ICD Revision Process Alpha Evaluation Meeting 11 – 14 April 2011: The Way Forward?
Post #70 Shortlink: http://wp.me/pKrrB-ZN
The information in this mailing relates only to ICD-11, the revision of ICD-10 scheduled for completion and pilot implementation in 2014/15. It does not apply to the forthcoming US specific “Clinical Modification” of ICD-10, known as ICD-10-CM.
The Way Forward?
ICD-11 Revision maintains a website on a Google platform where key documents, agendas for iCAMP and workgroup meetings, background documents and presentations can be viewed and downloaded. Minutes or summaries of meetings aren’t usually posted publicly:
ICD-11 Revision: http://sites.google.com/site/icd11revision/home
An ICD Revision Process Alpha Evaluation Meeting was held in Geneva, last week, between 11-14 April, for discussing the status of the revision of ICD-10 and development of ICD-11, for both content and software development, and reviewing the ICD revision “Roadmap” and Timeline.
A copy of the Meeting Agenda can be downloaded from the ICD-11 Revision site here or opened on DSM-5 and ICD-11 Watch site here: ICD11 April 11 Meeting Agenda. There are some interesting comments in the Agenda Appendix on project funding, lack of resources, project management and lines of communication.
There are five PowerPoint presentations available to download from this page.
If you are interested in the ICD Revision process, in general, then I suggest visiting the site and viewing or downloading the following three presentations – these are slides only, with no notes or transcripts.
(The 2007 MS PowerPoint viewer is required to view presentations that have been created in .pptx format. A .pptx viewer can be downloaded free from the Microsoft site.)
.ppt file: The Way Forward
.pptx file: Can Celik’s Presentation: Public Tooling
.pptx file: Stanford’s Presentation: iCAT Beta
These three presentations can also be opened in the next post on DSM-5 and ICD-11 Watch site and selected slides have been posted here:
Post #71: ICD Revision Process Alpha Evaluation Meeting documents and presentations
In mid 2009, ICD Revision launched a number of platforms as channels of communication with the public and maintains a YouTube Channel, Facebook site, Twitter and blog. The ICD-11 blog has not been updated since October 2009 and queries left on the Facebook site by members of the public may take several months before a response is provided or may receive no response, at all.
The YouTube videos made to accompany various Geneva meetings can also be accessed on the ICD Revision YouTube page of my site. The two most recent videos give an overview of the iCAT drafting process and the extent of the ICD-11 “Content Model” – the 13 parameters through which ICD-11 categories can be described.
Visibility of iCAT drafting platforms
Following last week’s ICD Revision Process Alpha Evaluation Meeting, it is anticipated that ICD Revision may make a public announcement, within the next few weeks, clarifying how it intends to proceed in light of the fact that the timeline for the Beta drafting phase is slipping.
The meeting Agenda and PowerPoint slides suggest that ICD Revision is working towards making a version of the drafting platform publicly available around 16 May, this year, but that this may represent a compromise on previous plans and may be a “hybrid” between the Alpha and Beta drafting phases.
From the Agenda:
a. iCAT continued alpha development and evaluation ( 2010-11)
b. iCAT beta phase ( 2012-2015)
c. iCAT continuous maintenance phase ( 2015+)”
Earlier timelines had projected endorsement by the World Health Assembly (WHA) and pilot implementation of ICD-11 in the spring of 2014. But one presentation slide suggests approval by WHA in 2015.
It’s unconfirmed, but if the “Milestones” timeline has been revised to accommodate a later release of a Beta drafting phase platform and later publication of a Beta Draft, then WHO may have already decided to shift the pilot implementation date for ICD-11 by 12 months, to 2015.
That would mean that by the time ICD-11 is ready for dissemination, the American Psychiatric Association’s DSM-5 would have already been put to bed and out in print two years prior to ICD-11 implementation.
It is intended that for ICD-11, all three volumes will be electronically published and capable of continuous updating in response to scientific developments (unlike ICD-10 where there are annual updates); there will also be electronic translations and print editions. The three volumes of ICD-11 are intended to be integrable with each other and also with some other classification systems.
The drafting platforms are based on Web 2.0 applications and it is proposed that there will be stakeholder and end user participation in the Beta drafting phase.
The IT work and software development for the various alpha and beta drafting platforms and final product platforms is enormously complex; there is also the potential for far more textual content in ICD-11 than there was in ICD-10 and overall, this revision project represents a huge undertaking by an under-resourced organization.
The ICD-11 Alpha/Beta drafting process
Topic Advisory Group (TAG) Managing Editors overseeing the revision of the various chapters of ICD-10 have responsibility for recruiting external experts, via networking. The function of the external experts is to peer review proposals being made by TAG members or submitted by external professional bodies and institutions and to review or assist with the generation of textual content.
[In late 2009, I approached the WHO's Dr Robert Jakob to enquire whether and at what stage the names of external peer reviewers would be identified in the drafting platforms, as visible to the public. I also asked whether the reviewing of proposals as they progressed through the Workflow review system would be a transparent process that could be monitored by the public. Neither query produced a response from Dr Jakob.]
So there are many lines of communication to be maintained between WHO classification experts, IT consultants and technicians, Revision Steering Group members, TAG Managing Editors, TAG members and external experts. There is an ICD-11 Collaborative Authoring Workflow chart here: workflow-2.
At the Beta drafting stage, the proposal is that TAG Managing Editors will continue to recruit external peer reviewers to assist workgoups with reviewing of categories, proposals and generation of content, but that versions of the Beta drafting platform would be opened up to the public for viewing, and interested stakeholders would be able to register for limited input and interaction.
Stakeholders (or preferably, communities of stakeholders) would not have editing rights, per se, but the proposal is that they would comment on proposals, “score” proposals and make evidence-based suggestions which the TAG groups would then consider for approval, which would then be incorporated into the draft or rejected. There has also been discussion of a “hierarchy” of levels of input according to professional status of stakeholders. How ICD Revision plans to verify the credentials of professionals isn’t clear, nor is it defined what would consitute a stakeholder “community”.
No static Beta Draft for public review and comment
Rather than release a static Beta draft for professional and public scrutiny in a feedback exercise for a pre-determined review period (as DSM-5 has already done and is scheduled to do again in August-September), the proposal appears to be for longer term feedback during an alpha/beta transition drafting phase on dynamic content that would be continuously updated, for example, on a four weekly cycle, to reflect the progress being made by the various Topic Advisory Groups in entering proposals for changes and populatation of textual content, and in response to external input.
So managing editors and members of the Topic Advisory Groups (mostly international clinicians and researchers juggling this work on top of their “day jobs”) are faced with maintaining lines of communication, largely via electronic means, between workgroup chairs, fellow workgroup members, external peer reviewers and WHO classification experts whilst also considering input from professional bodies, and working in the background on the drafting platform, while stakeholders are commenting and feeding suggestions into the process via the public versions of the drafting platforms.
[Some organizations and professional bodies have been compiling and submitting proposals via an ICD Revision Proposal Form, since late 2009. There is no publicly available list of which institutions and bodies have been invited to submit proposals, which have responded, or where their submissions for changes to ICD-10 can be scrutinised, but copies of these submissions occasionally turn up online, having been published in the organs of these organizations.]
Selected slides from ”Proposal for the ICD Beta Platform, Stanford team”:
“…who will do all this work?”
Presentations and video clips of the WHO’s Dr. Bedirhan Üstün suggest a man buzzed up on information and internet technology: “cloud sourcing”, portals, public commenting and “scoring” of proposals, wikis, blogs, internal and public “user communities”, drawing in the involvement of “Wikipedians” and other existing “editing communities” (one questions whether Dr Üstün has any experience of how Wikipedia functions and the problems inherent with some Wikipedia admins and editors, particularly in relation to editing of controversial scientific and medical areas), message boards, Facebook integration, “community engagement”…
But as the closing slide of one of last week’s presentations ruefully comments, “And just a small detail: who will do all this work?” 
ICD Revision and its IT and informatics advisors seem eager to use these internet applications because they exist, without having given due consideration to whether the WHO can fund, manage and sustain this level of public participation and interaction or whether this is the best way to approach the revision of the ICD.
How does ICD Revision intend to finance and recruit the personnel needed to manage the opening up of the drafting process to multiple platforms for stakeholder participation, given WHO’s limited resources when already, no-one can evidently be spared to even keep the ICD-11 blog updated or to respond to queries that members of the public have posted on ICD Revision’s existing public platforms and where Topic Advisory Group Chairs approached for brief clarifications are not always providing a response nine months down the line?
Who is going to pull this most ambitious project back down to earth?
Insufficient funding allocated and no Project Manager
From the Appendix to the April meeting Agenda:
“TAGs were supposed to be self-financed. The TAG chair was supposed to have funding to carry out their revision work.”
“As this is a core WHO activity, we should have regular budget funds for this project. The scale of this project is too big not to have funding for a project manager.”
“Additionally, ALL relevant WHO departments should have designated some financial and some human resources to this project as part of the collaborative effort.”
“…communication between the TAGs is growing, and it is beginning to become overwhelming in addition to clinical responsibilities.”
ICD-11 proposals for PVFS, ME and Chronic fatigue syndrome
Until some form of Alpha/Beta transition drafting platform is back in the public domain, it won’t be evident how much further forward the population of content for Chapter 6 Diseases of the nervous system has progressed since last November. As more information becomes available, I will update, and I will be posting a summary of how things stood in the iCAT last November in Post #72.
The meeting Agenda, selected slides and three of the PowerPoint presentations can be viewed/opened from Post #71, on DSM-5 and ICD-11 Watch site, here:
ICD Revision Process Alpha Evaluation Meeting documents and presentations
Key documents and related posts:
1] ICD Revision Process Alpha Evaluation Meeting Agenda and background documents
2] Report, WHO FIC Council conference call, 16 February 2011, PDF format
3] Key document: ICD Revision Project Plan version 2.1 9 July 2010
4] Key document: Content Model Reference Guide version January 2011
5] PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring Platform (DSM-5 and ICD-11 Watch report with screenshots from the iCAT): http://wp.me/pKrrB-KK
6] Closing remarks, PowerPoint presentation: “Proposal for the ICD Beta Platform”, Stanford team, 12.04.11, WHO, Geneva.