sports, occupational injury).

Technical aids for persons with disabilities - Classification
and terminology (ISO9999)
The international Standard establishes a classification of technical
aids for persons with disabilities. It is restricted to technical aids
intended mainly for the use of an individual.
The classification consists of three hierarchical levels, termed
classes, subclasses and divisions respectively. Each class, subclass or
division consists of a code, a term and if necessary an explanatory
note and/or reference to other part parts of the classification or the
ICF.

The Anatomical Therapeutic Chemical Classification
System with Defined Daily Doses (ATC/DDD)
The ATC/DDD system classifies therapeutic drugs. The purpose of
this system is to serve as a tool for drug utilization research in order
to improve quality of drug use.
In the ATC classification system, the drugs are divided into different
groups according to the organ or system on which they act and their
chemical, pharmacological and therapeutic properties.
Drugs are classified into five different levels. Drug consumption
statistics (international and other levels) can be presented for each of
these five levels.

International Classification for Nursing Practice (ICNP)
As an extend the coverage of the domain of nursing practice as an essential
and complementary part of professional health services, ICNP classifies
patient data and clinical activity in the domain of nursing and can be used
for decision-making and policy development aimed at improving health
status and health care delivery. ICNP can improve communication and
statistical reporting practices across health services
ICNP is used to compose and represent diagnoses, interventions, and
outcomes in a poly-hierarchy. A number of subsets are available to provide
pre-coordinated concepts for select health priorities, including nursing
outcome indicators, paediatric pain management, palliative care, and
partnering with patients and families to promote adherence to treatment.

Verbal autopsy standards: ascertaining and attributing
causes of death tool

The Startup Mortality List (ICD-10-SMoL)
The Start-Up Mortality List (SMoL) has been designed to be in line
with the International Classification of Diseases (ICD), and informs
setting public health priorities and tracking progress towards
national and international targets and goals.
This list is designed to be a first step towards standardized reporting
of causes of death in low-resource settings where capacities to code
causes of death to ICD 3- or 4-digits are lacking.

The Startup Mortality List (ICD-10-SMoL)

ICD – 11th Revision, Examples

References
• WHO home publications . ICD 11 fact sheet. Feb. 2022
https://icd.who.int/en/docs/icd11factsheet_en.pdf
• Harrison, J.E., Weber, S., Jakob, R. et al. ICD-11: an international
classification of diseases for the twenty-first century. BMC Med Inform
Decis Mak 21 (Suppl 6), 206 (2021). https://doi.org/10.1186/s12911-
021-01534-6
• WHO home/classification. Classification and Terminologies. 2023
https://www.who.int/standards/classifications
• Abdul Rahman Dawood Mia. International Statistical Classification of
Diseases and Related Health Problems. 10th Revision. Volume 1, 2003
https://archive.org/details/InternationalStatisticalClassificationOf

International Classification of Diseases, 10th & 11th review.pptx

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