ICD-11 Revision releases External review and Response: shifts projected WHA adoption to 2018

Post #321 Shortlink: http://wp.me/pKrrB-44N

Update: August 6, 2015

ICD Revision has now published a revised Project Plan and Communication Schedule:

ICD Project Plan 2015 to 2018

 

As previously posted

2017

And so it goes on…

The revision of ICD-10 and development of ICD-11 kicked off in April 2007. The original projected WHA adoption date was 2011/12 [1].

Then a shift to 2015, then to 2017.

WHO has just kicked the can further down the road to May 2018.

In July 2014, the World Health Organization (WHO) Office of the Assistant Director General, Health Systems and Innovation, posted a call for expressions of interest from suitable contractors to conduct an interim assessment of the 11th Revision for International Classification of Diseases (ICD).

External assessment was prompted by concerns raised by WHO Member States, UN Statistical Commission and other stakeholder organizations about the status of the revision and the utility of the ICD-11 product.

The External review of ICD-11 Revision’s progress has now been completed.

Last week, WHO quietly released a report on the status of the ICD revision process, its management and resources, the feasibility of meeting its goals and timelines, and its fitness for purpose.

The reviewers’ assessment and recommendations can be read here: External report

Read WHO’s initial response to the report’s findings and the actions ICD Revision proposes to take here: WHO Response to External Report

WHO says:

WHO welcomes the constructive messages of the Report of the ICD-11 Revision Review. WHO is initiating the second phase of the revision process, acting immediately on the Review’s recommendations.

A revised workplan will be formulated before the end of June and submitted for approval to the RSG-SEG. During 2015 the WHO secretariat will be strengthened in terms of project management, communication of progress and plans, documentation and transparency of decision-making and classification expertise, as recommended by the reviewers.

As I predicted, a further shift in the development timeline from WHA adoption in May 2017 to May 2018 is proposed, along with other measures.

References

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

2 External Review ICD-11 (Consultancy Interim Assessment of 11th ICD Revision, January – March 2015)

3 WHO Response to External Review of ICD-11 (Initial WHO response to the report of the external review of the ICD-11 revision,Department of Health Statistics and Information Systems, May 12 2015)

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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.”

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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.

(…)

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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.

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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].

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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

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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.

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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
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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

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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

Psychologists’ perspectives on the diagnostic classification of mental disorders: Results from the WHO-IUPsyS Global Survey

Post #263 Shortlink: http://wp.me/pKrrB-3dj

Psychologists’ perspectives on the diagnostic classification of mental disorders: Results from the WHO-IUPsyS Global Survey

Int J Psychol. 2013 Jun 10. [Epub ahead of print]

Psychologists’ perspectives on the diagnostic classification of mental disorders: Results from the WHO-IUPsyS Global Survey.

Evans SC, Reed GM, Roberts MC, Esparza P, Watts AD, Correia JM, Ritchie P, Maj M, Saxena S.
Source
a Clinical Child Psychology Program, University of Kansas, Lawrence , KS, USA.

Abstract

This study examined psychologists’ views and practices regarding diagnostic classification systems for mental and behavioral disorders so as to inform the development of the ICD-11 by the World Health Organization (WHO). WHO and the International Union of Psychological Science (IUPsyS) conducted a multilingual survey of 2155 psychologists from 23 countries, recruited through their national psychological associations. Sixty percent of global psychologists routinely used a formal classification system, with ICD-10 used most frequently by 51% and DSM-IV by 44%. Psychologists viewed informing treatment decisions and facilitating communication as the most important purposes of classification, and preferred flexible diagnostic guidelines to strict criteria. Clinicians favorably evaluated most diagnostic categories, but identified a number of problematic diagnoses. Substantial percentages reported problems with crosscultural applicability and cultural bias, especially among psychologists outside the USA and Europe. Findings underscore the priority of clinical utility and professional and cultural differences in international psychology. Implications for ICD-11 development and dissemination are discussed.

PMID: 23750927

[PubMed – as supplied by publisher]

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Slide Presentation: Aug 3, 2012

The WHO-IUPsyS Global Survey of Psychologists’ Attitudes Toward Mental Disorders Classification.

Download PDF WHO-IUPsyS Global Survey slides

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More information on this WHO study can be found on Page 7 (3.) of this report:

http://www.apa.org/international/outreach/icd-report-2012.pdf

2012 Annual Report of the International Union of Psychological Science to the American Psychological Association

Revision of World Health Organization’s ICD-10 Mental and Behavioural Disorders

Pierre L.-J. Ritchie, Ph.D., Main Representative to the World Health Organization, International Union of Psychological Science, January, 2013

Click link for PDF document    WHO-IUPsyS ICD Survey Report Report 2012

This report also sets out the responsibilities of ICD Revision working groups, on Page 3 (1.1), and gives some information on the field studies for ICD-11 and ICD11-PHC, on Page 8 (4.)

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The earlier study: WPA-WHO Global Survey of Psychiatrists’ Attitudes Towards Mental Disorders Classification can be downloaded here: 

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

World Psychiatry 2011;10:118-131

Research report

Geoffrey M Reed, João Mendonça Correia, Patricia Esparza, Shekhar Saxena, Mario Maj

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