iCamp2 meeting and status of ICD-11 Alpha Draft

ICD Revision iCamp2 meeting, new documents and status of the ICD-11 Alpha Draft

Post #48 Shortlink: http://wp.me/pKrrB-O9

The information in this update relates only to proposals for ICD-11.   

This information does not apply to ICD-10-CM, the forthcoming “Clinical Modification” of ICD-10, which is scheduled for implementation in October 2013 and is specific to the US.

Post #45 is intended to clarify any confusion between ICD-10, ICD-11 and the forthcoming US specific “Clinical Modification”, ICD-10-CM.

See: US “Clinical Modification” ICD-10-CM

iCamp2: 27 September – 1 October 2010


The iCamp2 meeting, scheduled for April but postponed due to volcanic ash cloud disruption of air traffic, was held between 27 September – 1 October, in Geneva.

27 September – 1 October 2010 Geneva, Switzerland WHO Headquarters   

RSG 2010 [Revision Steering Group]
30 September – 1 October 2010 Geneva, Switzerland WHO Headquarters  

The revised Agenda for the meeting can be read here in html on the ICD Revision site.

Download here as a Word document from the ICD Revision site or open here iCamp2 Agenda September 2010 on DSM-5 and ICD-11 Watch site.

I will post a link for the minutes, summary or note of this meeting when these are available on the ICD Revision site.

Click here for a list and bios of Meeting Participants

ICD-11 iCamp2 on YouTube 

ICD-11 ICAMP2 Day 5

WHOICD11’s Channel  | 21  October 2010  |  9.53 mins

iCAMP2 Day 2

WHOICD11’s Channel  | 29 September 2010  |  7:32 mins


Status and format of the ICD-11 Alpha Draft

Slipping timeline

In his iCamp2 Introductory presentation, Dr Bedirhan Üstün says there are just seven months to go before the start of the ICD-11 beta drafting phase and 43 months to the final version. Beta drafting remains scheduled to begin in May 2011, even though targets for the drafting of content are slipping and an Alpha Draft has yet to be published.

The Beta Requirements Document says, “The Beta Phase will be open to [the] general public in May 2011 to enable structured input by interested parties subject to peer-review by relevant Technical Advisory Groups” and that the time until May 2011 “will be used to develop and test the Beta Draft software and procedures and make consultations with end users around key issues and basic questions.”

iCamp2 acknowledged that a considerable amount of work needs to be done in the interim if ICD Revision is going to meet its targets.

No detailed timeline for the development of ICD-11 is available on the WHO’s main website. But in March, an ICD Revision Project Plan document, published on the ICD Revision Google site, had projected an Alpha Draft release date of May 2010, with a Beta Draft ready by May 2012. [Source: Page 7, “Project milestones and budget, and organizational overview”.]

A press launch for the Alpha Draft had been tabled for discussion on the Agenda for the April iCamp2 meeting. In the event, the April meeting was postponed, but ICD Revision has issued no public explanation for why the anticipated Alpha Draft failed to be released in April/May, nor has the Steering Group issued a revised ETA.

From the ICD Revision Project Plan:

The Alpha draft will be produced in a traditional print and electronic format. The Alpha Draft will also include a Volume 2 containing the traditional sections and including a section about the new features of ICD-11 in line with the style guide. An index for print will be available in format of sample pages. A fully searchable electronic index using some of the ontological features will demonstrate the power of the new ICD.

According to sources, in July, a print version of the Alpha Draft was expected to be made available around the time that the rescheduled iCamp2 meeting took place in September. Requests for clarification of the status and accessibility of an alpha draft have been left on ICD Revision Facebook site by several members of the public. When a response was eventually forthcoming, in August, it was confirmed that a “draft print version will be available in September 2010”.

iCamp2 is over now, but it remains unclear whether a print version has been produced, whether it is intended for internal use only or is going to be made available for public scrutiny, and if so, when, and in what format(s). ICD Revision has been asked to clarify.

This slide from a DSPIM presentation says the Alpha Draft was scheduled for completion by 27 September:

Source: Slide 9, PDF presentation slides: ICD-11 Revision: where are we now? Ontology driven tools and web platform. JM Rodrigues et al, DSPIM, University of Saint Etienne, WHO Collaborating Centre for International Classifications in French Language, Paris.


The WHO is promoting the development of ICD-11 as a transparent, collaborative and inclusive process

The Revision Steering Group (RSG) has launched a number of public interfaces – the ICD-11 Revision site (meeting agendas, minutes, documents and presentations), a YouTube channel, a blog (not updated since October 2009), a Facebook site, Twitter and an iCAT users Google Group, open to any stakeholders who register for access.  The iCAT Web 2.0 drafting platform is also viewable by the public and the production server can be accessed here: http://icat.stanford.edu/.

But little consideration appears to have been given to who should take responsibility for responding to questions from stakeholders or fielding queries left on the ICD Revision Facebook site, which rarely receive a reasonably prompt response, or any response, at all.

WHO Secretariat do not always acknowledge or respond to enquiries. A request for clarifications from a Topic Advisory Group (TAG) Chair, whilst acknowledged, has received no response after three months. The 5th meeting of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders (currently ICD-10 Chapter V) was held on 28 – 29 September 2009. A year later, a Summary Report is still pending publication and no meeting summaries for TAG Mental Health have been published on the WHO website since the 4th Meeting 1 – 2 December 2008.

The WHO needs to decide whether, in launching public interfaces and using “social networking” for input and feedback from stakeholders it genuinely seeks to provide platforms for meaningful interaction with the public or whether these are tokenistic nods at “transparency”.

Content posted by ICD Revision admin on its Facebook Wall often lacks meaning and substance. What stakeholders really need to know is whether any form of alpha draft is going to be publicly released before the Beta phase – not photos of happy iCampers playing bassoons at musical soirées and iCamp bonding sessions.

I will update if and when any information is released on the status and public availability of an alpha draft, and what format(s) it will be available in.


Since 2007, it has been possible for stakeholders in the development of ICD to submit proposals and comments, supported by citations, via the ICD Update and Revision Platform Intranet. It was understood, last September, that for some Topic Advisory Groups (notably Chapters 5 and 6) a proposal form for ICD-11 was being prepared for use by stakeholders.

Information about the availability of proposal forms for the various Topic Advisory Groups, up to what stage in the development process timeline these might be used and which stakeholders might be permitted to make use of any proposal forms already being issued or in preparation would also be welcomed from the Revision Steering Group or TAG managing editors.

Slipping targets

According to the iCamp2 PowerPoint presentation, Frequent Criticisms and this iCamp2 YouTube, targets for the population of content for the Alpha Draft have not been reached.

Less that 80% of Terminology Definitions have been uploaded to the iCAT and less than the 20% target for full Content Model completion for the many thousands of diseases and disorders classified within ICD has been met. [The Content Model identifies the basic properties needed to define any ICD concept (unit, entity or category) through the use of multiple parameters.] Not all parameters of the Content Model are implemented yet. Not all Topic Advisory Groups are at a similar developmental stage; Beta Plans are behind schedule.

The Revision Steering Group identifies barriers to keeping this technically very ambitious project on track:  lack of finances; the sheer amount of time required for the drafting of definitions and population of textual content according to the complex ICD-11 Content Model; recruiting external experts for reviewing proposals and generating content; familiarising TAG workgroup members with the functionality of the iCAT, the collaborative authoring platform through which ICD-11 is being drafted, and with informatics; entering data into the iCAT; the paucity of face-to-face meetings for TAG managing editors and workgroup members who are scattered across the globe and undertaking these roles in addition to professional commitments; difficulties facilitating interaction between the various Topic Advisory Groups where diseases overlap with other chapters.

A number of new workgroups have recently been created (Paediatrics, Dentistry, E.N.T, Traditional Medicine and Communicable/Tropical Diseases).

Under “Overall Directions” in the Beta Requirements Document, it says:

The knowledge representation space is too large to be curated by a small number of experts (e.g. 20,000 ICD Categories, 15 parameters of CM [Content Model], each may have 1-20 entries – on average a relational database matrix with 300,000 entries).


Scaling up the process from the alpha phase to beta should be carefully planned and modelled. It is estimated that the alpha phase participants will be at the magnitude of 500-1000 persons. In beta phase it is expected to have 10-100 fold increase.

If the Revision Steering Group is already struggling to maintain motivation and interaction between the various Topic Advisory Groups, then management of the project once the beta phase is reached and the process opened up to stakeholders is going to present the Steering Group and TAG workgroup managing editors with considerable challenges.

The original dissemination date for ICD-11 had been 2012, with the timelines for the revision of ICD-10 and DSM-IV running more or less in parallel. The dissemination date for ICD-11 was later extended to 2014 and the publication date of the next edition of the DSM, DSM-5, extended to May 2013.

(John Gever, Senior Editor, MedPage Today, reported on 5 October that Testing of new diagnostic criteria proposed for DSM-5, the revision of the psychiatric profession’s manual for patient assessment, is finally underway, more than two months behind schedule.)

The development of ICD-11 is a hugely complex and technically ambitious undertaking; all three volumes will be electronically published, integrable and intended to be integrable with some other health classification publications; the scope of ICD-11 is far greater than that of the previous edition.

It may be that come May 2011, we might anticipate some scaling back of plans and/or possibly a shift in the release of the Beta Draft from May 2012 to 2013+, in response to the recognition that the WHO may have significantly overestimated its capacity for securing the funding and resources to complete the technical work on this project by 2012, if implementation of the final version is to take place in 2014.

The iCamp YouTube commentaries have an air of brittle optimism about them.

Coming up

In a forthcoming post, in lieu of an Alpha Draft, I shall be reporting on what can currently be seen in the ICD-11 iCAT drafting platform and associated Revision documents in relation to the three ICD-10 categories: “Postviral fatigue syndrome”, “Chronic fatigue syndrome” and “(Benign) myalgic encephalomyelitis” and why I have asked the Chair of the Topic Advisory Group for Neurology for a clarification.

iCamp2 meeting documents  and presentations

A number of new and existing ICD revision related documents have been published on the ICD-11 Revision Google site in association with the iCamp2 and RSG September meetings. Not all the documents listed have been uploaded to the ICD Revision site and several links are returning “File not found”.

Face-to-Face Meetings‎ > ‎iCamp2: 27 September – 1 October 2010‎

iCamp2 Agenda  [27 September – 1 October 2010]

Workflow  [PDF]

iCAT Progress Table  [Not currently available]
Alpha Draft Print Sample  [Not currently available]
iCAT Tool Documents  [Not currently available]

• User Manual  [Content Model User Guide, 53 pp Word doc]  Key ICD-11 document
• Issues and Feature Lists  [Not currently available]

Tasks Completed  [Not currently available]
Tasks In Progress/Pending  [iCAT Release Notes on iCAT Google Group platform]

Narrative Workflow Diagram  [Not currently available]

Standard Operating Procedures  [Not currently available]

Beta Requirements Document   [3 pp Word doc]


TAG HIM  [Not currently available]
RSG  [Not currently available]
TAGs  [Not currently available]

3 Component Content Model Description   [File not found]

• Linearization Component  [File not found]
• Foundation Component  [File not found]
• Ontology Component  [1 slide pptx + notes; PowerPoint slides require MS PP 2007 pptx reader]

Evaluation Strategy for Alpha Draft

Questions for Reviewers  [Not currently available]
Quality Assurance  [Not currently available]

Dagger-Asterisk Convention Abolition  [Not currently available]

DIFF File–Changes from ICD-10  [MS Excel doc. Retrieved 29.09.10; Not available on 01.10.10]

Field “A Type” specifies: new; unchanged; decision to be made; retired; real retired

[Note: ICD11 Alpha Codes may be temporary sorting codes; “FXC” against “G93.3” does not relate to the F Codes in ICD Chapter 5 (V); note also that Gj92 is an ICD-11 “Sorting label” not an ICD code.]

Extract Spreadsheet:


Frequent Criticisms   [11 slide pptx; PowerPoint slides require MS PP 2007 pptx reader]

Signs and Symptoms   [4 pp Word doc; Discussion document: Considerations for handling categories and concepts currently found in chapter 18 of ICD-10, “SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND
LABORATORY FINDINGS NOT ELSEWHERE CLASSIFIED”, (R-codes), authors: Aymé, Chalmers, Chute, Jakob.] Or open here: Discussion: Signs and Symptoms (Chapter 18)

PDF: https://dxrevisionwatch.files.wordpress.com/2018/08/icd-revision-signs-and-symptoms-discussion-document.pdf

Multisystem Chapter   [12 pp Word doc; Discussion document: Multisystem Chapter, authors: Aymé, Chalmers, Chute, Jakob.] Or open here: Discussion: Multisystem Chapter

PDF: https://dxrevisionwatch.files.wordpress.com/2018/08/icd-revision-multisystem-diseases-discussion-document.pdf

“ICD has traditionally grouped diseases by aetiology and by affected organ system.  For ICD­11 the creation of a new chapter for multisystem disorders has been proposed.  The following text sets out the rationale for and the possible scope of a multisystem disorders chapter.”

Contains Literature search reference at 119 to the Maes and Twisk paper, Treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a multisystem disease, should target the pathophysiological aberrations (inflammatory and oxidative and nitrosative stress pathways), not the psychosocial “barriers” for a new equilibrium. 2010: Ireland. p. 148-9.

Contains Literature search reference at 118 to published response to Maes and Twisk paper by Luyten, P. and B. Van Houdenhove, Treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a multisystem disease, should target the pathophysiological aberrations (inflammatory and oxidative and nitrosative stress pathways), not the psychosocial “barriers” for a new equilibrium – Response to Maes and Twisk. 2010, ELSEVIER IRELAND LTD, ELSEVIER HOUSE, BROOKVALE PLAZA, EAST PARK SHANNON, CO, CLARE, 00000, IRELAND. p. 147-147.

Presentations  [PowerPoint slides require the MS PP 2007 pptx reader unless identified as ppt]

Introduction (USTUN)  [14 slides]

Volume 1 (JAKOB)  [26 slides]

Volume 2 (JAKOB)  [11 slides]

Volume 3 (CELIK)  [6 slides + notes]

iCAT (TUDORACHE)  [26 slides PDF; iCAT Progress Update, Stanford Center for Biomedical Informatics Research]

iCAT & TAG Statistics (COTTLER)  [10 slides; New, Retired and Unchanged ICD Concepts (statistics)]

Rare Diseases (RATH)  [19 slides; Rare Diseases TAG feedback on ICD revision]

Dermatology (CHALMERS/WEICHENTHAL)  [ppt; 15 slides]

Ophthalmology (COLENBRANDER/KASHII)  [ppt; 3 slides]

Internal Medicine (SUGANO)  [10 slides]

Paediatrics (LINZER)  [ppt; 4 slides; Newly created TAG]

Musculoskeletal (SUNDBERG)  [ppt; 7 slides]

External Causes and Injuries  (HARRISON)  [ppt; 11 slides]

Maternal, Neonatal and Urogenital  (CHOU)  [ppt; File will not open at 01.10.10]

Socio-Technical Systems (STOREY)  [pptx; 31 slides]


TAG Neoplasms  [ppt; 105 slides]

Functioning TAG  [ppt; 21 slides]

TAG Morbidity  [ppt; 5 slides]

Additional documents  [All PDFs]

Ophthalmology TAG DRAFT
Pre001.2 Dermatology TAG
Rare Diseases Chapter 3 Haematological diseases DRAFT 2
Rare Diseases Chapter 3 Immunological Diseases DRAFT
Rare Diseases Chapter 4 Endocrine Diseases DRAFT
Rare Diseases Chapter 4 Metabolic Diseases DRAFT

Rare Diseases Chapter 4 Nutritional Diseases DRAFT
Rare Diseases Chapter 6 Neurological Diseases DRAFT



PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring Platform, 7 June 2010, Post # 46: http://wp.me/pKrrB-KK

[1] ICD-11 Revision Project Plan – Draft 2.0 (v March 10):
Describes the ICD revision process as an overall project plan in terms of goals, key streams of work, activities, products, and key participants: ICD Revision Project Plan

[2] User Manual [Content Model User Guide, 53 pp Word doc]  Key ICD-11 document
Identifies the basic properties needed to define any ICD concept (unit, entity or category) through the use of multiple parameters. Open here on DSM-5 and ICD-11 Watch: User Manual 20.09.10

[3] iCAT production server:
iCAT production server: http://icat.stanford.edu/

[4] iCAT Glossary


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