Briefing paper on ICD-11 and PVFS, ME and CFS: Part 1

Post #315 Shortlink: http://wp.me/pKrrB-40E

 

Part one of a three part report on the status of ICD-11 proposals for the classification of the three ICD-10 entities:

G93.3 Postviral fatigue syndrome (coded under parent class G93 in Tabular List)

Benign myalgic encephalomyelitis (inclusion term to G93.3 in Tabular List)

Chronic fatigue syndrome (indexed to G93.3 in Volume 3: Alphabetical Index)

 

Part 1: Status of the ICD-11 development process

Part 2: Status of proposals for the classification of PVFS, BME, and CFS in the public version of the ICD-11 Beta drafting platform

Part 3: Status of proposals for the revision of ICD-10’s Somatoform disorders for the core and primary care versions of ICD-11

 

Part 1: Status of the ICD-11 development process

The revision of ICD-10 and development of the structure for ICD-11 began in April 2007.

ICD-11 was originally planned for completion by 2012, but the timeline was extended to 2015 early in the development process.

In January 2014, WHO/ICD Revision extended the timeline by a further two years to allow more time for generation of content, peer review, field testing and evaluation, translations and transition preparations [1].

The current projected date for approval by the World Health Assembly (WHA) is May 2017 with implementation timelined for 2018+.

In July 2014, WHO issued a call for expressions of interest in a contract for an external interim assessment of the revision process. Due date for the assessment report is December 15, 2014. It is not known whether WHO intends to publish a summary of the external assessment report.

Once ICD-11 is ready for dissemination, WHO Member States will transition to the new edition at their own pace. There is no WHO mandated date by which ICD-11 must be implemented, but WHO has said that it won’t support the annual updating of ICD-10 indefinitely. Developing and low resource countries may take many years before migrating to ICD-11.

 

Print and electronic versions

The scope of the revision project is ambitious and technically very complex. The project is under-resourced and underfunded and there is no overall project manager. Work groups have complained about the burden of work and poor internal communications.

There will be an ICD-11 print edition and a more expansive computerized version planned to be integrable with the international SNOMED CT terminology system.

The electronic version has a Foundation Component which includes all the ICD-11 diagnostic categories arranged in hierarchical “trees.”

From the Foundation Component, subsets (known as “linearizations”) are derived that contain mutually exclusive lists of terms for different purposes, e.g. for mortality, morbidity or primary care.

There are anticipated to be linearizations for mental and behavioural disorders, low resource and high resource primary care settings, rare diseases and occupational health and speciality classifications, including neurology, paediatrics, ophthalmology and dermatology.

The public version of the Beta drafting platform currently displays only the Foundation Component and a Joint Linearization for Mortality and Morbidity Statistics.

The country specific “Clinical Modifications” of ICD-10, including the U.S.’s forthcoming ICD-10-CM, are expected to be incorporated into ICD-11, as linearizations, as is ICPC-2.

The development process is overseen by a Revision Steering Group (RSG) chaired by biomedical informatics expert, Christopher Chute, MD, Mayo Clinic, Rochester, MN [2].

 

Primary Care version

An abridged version of the core ICD-11 for use in primary care and low resource settings, known as ICD-11-PHC, is being developed simultaneously with the core version.

The ICD-11 Primary Care Consultation Group, chaired by Prof Sir David Goldberg, is charged with the revision of the 26 mental and behavioural disorders in ICD-10 PHC, the abridged version of ICD-10. The 28 mental disorders proposed for the new primary care edition (ICD-11-PHC) will require an equivalent category within the core ICD-11 version [5].

 

Work Groups

Over 20 work groups have been assembled since 2007 reporting to the RSG. These are known as Topic Advisory Groups (TAGs). Professional and scientific organisations also have representatives on the TAGs [3].

TAG Managing Editors may also recruit external reviewers for reviewing proposals and textual content. Terms of Reference for TAGs and work groups can be viewed in reference [4].

Reporting to the TAGs are sub working groups charged with making recommendations for specific chapter sections. TAG membership lists are available from the WHO site but the names of sub working group members and external reviewers are not posted.

The Work Groups with most relevance for the ICD-10 G93.3 categories are:

TAG Neurology (Diseases of the nervous system) Chair: Prof Raad Shakir, Managing editor: Tarun Dua, WHO.

TAG Mental Health (Mental and behavioural disorders) Co-Chairs: Geoffrey Reed, PhD, WHO; Steven Hyman, MD, Harvard University.

ICD-11 Expert Working Group on Somatic Distress and Dissociative Disorders (S3DWG) Chair: Prof Oye Gureje. A sub working group to TAG Mental Health. Prof emeritus, Francis Creed, is a member. This group is said to have 17 members but apart from two others, I have been unable to establish the full membership list.

ICD-11 Primary Care Consultation Group (PCCG) Chair: Prof Sir David Goldberg, Vice-chair: Prof Michael Klinkman (U.S.). Per Fink’s research collaborator, Marianne Rosendal, is a member of the 12 person, PCCG. The full member list has been published in a journal paper [5] but is not posted on the WHO website.

 

Differences between ICD-10 and ICD-11

There are significant differences between the structure of ICD-10 and ICD-11: more chapters (currently 26 against ICD-10’s 22); reordering of chapters; restructuring of disease classes and parent/child hierarchies within chapters; renaming of some terms; relocation of some terms to other existing chapters or to new chapters; multiple linearizations; more descriptive content; a new system of code numbers.

Disease terms with an equivalent ICD-10 term are back referenced to their legacy terms and codes in the electronic platform for ICD-10 Version: 2010 [6].

 

Multiple parents and multisystem diseases

For ICD-10 Tabular List, an ICD entity (a parent class, title term or inclusion term) can appear in only one place within the classification.

For ICD-11, multiple parentage is permissible. In the Foundation Component, disorder or disease terms can appear under more than one hierarchical parent [7].

Diseases that straddle two chapters, like malignant neoplasms of the skin, can now be viewed under Diseases of the skin as well as cross-linking to the Neoplasms chapter. Premenstrual Dysphoric Disorder (PMDD), proposed for inclusion in ICD-11, is listed under both Depressive disorders, in the Mental and behavioural disorders chapter, and also under Premenstrual tension syndrome under new chapter, Conditions related to sexual health.

So the ICD-10 concept of discrete chapter location is being dispensed with for ICD-11.

In 2010, the Revision Steering Group posted a discussion paper on the potential for incorporating a new chapter into ICD-11 for Multisystem diseases, but this proposal has been rejected [8].

In 2013, consideration was being given, instead, for generating a multisystem diseases linearization – as a virtual chapter – compiled from the Foundation Component that lists all ICD disorders and diseases, but there would be no separate Multisystem diseases chapter within the print version [9].

It isn’t known whether a decision has been reached but there is currently no ability to generate a multisystem diseases linearization from the Foundation Component, at least not within the public version of the Beta drafting platform.

How to represent multisystem diseases within ICD-11 (and the potential for an ICD category term to be assigned to multiple parents) could have implications for classification of one or more of the three ICD-10 G93.3 terms.

 

The Content Model

Another major difference between ICD-10 and ICD-11 is the Content Model. For ICD-11, all uniquely coded ICD Title terms (but not their Inclusion terms or Synonyms) are intended to have Definitions and in some cases, other descriptive content populated [10]. Whereas category terms located in ICD-10 chapters other than Chapter V: Mental and behavioural disorders were listed, to quote WHO’s, Bedirhan Üstün, like a laundry list, with no descriptive content.

 

Outside of the WHO classification experts, the RSG, the working groups, sub working groups and their external advisers who else is inputting into the development process?

In 2009, ICD Revision Steering Group began inviting professional bodies and Royal Colleges to submit proposals for revisions to the ICD structure and content for ICD-11.

WHO has also set up a Global Clinical Practice Network (GCPN), an international network of over 11,000 mental health and primary care professionals [11].

Calls have gone out for various classes of professional stakeholder to register with the public version of the Beta draft to participate in the revision process:

Medicine; Nursing; Midwifery; Dentistry; Pharmacy; Health information management (coding, medical records); Environmental and occupational health and hygiene; Physiotherapy or Physical therapy; Nutrition; Social Sciences; Psychology; Social work and counseling; Epidemiology; Health Policy; Traditional and complementary medicine.

A pre-final draft for ICD-11 is expected to be released for public comment at some point in 2015/16, but no firm date for this has been announced.

 

How can stakeholders participate?

Professional stakeholders and others who register an interest are able to interact with the Beta drafting platform and access additional content, e.g. PDFs of the print versions and Index.

The public version of the Beta drafting platform can be viewed without registration but comments submitted by registered stakeholders are not visible to non registered viewers.

Comments and suggestions are screened and forwarded to the appropriate TAG Managing editors for review. Occasionally, a TAG Managing editor or one of the ICD Revision staff will respond to a proposal or a request for correction via the comments facility.

Registered stakeholders are permitted to:

• Add comments on and read other stakeholder comments on concepts; title terms; synonyms; inclusion terms; exclusions and other Content Model parameter terms;
• Comment on whether a category is in the right place;
• Comment on whether the category is useful for Primary Care; Research; Clinical;
• Suggest definitions (with sources) for a disease or disorder and comment on already populated draft definitions;
• Make proposals to change ICD categories, supported with references;
• Offer to participate in field trials (for professionals only);
• Offer to assist in translating ICD into other languages

Stakeholders can register for participation here: http://www.who.int/classifications/icd/revision/en/

Video inviting professional and stakeholder participation here: http://www.who.int/classifications/icd/revision/video/en/

The Beta platform is intended for considered and collegiate input – not as a platform for campaigning or activism.

Some patient advocacy organisations, for example, gender and trans* groups, have been holding face to face meetings with ICD Revision personnel at conferences or other venues to inform the revision process and represent their constituencies’ interests.

A new Proposals mechanism was launched on the public Beta draft in July 2014. This is a more sophisticated system through which registered users can submit proposals, supported with rationales and references, for changes/additions/deletions to proposed ICD-11 entities.

Proposals guide: http://apps.who.int/classifications/icd11/browse/Help/Get/proposal_main/en

 

Where to view the Beta drafting platform

ICD Revision and TAG Managing editors are developing the Beta draft on a separate electronic multi-authoring platform, known as the iCAT, on a server which is not accessible to the public.

The iCAT Beta platform is more layered than the Beta version which the public sees: it displays a larger number of “Content Model” parameters; there are tabs for tracking “Change Histories” and “Category Notes and Discussions” for comparing earlier iterations of a specific chapter section with the most recent edits. There are sub lists for terms that are proposed to be retired or for which decisions are needing to be made.

The public version of the Beta has no means through which changes to the draft (and rationales for changes) can be tracked, or for comparing, for example, an earlier edit of a specific chapter section with the most recent content.

The inability to monitor editing histories in the public Beta draft and the absence of progress reports from the work groups adds to confusion around interpretation of the Beta content. The draft is updated daily, so it needs checking every day for relevant changes.

You can view the public version of the Beta drafting platform here:

http://apps.who.int/classifications/icd11/browse/f/en

Foundation Component (the entire ICD universe):

http://apps.who.int/classifications/icd11/browse/f/en#/

Joint Linearization for Mortality and Morbidity Statistics:

http://apps.who.int/classifications/icd11/browse/l-m/en#/

User Guide: http://apps.who.int/classifications/icd11/browse/Help/en

 

Click on the small grey arrows next to the Beta draft categories to display their parent, child and grandchildren categories, as drop down hierarchies.

Linearization display button1Select this coloured button to display symbols and hover text indicating which linearization(s) a selected term is listed under.

The display panel on the right contains the “Content Model” text: Short and Long Definitions, Inclusion terms, Synonyms, Exclusions, Index terms etc. for the selected ICD Title term. Many terms are still awaiting population of Short Definitions (for print version) and Long Definitions (for electronic version), and other descriptive content.

For comparison between the public Beta draft and the iCAT, view this 2 minute iCAT screencast animation (with audio), intended as a demo for ICD Revision editors.

The animation is an .ogv file which should run in recent releases of Firefox but may not load in other browsers. If you don’t have the right program installed to run an .ogv file, the iCAT multi-authoring platform that the TAG editors are using looks like this:

iCAT editing platform 3

 

In Part Two, I shall be setting out what is currently known about proposals for the classification of Postviral fatigue syndrome, Benign myalgic encephalomyelitis and Chronic fatigue syndrome for ICD-11.

Important caveats: The public Beta platform is not a static document, it is a work in progress, subject to daily editing and revision, to field test evaluation and to approval by the RSG and WHO classification experts. Not all new proposals may survive the ICD-11 field tests. Chapter numbering, codes and “sorting codes” currently assigned to ICD categories are not stable and will change as chapters and parent/child hierarchies are reorganized. The public version of the Beta is incomplete; not all “Content Model” parameters display or are populated; the draft may contain errors and omissions.

 

Part 2: Status of proposals for the classification of PVFS, BME, and CFS in the public version of the ICD-11 Beta drafting platform published September 30, 2014

Part 3: Status of proposals for the revision of ICD-10’s Somatoform disorders for the core and primary care versions of ICD-11 [to follow]

 

References for Part 1

1 Committee for the Coordination of Statistical Activities, Twenty-second Session 4-6 September 2013, Items for discussion and decision: Item 8, provisional agenda, pp 8-10: http://unstats.un.org/unsd/accsub/2013docs-22nd/SA-2013-12-Add1-Health-WHO.pdf

2 http://www.who.int/classifications/icd/RSG/en/

3 http://www.who.int/classifications/icd/TAGs/en/

4 http://www.who.int/entity/classifications/TOR_TAGs_WGs.pdf?ua=1

5 Lam TP, Goldberg DP, Dowell AC, Fortes S, Mbatia JK, Minhas FA, Klinkman MS: Proposed new diagnoses of anxious depression and bodily stress syndrome in ICD-11-PHC: an international focus group study. Family Practice (2012) 30 (1): 76-87. Free text: http://fampra.oxfordjournals.org/content/30/1/76.full.pdf+html

6 http://apps.who.int/classifications/icd11/browse/f/en#/

7 http://apps.who.int/classifications/icd11/browse/Help/Get/architecture/en

8 http://dxrevisionwatch.files.wordpress.com/2010/10/considerations20on20multisystem_diseases_201008181.doc

9 http://informatics.mayo.edu/WHO/ICD11/collaboratory/attachments/208/19.Multisystem_Diseases_Chapter.v1.2.docx

10 http://www.who.int/classifications/icd/revision/contentmodel/en/

11 http://www.globalclinicalpractice.net/en/

Call for Expressions of Interest to review the ICD revision process

Post #312 Shortlink: http://wp.me/pKrrB-3Yw

(If the consulting team that secures the ICD Revision interim assessment contract extends their outreach to include analysis of advocate stakeholder views and experience of interacting with the revision process, I shall be happy to discuss key concerns.)

The World Health Organization (WHO) Office of the Assistant Director General, Health Systems and Innovation, has posted a call for expressions of interest from suitable contractors to conduct an interim assessment of the 11th Revision for International Classification of Disease (ICD).

Deadline for expressions of interest is July 31, 2014. Following the selection process, WHO will inform the contracted party by 15 August 2014.

Lead time is four months

Target date for the completed first draft of the deliverable is by 10 October 2014. Due date for the completed final product submitted to WHO will be 15 December 2014 latest.

“WHO keeps the right to publicize the report and its contents as a whole or in parts.”

+++

Call for Expressions of Interest to review the ICD revision process

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Terms of Reference:

Review of

WHO’s Revision Process
for the International Classification of Diseases (ICD)

Request for Expressions of Interest

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Table of Contents

(…)

1. INTRODUCTION

WHO Office of the Assistant Director General, Health Systems and Innovation, solicits expressions of interest from a suitable Contractor(s) to conduct an interim assessment of the 11th Revision for International Classification of Disease (ICD) to carry out the following work:

1.1 Objective of the Request

WHO Office of the Assistant Director General, Health Systems and Innovation, solicits expressions of interest from a suitable Contractor(s) to carry out the following work:

1. Conduct an interim assessment of the 11th Revision for International Classification of Disease (ICD) in terms of:

Progress towards the goals of the Revisions
• Process and mechanisms put in place for the ICD revision
Project resources (financial & human) in relation to the proposed outcomes of the revision
• Project Plans and proposed timeline for the completion of ICD 11 for 2017
• Organization for maintenance and updates of ICD beyond 2017

2. Analyze the relevance and effectiveness of the planned features of ICD 11 in meeting the needs of the key stakeholders in WHO Member States including its:

a. Use in Mortality statistics – e.g. Cause of Death statistics, Verbal Autopsy, others…
b. Use in Morbidity statistics – e.g. Discharge summaries, Case-mix groupings, others…
c. Use in Primary Care – in low and intermediate resource settings…
d. Use in Clinical Care – for diagnosis, guidance, quality and safety indicators
e. Use in Scientific Research for epidemiology, genetic studies and other

3. Compile an assessment report summarizing the findings and making recommendations for improvement.

Potential contractors are requested to state the reason why they consider themselves suitable for this work and explain how they will respond to the requirements stated in this request with (a) a proposed draft work plan; (b) timeline; (c) budget with annotation.

1.2 Deadline for Expressions of Interest

Expressions of interest must be submitted on or before July 31, 2014 in order to be considered. The description of the contracting agency and curriculum vitae of the proposed team members, and proposed methods for assessment and timeline should be attached to the expressions of interest (see also 2.3). A point of contact for inquiries should be identified. WHO may contact the parties for further clarification. WHO will inform the contracted party following the selection process by 15 August 2014.

(…)

+++
Full document here:

http://www.who.int/classifications/icd/revision/en/

or open PDF on Dx Revision Watch here:

Click link for PDF document  Call for Expressions of Interest to review the ICD revision process

 

Annex I to this document (Page 12) contains a Summary of the ICD Revision Process

“This document summarizes the ICD Revision Process, in particular, in terms of the timelines for the finalization date and submission to WHO Governing Bodies. Following various consultations with the WHO Member States and relevant international stakeholders, it was decided decided to postpone the submission to WHA to 2017 May in various consultations with the WHO Member States and relevant international stakeholders taking into account [sic]*: the developmental stage of ICD 2013 Beta, and allowing for reasonable time to complete the remaining tasks: reviews; additional proposals; field trials; translations; and the transition preparations.”

Section 2 (Page 23) sets out ICD Revision Process: Tasks for Beta Phase and Finalization 2013-2017

Annex II contains The Detailed List of Multiple Stakeholders to be contacted

*I guess no-one at WHO reviewed and edited this document before posting it?

Extension to timeline official: ICD-11 rescheduled for 2017

Post #292 Shortlink: http://wp.me/pKrrB-3H9

Update at February 8, 2014: ICD Revision has now updated its Timeline page:

May 2017 Present the ICD-11 to the World Health Assembly”

ICD-11_20177

In the last day or so, edited text on two WHO webpages confirms a decision by ICD Revision to postpone release of ICD-11 by a further two years, from 2015 to 2017.

From WHO site: “The International Classification of Diseases 11th Revision is due by 2017″

Also ICD Information Sheet: “…The development phase will continue for three years and ICD-11 will be finalized in 2017.”

And from a note accompanying a slide presentation: “…Now ICD 11 is scheduled in 2017 and ICD-10-CM can be made as a National Linearization.” Bedirhan Üstün, January 29, 2014 [1]

ICD-11 Revision has yet to issue a formal announcement or news release or update its Timeline page to reflect this decision.

There are no reports on the revised schedule on ICD-11 on Facebook or Twitter @WHOICD11 – all very low key.

Delaying the release of ICD-11 has been under consideration for several months.

+++
Slipping targets

The development process for ICD-11 began in April 2007, with ICD-11 scheduled for dissemination by 2012 and the timelines for the development of ICD-11 and DSM-5 running more or less in parallel [2,3].

Early on in the revision process, the ICD-11 dissemination date was extended. By 2009, the final draft was scheduled for World Health Assembly (WHA) approval in 2014. The WHA approval date was subsequently shunted to 2015 – four years later than originally planned.

ICD-11 is now scheduled for finalization in 2017.

Rationales for extending the timeline:

Pages 8-10: Committee for the Coordination of Statistical Activities, Twenty-second Session 4-6 September 2013, Items for discussion and decision: Item 8 of the provisional agenda, 3 September 2013 [4].

Slide presentation, Bedirhan Üstün, September 9-10, 2013, Slides 29-35: [5].

+++
Related reports from Dx Revision Watch

January 22, 2014: WHO Collaborating Centre confirms Revision Steering Group seriously considering extension to ICD-11 timeline: http://wp.me/pKrrB-3E8

September 15, 2013: WHO considers further extension to ICD-11 development timeline: http://wp.me/pKrrB-3sc

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References

1. Slideshare: AHIMA ICD-10 ICD-11 switch to ICD-10-CM in the USA, presentation note, Bedirhan Üstün, Coordinator at World Health Organization, January 29, 2014

2. Agenda Item No. 25: Revision of the International Classification of Diseases (ICD-10) and Involvement of Psychology International Union of Psychological Science Committee on International Relations Action, March 28–30, 2008
IUPsyS Mar 08 Agenda Item 25 ICD-10

3. Letter Saxena, WHO, to Ritchie, IUPsyS (International Union for Psychological Science), August 2007
Exhibit 1 WHO Letter Aug 07

4. Committee for the Coordination of Statistical Activities, Twenty-second Session 4-6 September 2013, Items for discussion and decision: Item 8 of the provisional agenda, 3 September 2013, Pages 8-10:
http://unstats.un.org/unsd/accsub/2013docs-22nd/SA-2013-12-Add1-Health-WHO.pdf

5. Slide presentation: ICD Revision: Where are we? Bedirhan Üstün, World Health Organization Classifications, Terminologies, Standards, ICD Revision: Quality Safety Meeting 2013, September 9-10, 2013, Slides 29-35:
http://www.slideshare.net/ustunb/icd-2013-qs-tag-260276686

WHO Collaborating Centre confirms Revision Steering Group seriously considering extension to ICD-11 timeline

Post #289 Shortlink: http://wp.me/pKrrB-3E8

Update at January 30, 2014:

ICD-11 Revision has confirmed that a decision has now been taken to postpone ICD-11 by a further two years, from 2015 to 2017.

From WHO site: “The International Classification of Diseases 11th Revision is due by 2017″

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Information in this report relates to the development of the World Health Organization’s ICD-11. It does not apply to the forthcoming US specific, NCHS developed, clinical modification of ICD-10, known as ICD-10-CM.

Ustun 34

Source: Slide 34: Where are we? What remains to be done? Shall we have ICD WHA submission in 2015 or later? B Üstün, World Health Organization Classifications, Terminologies, Standards ICD Revision: Quality Safety Meeting, September 2013

+++
The December newsletter of the WHO Collaborating Centre for the Family of International Classifications (FIC) in the Netherlands reports that ICD-11 Revision Steering Group (RSG) is reviewing options for a further extension to the ICD-11 development timeline [1]:

Newsletter on the WHO-FIC, Volume 11, Number 2, 2013, Latest News, Page 3 [PDF]

The Revision Steering Group and WHO Secretariat seriously consider amending the timeline of submitting the ICD-11 for endorsement by the World Health Assembly to allow more time for field testing in multiple countries and settings, and following up on resulting edits. WHO currently discusses options and scenarios with stakeholders.

This announcement from WHO-FIC’s Marijke de Kleijn-de Vrankrijker reinforces information and resources provided in my September report (WHO considers further extension to ICD-11 development timeline) – that ICD-11 Revision is failing to meet development targets and delaying submission of ICD-11 for WHA for approval until 2016, or alternatively, extending the timeline by a further two years, for WHA approval in 2017, is under consideration.

+++

ICD-11 already four years behind original targets

The revision of ICD-10 and development of the structure for ICD-11 began in 2007. WHO’s original goal had been to complete the revision and release of ICD-11 by 2011-12, Archived documents [2] [3].

By 2009, the date for submission of ICD-11 for WHA approval had been extended to 2014. The launch of the public version of the Beta drafting platform was later postponed from May 2011 to May 2012.

The current projection for submission of ICD-11 for approval to WHA is May 2015, with dissemination in 2015+ [4].

Mayo’s Christopher Chute, MD, chairs the ICD-11 Revision Steering Group. According to Chute, in this paper published in March 2012, publication of ICD-11 is “expected around 2016″:

Chute CG, Huff SM, Ferguson JA, Walker JM, Halamka JD. There Are Important Reasons For Delaying Implementation Of The New ICD-10 Coding System. Health Aff March 2012 DOI: 10.1377/hlthaff.2011.1258
+++

ICD Revision considers its options

In September, WHO posted this meeting materials document [5] and this slide presentation [6]. The document summarized, inter alia, ICD-11’s progress, current development status, timelines for finalization date and approval by WHO Governing Bodies, and rationales and options for a further shift in the timeline.

You can read extracts from the document and view slides setting out the options currently under consideration in this report: WHO considers further extension to ICD-11 development timeline, selected of which I am appending to this post.

The earliest ICD-11 might be ready for dissemination is late 2015/16 – which may require some further scaling back of the project’s goals.

But if ICD-11 Revision Steering Group does elect to postpone submission for World Health Assembly approval until May 2017, dissemination of ICD-11 may not be viable before 2018.

I will update this post if and when WHO or ICD-11 Revision Steering Group publish a statement of clarification on the WHO website or issue a news release, or if other information becomes available that confirms a revision to the timeline.

Implementation date

I’ve noted some confusion in reporting and comments around ICD-11 approval by WHA and dissemination and implementation dates.

Unlike the U.S. specific ICD-10-CM, there is no mandatory date by which Member States must switch from using ICD-10 to ICD-11.

World Health Assembly adoption of ICD-11 and ICD-11 implementation dates are separate. WHA adoption enables official use for countries who wish to move on to the next edition. But Member States using ICD-10 will transition to the next version at their own convenience [6].

Once approved, prepared for implementation and released, global adoption of ICD-11 isn’t going to happen overnight. It may take several years before WHO Member States transition from ICD-10 to ICD-11. Low resource and developing countries may take longer to prepare for and transition to the new edition.

The annual update process for ICD-10 will continue during the creation of ICD-11.

Extracts from document [5] setting out the rationale and options for postponement of WHA Approval:

[…]

3. Progress and Current Status of ICD Revision:

[…]

BETA PHASE:

At this point in time, 1 September 2013, an ICD2013 Beta version has been produced for review purposes and field trials after 6 years of drafting phases.

The current ICD 2013 Beta version has relatively stable classification lists (i.e. linearizations) for Mortality and Morbidity recording. It will be reviewed by the specific Mortality Reference Group and the Morbidity Reference Group to see how well it fits the purpose and proposed transition from ICD‐10.

In addition, the Beta version has planned processes for:

(i) Systematic international scientific peer review (ii) Submission of additional proposals from public groups and scientists (iii) Conducting field trials for its applicability and reliability (iv) Production support in multiple languages (translations) starting with WHO official languages (v) Preparations for transitions from ICD‐10 to ICD‐11.

[…]

6. Timelines

The current ICD Revision Process timeline foresees that the ICD is submitted to the WHA in 2015 May and could then be implemented. Between now and 2015, there remains 20 months to conduct the remaining tasks summarized above as: 1. Reviews, 2. Additional Proposals, 3. Field Trials, 4. Translations, and 5. Transition Preparations.

Given the technical requirements these steps could be expedited in the next 20 months. The experience obtained thus far, however, suggests that this timeframe will be extremely tight for paying due diligence to the work especially in terms of: appropriate consultations with expert groups; communication and dissemination with stakeholders; and sufficient time for field testing in multiple countries and settings, and carrying out the resulting edits.

WHO Secretariat would like to discuss this with all stakeholders and evaluate the possible options:

a. Keep ICD submission to WHA to 2015 as originally planned and implementation / adoption date may be free by any Member State (current position – no change).

b. Postpone submission to WHA to a later year to allow longer time for field trials and other transition preparations.

[…]

In conclusion:

(a) WHO Secretariat could produce an ICD 2015 ready including Mortality and Morbidity Linearizations, Reference Guide and Index with the appropriate resolution to go to the World Health Assembly. This timeframe, however, is extremely tight for paying due diligence to the work especially in terms of: appropriate consultations with expert groups; and sufficient time for field testing in multiple countries and settings, and carrying out the resulting edits

(b) If the timeline is advanced to 2016, there will be more time to have ICD 2016 version with more translations and incorporations of some field tests results.

(c) If the timeline is advanced to 2017, ICD 2017 will be ready with most Field Test results incorporated and maintenance scheme tested.

[…]

Slide presentation: B Üstün, World Health Organization Classifications, Terminologies, Standards, ICD Revision: Quality Safety Meeting 2013 September 9-10

Where are we? What remains to be done? Shall we have ICD WHA submission in 2015 or later?

Slide 34:

Ustun 34rule

Slide 35: [WHA Approval timeline – options under consideration]

Ustun 35rule

+++

References:

1. Newsletter on the WHO-FIC, Volume 11, Number 2, 2013, Latest News, Page 3. WHO Collaborating Centre for the Family of International Classifications (FIC) in the Netherlands.

2. IUPsyS Mar 08 Agenda Item 25 ICD-10 International Union of Psychological Science COMMITTEE ON INTERNATIONAL RELATIONS ACTION, March 28–30, 2008, Agenda Item No. 25: Revision of the International Classification of Diseases (ICD-10) and Involvement of Psychology.

3.  Exhibit 1 WHO Letter Aug 07 Letter Saxena, WHO, to Ritchie, IUPsyS (International Union for Psychological Science), August 2007.

4. ICD-11 Timeline: http://www.who.int/classifications/icd/revision/timeline/en/index.html

5. Committee for the Coordination of Statistical Activities, Twenty-second Session 4-6 September 2013, Items for discussion and decision: Item 8 of the provisional agenda, 3 September 2013, Pages 8-10: http://unstats.un.org/unsd/accsub/2013docs-22nd/SA-2013-12-Add1-Health-WHO.pdf

6. Slide presentation: ICD Revision: Where are we? Bedirhan Üstün, World Health Organization Classifications, Terminologies, Standards, ICD Revision: Quality Safety Meeting 2013, September 9-10, 2013, Slides 29-35: http://www.slideshare.net/ustunb/icd-2013-qs-tag-260276686

ICD-11 Round up: April #1

ICD-11 Round up: April #1

Post #239 Shortlink: http://wp.me/pKrrB-2Qy

[PMID 23583019]

The Lancet, Early Online Publication, 11 April 2013
doi:10.1016/S0140-6736(12)62191-6

Proposals for mental disorders specifically associated with stress in the International Classification of Diseases-11

Maercker A, Brewin CR, Bryant RA, Cloitre M, Reed GM, Ommeren MV, Humayun A, Jones LM, Kagee SA, Llosa AE, Rousseau C, Somasundaram DJ, Souza R, Suzuki Y, Weissbecker I, Wessely SC, First MB, Saxena S.

Mental disorders specifically associated with stress are exceptional in needing external events to have caused psychiatric symptoms for a diagnosis to be made. The specialty of stress-associated disorders is characterised by lively debates, including about the extent to which human suffering should be medicalised, 1 and the purported overuse of the diagnosis of post-traumatic stress disorder (PTSD). 2 Most common mental disorders are potentiated or exacerbated by stress and childhood adversity…

Contributors
AM, CRB, RAB, MC, GMR, MvO, SW, MBF, and SS were the core writing group. AH, LJ, SAK, AEL, CR, DS, RS, YS, and IW discussed the text and gave feedback to the core writing group.
Conflicts of interest
AM, CRB, RAB, MC, AH, LJ, SAK, CR, DS, SCW, and YS are members of the WHO ICD-11 Working Group on the Classification of Disorders Specifically Associated with Stress, reporting to the WHO International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders. GMR, MvO, and SS are members of the WHO Secretariat, Department of Mental Health and Substance Abuse. AEL, RS, IW, and MBF are special invitees to Working Group meetings. However, the views expressed in this article are those of the authors and, except as specifically noted, do not represent the official policies or positions of the International Advisory Group or WHO.
[Subscription required for full paper. A PDF may be available on authors’ personal websites or academic websites.]

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According to CDC’s, Donna Picket, as reported by AHIMA (American Health Information Management Association), “ICD-11 would likely not be ready for implementation in the US until after 2020.”

AHIMA

Update: ICD-11 on Track For 2015

Melanie Endicott | AHIMA & ICD-10 & ICD-10/CAC Summit | April 23, 2013

While the United States is preparing to implement ICD-10-CM/PCS on October 1, 2014, the World Health Organization (WHO) is anticipating a 2015 release of ICD-11. Taking into account the need to then clinically modify the WHO version, ICD-11 would likely not be ready for implementation in the US until after 2020. Donna Pickett, MPH, RHIA, medical systems administrator at Centers for Disease Control and Prevention/National Center for Health Statistics, delivered an update on the progress of ICD-11 development in Monday’s presentation “ICD-11 Update” at the 2013 AHIMA ICD-10-CM/PCS and Computer-Assisted Coding Summit, taking place in Baltimore, MD this week...  Read on

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Go here to view ICD-11 Beta drafting platform public version

http://www.who.int/classifications/icd/revision/betaexpectations/en/

ICD-11 Beta: Expectations, Concerns and Known Issues

Information for Beta Participants

ICD-11 Beta Phase started on 14 May 2012. The objective is to have a final ICD-11 version by 2015. This announcement clarifies that ICD-11 Beta version is not final, and will be enhanced by input from multiple stakeholders during the beta phase, which will last 3 years.

Caveats
Problems and Issues
Concerns and Criticisms etc

http://www.who.int/classifications/icd/revision/en/index.html

Revision

Participate in ICD Revision
Video invitation to participate
Frequently Asked Questions About ICD-11
ICD Information Sheet
ICD Revision Information Notes
Register to become involved
Timelines
Content Model
Definitions etc

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Presentation | T Bedirhan Üstün

ICD Revision Summary presentation: Quality and Safety Topic Advisory Group meeting, New York, April 2-3, 2013.

ICD11 Quality and Safety TAG 2013 Presentation | Slideshare

According to this presentation, by WHO’s Bedirhan Üstün, all ICD-11 Topic Advisory Groups (TAGs) have finished their editing of the structure. A good deal of work remains for the population of content, in accordance with the ICD-11 Content Model, across all chapters and on compatibility of linearizations across primary care, specialty and detailed research versions.

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Presentation [PDF Format, no PP viewer required]

Revising the ICD Definition of Intellectual Disability: Implications and Recommendations | March 19, 2013

Intellectual Disability’s Long Journey: George Jesien, Ph.D., Executive Director, Association for University Centers on Disabilities (AUCD)
Intellectual Disability and the Revision of ICD-10 Mental and Behavioural Disorders: Geoffrey M. Reed, Department of Mental Health and Substance Abuse, WHO
AAIDD Proposed Recommendations for ICD-11: Marc J. Tassé, Nisonger Center – UCEDD, The Ohio State University, Webinar

On Slides 17 and 18, Classification System Most Used and Classification Most Used by Country, graphics for data from WPA-WHO Survey of Practicing Psychiatrists* on global use of ICD-10, ICD-8/9, DSM-IV and Other diagnostic system(s).

*World Psychiatry. 2011 Jun;10(2):118-31.

The WPA-WHO Global Survey of Psychiatrists’ Attitudes Towards Mental Disorders Classification.

Reed GM, Mendonça Correia J, Esparza P, Saxena S, Maj M.

Abstract

Full free paper

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Medscape

Schizophrenia Bulletin

Schizophr Bull.2012;38(5):895-898.

Status of Psychotic Disorders in ICD-11

Wolfgang Gaebel

Abstract and full report

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ICD-11 Revision Beta drafting process: stakeholder participation

ICD-11 Revision Beta drafting process: stakeholder participation

Post #194 Shortlink: http://wp.me/pKrrB-2nw

Information in this report relates to the World Health Organization’s ICD-11, currently under development. It does not apply to the existing ICD-10 or to the forthcoming US specific “clinical modification” of ICD-10, known as ICD-10-CM.

Update at August 2, 2012:

ICD-11 Slide Presentation:     Harrison Slides 2011 PDF 3MB

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Update at August 2, 2012:

Dr Robert J.G. Chalmers, co-chair and managing editor of ICD Revision Dermatology Topic Advisory Group put out a call, yesterday, on the website of the American Academy of Dermatology Association (AAD) for input into the Beta draft for Chapter 12 Diseases of the skin:

An invitation to contribute to the future of dermatology

ICD-11 Update

By Robert J.G. Chalmers

ICD-11 draft is ready for comments and criticism

By Robert J.G. Chalmers, MB, FRCP, August 01, 2012

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When will ICD-11 be ready for dissemination?

Slipping targets

The revision of ICD-10 and development of the structure for ICD-11 began in 2007.

ICD-11 was originally planned to be ready for dissemination by 2012, with the timelines for the revisions of ICD-10 and DSM-IV running more or less in parallel. Source: Archive documents, References [1] [2].

Very early on in the revision process, the ICD-11 dissemination date was extended from 2012 to 2015. In 2009, launch of the Beta draft was timelined for May 2011, with the final draft scheduled for submission to World Health Assembly (WPA) for approval in 2014.

In order to be ready for global implementation in 2015, the technical work on ICD-11 would need to be completed by 2012. Source: Dr Geoffrey Reed, Ph.D., May 2009, via personal correspondence.

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ICD-11 still at the Beta drafting stage

In early 2011, in response to slipping targets for content population and software development, ICD Revision and WHO-FIC were discussing the pros and cons of postponing the launch of a Beta drafting platform until later that year or until May 2012, and whether an interim solution might be to launch “a hybrid model of opening the revision process to public comment and suggestions at the same time not a full scale beta phase with field trials…”

Sources: Slide presentation: ICD Revision Paediatrics Meeting, Ankara, Turkey, February 28 – March 1, 2011;
Report: WHO-FIC Council conference call, February 16, 2011: Page 6: 
PDF for Report [3]

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Launch of the Beta delayed

The decision was made to delay launching the Beta draft until May 2012. With the Alpha and Beta stages already running a year or more behind 2009 targets, it’s not clear how much time can be allocated for completing the Beta phase and two year field trials period – if the target for a final version for public viewing in 2014 is going to be reached.

According to the ICD-11 Timeline, presentation for World Health Assembly approval has been shifted to May 2015 and in this paper, published in March 2012 by Christopher Chute, MD, (Chair, ICD-11 Revision Steering Group) et al, publication of ICD-11 is now expected “around 2016.”

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“…And just a small detail: who will do all this work?” [4]

ICD-11 is a very ambitious project.

The burden of drafting and liaison is being carried out largely via electronic means between individuals scattered across the globe and in addition to their clinical and academic responsibilities.

Given the scale of the undertaking, its technical complexity, limited funding and human resources, lack of an overall project manager, reported communication problems between WHO, Revision Steering Group, Topic Advisory Group managing editors and members and the amount of work that remains to be completed, I cannot see this vision of WHO’s Bedirhan Üstün reaching fruition by 2016.

There are some interesting comments in this Agenda Appendix (Page 6 of 10) on project funding, lack of resources, project management and lines of communication: ICD-11 April 11 Meeting Agenda

For make-up of the Revision Steering Group (RSG) and the various Topic Advisory Groups (TAGs) see links at end of post. Membership of the various sub working groups to Topic Advisory Groups and the names of external peer reviewers of proposals and content have not been published by ICD-11 Revision.

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Where can the Beta drafting platform be viewed?

ICD Revision Steering Group and the various Topic Advisory Groups that are developing the Beta draft are working on an electronic collaborative authoring platform, called the iCAT, on a password protected server accessible only by WHO classification experts, Revision Steering Group, Topic Advisory Group Managing Editors and revision process IT personnel and software developers. It looks similar to this:

For more views of the iCAT see Slides 20-25 and Slide 39 of this 2011 slide presentation:

ICD-11 Slide Presentation:     Harrison Slides 2011 PDF 3MB

The iCAT platform is more complex than the publicly viewable version of the Beta platform and has a mechanism for recording change histories which tracks additions, deletions and revisions to the draft as ICD chapters are reorganized and new content generated and populated.

Population of content is managed by the Topic Advisory Group (TAG) Managing Editors following review by the Revision Steering Group. Structural changes to the classification, eg changing parent/child relationships and editing the linearizations can only be done by TAG Managing Editors in liaison with WHO classification experts. Source: Drafting Workflow text and chart [MS Word]; Swim Lane Workflow chart [PDF].

The publicly viewable version of the Beta drafting platform, which was launched in May 2012, looks like this:

With no change histories displaying in the public version of the Beta it is difficult for stakeholders to track proposed hierarchical changes to existing categories, changes to the names of parent classes or child categories, proposed introduction of new category terms (and the rationales for these) or proposed retirement of ICD-10 categories.

In the absence of rationales, it cannot be determined whether the disappearance of a category or group of categories is due to error or oversight by Advisory Group Managing Editors or others with editor level access, a temporary absence while a specific chapter section is being reorganized or whether these no longer displaying categories are intended to be subsumed under existing or new categories.

For example, a number of ICD-10 F45 and F48 Somatoform Disorder categories were removed from the Beta draft in early July with no explanation of intention.

Whilst ICD Revision invites interaction with the drafting process, the lack of clear intent on the part of Advisory Group editors and lack of response to requests for clarifications hinder submission of meaningful stakeholder comment and productive interaction with the process.

Caveats

When viewing the Beta draft, be mindful of the Caveats published by ICD Revision; the draft is in a state of flux.

The ICD-11 Beta drafting process is a work in progress over the next two to three years. The Beta draft is updated on a daily basis to reflect the work being carried out on the iCAT platform. Parent terms, category terms and sorting codes assigned to categories are subject to change as chapter reorganization progresses.

The Beta draft can be accessed here:

Beta draft Foundation Component (FC) view:

http://apps.who.int/classifications/icd11/browse/f/en

Beta draft Linearization Morbity (LM) view:

http://apps.who.int/classifications/icd11/browse/l-m/en

For definitions of Synonyms, Inclusions, Exclusions and ICD-11 terminology see the iCAT Glossary.

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Who are the stakeholders in ICD?

government service providers
policy makers and policy implementation agencies
health care professionals and practitioners
physician groups, especially primary care physicians
psychiatrists
psychologists
nurses
researchers and clinician academics
lay health care workers (who deliver most of the primary and mental health care in some developing countries)
social workers
patients (aka service users/consumers of health services), their families and carers
advocacy and disability rights organizations
health information managers and coders
health information technology workers
insurers

On its Facebook page, in June, ICD Revision put out a specific call for professionals with backgrounds in the following fields:

http://www.facebook.com/ICD11

Do you have a background in any of the following areas?

Medicine
Nursing
Midwifery
Dentistry
Pharmacy
Health information management (coding, medical records)
Environmental and occupational health and hygiene
Physiotherapy or Physical therapy
Nutrition
Social Sciences
Psychology
Social work and counseling
Epidemiology
Health Policy
Traditional and complementary medicine

WHO is asking experts from all over the world to sign up today to participate in the ICD revision.

www.who.int/classifications/icd11 

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How can stakeholders participate in the Beta process?

The public version of the Beta platform can be viewed without registration.

Professional stakeholders and others who register an interest are able to interact with the drafting process and have access to additional content.

Interested stakeholders can register here

Registered stakeholders are permitted to:

• Add comments on and read other stakeholder comments on concepts; title terms; synonyms; inclusion terms, exclusions and other Content Model parameter terms;
• Comment on whether a category is in the right place;
• Comment on whether the category is useful for Primary Care; Research; Clinical;
• Suggest definitions (with source for definition) for a disease or disorder and comment on already populated draft definitions;
• Make proposals to change ICD categories;
• Offer to participate in field trials (for professionals);
• Offer to assist in translating ICD into other languages

Comments left by registered stakeholders are not visible to non registered viewers. Comments cannot be edited or deleted and appear immediately.

Recent comments get aggregated here:

http://apps.who.int/classifications/icd11/browse/Contributions/RecentComments

+++
PDFs of Print Versions for the ICD-11 Beta Morbidity Linearization

Registered users can download individual chapters or the full linearization using the links on this page. These PDF files are updated every few days to reflect the daily revisions to the drafting platform:

http://apps.who.int/classifications/icd11/browse/l-m/en/Printables
 

For more information on how it is envisaged professional and lay stakeholders will interact with the drafting process see:

PowerPoint presentation slides in Posts #70 and #71:

ICD Revision Process Alpha Evaluation Meeting 11 – 14 April 2011: The Way Forward?

ICD Revision Process Alpha Evaluation Meeting documents and PowerPoint slide presentations

ICD-11 Revision Video invitation to participate here: Video invitation to participate

Press Release here announcing launch of Beta drafting platform. Further media coverage here

Specific call for comments from neurology professionals on The Lancet Neurology site here:

http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(12)70125-4/fulltext

+++

Recently issued documents around the Beta drafting process

Frequently Asked Questions About ICD-11

ICD-11 Beta: Expectations, Concerns and Known Issues: Information for Beta Participants

http://www.who.int/classifications/icd/revision/betaexpectations/en/

ICD-11 Known Concerns and Criticisms: Known concerns about the ICD-11 Beta phase

http://www.who.int/classifications/icd/revision/icd11betaknownconcerns.pdf 

     ICD-11 Beta known concerns

ICD-11 Known Problems and Issues: General known issues

http://www.who.int/classifications/icd/revision/icd11knownissues.pdf 

     ICD-11 General known issues

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The ICD-11 Content Model

ICD Revision says that the most important difference between ICD-10 and ICD-11 will be the Content Model.

In ICD-10, other than Chapter V Mental and behavioral disorders, there are no definitions or other descriptive content associated with ICD categories – just hierarchical lists of diseases arranged by chapter and their ICD codes.

But content in ICD-11 is being populated in accordance with the Content Model Reference Guide and there will be the potential for considerably more content to be included for diseases, disorders and syndromes in ICD-11 than appears in ICD-10, across all chapters:

“Population of the Content Model and the subsequent review process will serve as the foundation for the creation of the ICD-11. The Content Model identifies the basic characteristics needed to define any ICD category through use of multiple parameters.”

The most recently published version of the Content Model Reference Guide is here:

Content Model Reference Guide January 2011  [MS Word]

There are currently 13 defined parameters in the content model to describe a category in ICD. All categories will have an ICD Entity Title, Classification Properties, Textual Definition, Terms and up to 13 parameters described.

Content Model Parameters

  • ICD Entity Title
  • Classification Properties
  • Textual Definitions
  • Terms
  • Body System/Structure Description
  • Temporal Properties
  • Severity of Subtypes Properties
  • Manifestation Properties
  • Causal Properties
  • Functioning Properties
  • Specific Condition Properties
  • Treatment Properties
  • Diagnostic Criteria

Some ICD-11 chapters are more advanced than others for reorganization of categories and population of proposed definitions and text for other parameters.

In setting itself the task of generating, peer reviewing, populating and approving this amount of detail across the entire ICD, one has to question how realistic a goal this is within current timeframes.

“Populating the Content Model is a critical task for the revision. Failure results in failure of delivery of ICD‑11.” [4]

It would not surprise me if at some point before the end of this year, ICD Revision Steering Group announces further delays for the Beta drafting and field trial stages and an extension to the projected dissemination date, or a scaling back of the project if completion of ICD-11 and its several, planned speciality publications, by 2016, is to be viable.

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Will ICD-11 be implemented worldwide from 2015/16?

ICD-10 is used in over 100 countries, worldwide. Assuming ICD-11 does meet it schedules, it may still take several years before countries currently using ICD-10 are ready to adopt ICD-11.

Several countries have been authorized by WHO to develop their own “Clinical Modification (CM)” of ICD. Canada uses an adaptation called ICD-10-CA, with a version published for 2009. Germany uses a version called ICD-10-GM. Australia (ICD-10-AM) and Thailand (ICD-10-TM) also use country specific modifications of ICD-10.

The US lags behind the rest of the world and is still using a CM version of ICD based on the ICD-9, which is long since retired by the WHO.

Instead of moving onto ICD-11, once this is completed, the US had scheduled implementation of a clinical modification of ICD-10 called ICD-10-CM, for October 1, 2013. ICD-10-CM has been in development for a considerable number of years.

On April 17, 2012 the Secretary of HHS issued a proposed rule to delay the compliance date for ICD-10-CM and ICD-10-PCS codes sets from October 1, 2013 to October 1, 2014, in order to allow more time for clinical practices and the coding industry to prepare for transitioning from ICD-9-CM to ICD-10-CM.

The public comment period for the proposed rule to delay the compliance date is now closed and comments are in the process of being reviewed. A final rule has yet to be announced. Until a new compliance date has been ratified and the revised implementation date reached, codes in ICD-10-CM are not valid for any purpose or use but can be viewed for free on the CDC website together with other ICD-10-CM documentation.

The US might not anticipate moving on to a clinical modification of ICD-11 before 2020 and possibly later*.

*Source: DHSS Office of Secretary Final Rule document“We estimated that the earliest projected date to begin rulemaking for implementation of a U.S. clinical modification of ICD–11 would be the year 2020.”

WHO-FIC meeting materials suggest no earlier than 2018 for Canada. Australia is discussing earlier adoption of ICD-11 (or a CM of ICD-11).

Harmonization between ICD-11 and DSM-5

There is already a degree of correspondence between DSM-IV categories and Chapter V of ICD-10. For the next editions, the APA and WHO have committed as far as possible:

“To facilitate the achievement of the highest possible extent of uniformity and harmonization between ICD-11 mental and behavioural disorders and DSM-V disorders and their diagnostic criteria.”

with the objective that

“The WHO and APA should make all attempts to ensure that in their core versions, the category names, glossary descriptions and criteria are identical for ICD and DSM.”

WHO acknowledges that there may be areas where congruency may not be achievable.

With the timelines for DSM-5 and ICD-11 running out of synch (DSM-5 slated for publication in May 2013; ICD-11 still at the Beta drafting stage with a two year period scheduled for completion of its field trials), this may present barriers to harmonization.

In a June 2011 presentation to the International Congress of the Royal College of Psychiatrists, APA President, John M. Oldham, MD, MS, spoke of “Negotiations in progress to ‘harmonize’ DSM-5 with ICD-11 and to ‘retro-fit’ these codes into ICD-10-CM” and that DSM-5 would need “to include ICD-10-CM ‘F-codes’ in order to process all insurance claims beginning October 1, 2011.”

With the three systems: DSM-5 (publication date May 2013), ICD-10-CM (subject to partial code freeze since October 1, 2011 until 2014+ with new compliance date t.b.a.) and ICD-11 (dissemination scheduled for 2015+) set to become potentially more closely aligned, proposals for ICD-11 may have implications for US health care professionals and patient populations who might also consider themselves stakeholders in the ICD-11 development process.

+

References and additional ICD-11 related links and documentation

According to documents [1] and [2], ICD-11 was originally planned for dissemination by 2012, with the timelines for revisions of ICD-10 and DSM-IV running more or less in parallel. By 2008, the completion date for ICD-11 had been extended to 2014. In December 2009, the American Psychiatric Association (APA) announced a shift in the publication date for DSM-5 to May 2013. APA News Release No. 09-65 

1] IUPsyS Mar 08 Agenda Item 25 ICD-10
International Union of Psychological Science COMMITTEE ON INTERNATIONAL RELATIONS ACTION, March 28–30, 2008, Agenda Item No. 25: Revision of the International Classification of Diseases (ICD-10) and Involvement of Psychology

2] Exhibit 1 WHO Letter Aug 07 
Letter Saxena, WHO, to Ritchie, IUPsyS (International Union for Psychological Science), August 2007
Source: http://www.apa.org/international/governance/cirp/s08agenda25-Exhibit1.pdf  

3] Pages 5-6: Report, WHO FIC Council conference call, 16 February 2011, PDF format

4] Closing remarks, PowerPoint presentation: “Proposal for the ICD Beta Platform”, Stanford team, 12.04.11, WHO, Geneva.

5] Key document: ICD Revision Project Plan version 2.1 9 July 2010

Key links

ICD-11 Beta drafting platform  |  Publicly viewable version

WHO ICD Revision  |  Main WHO website: Revision Steering Group and Topic Advisory Groups
ICD-11 Revision site  |  Revision resources [Google site currently unavailable]
ICD-11 Revision site Documents Page  |  Key revision documents and meeting materials  [Google site currently unavailable]

ICD-11 Revision Information  |
ICD-11 Timeline  |

ICD Information Sheet  |

Revision News  |
Steering Group  |
Topic Advisory Groups  |

ICD-11 YouTube Channel  |  Video reports
ICD-11 on Facebook  |
ICD-11 on Twitter  |
ICD-11 Blog  |  Not updated since October 2009

ICD-11 YouTubes collated on Dx Revision Watch ICD-11 YouTubes  |

WHO Publications

ICD-10 Tabular List online Version: 2010  |  International Statistical Classification of Diseases and Related Health Problems 10th Revision Version: 2010, Tabular List of inclusions and Chapter List

ICD-10 Volume 2: Instruction Manual  |  Volume 2 online Version: 2010 PDF Download

ICD-10 for Mental and Behavioural Disorders Diagnostic Criteria for Research  |  PDF download
ICD-10 for Mental and Behavioural Disorders Clinical Descriptions and Diagnostic Guidelines  |  PDF download

ICD-10 Volume 3: The Alphabetical Index  |  WHO does not make ICD-10 Volume 3: The Alphabetical Index available online

About the World Health Organization (WHO)

The WHO Family of International Classifications  

History of ICD

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