ICD-11 revision process: External assessment now due April 1

Post #317 Shortlink: http://wp.me/pKrrB-42A

This post is the first in a series of updates on the ICD-11 revision process.

Last July, in Call for Expressions of Interest to review the ICD revision process, I reported that the World Health Organization (WHO) Office of the Assistant Director General, Health Systems and Innovation had posted a call for expressions of interest from suitable contractors to conduct an interim assessment of the 11th Revision of the International Classification of Diseases (ICD).

Lead time was four months, with the completed final report targeted for submission to WHO by December 15, latest.

With no sign of a report in the offing, I asked WHO’s Bedirhan Üstün, last week, whether an interim assessment had been delivered in December and did WHO intend to publish a summary report.

Dr Üstün confirmed on January 10 that the external report will now be delivered by April 1 and that it “will certainly be made available.”

So the delivery of this interim assessment has slipped targets by some 15 weeks.

I have no information about the contractors who successfully pitched for the review and no date by which WHO aims to release a copy of the report’s findings (or summary of key findings).

The Call for Expressions of Interest to review the ICD revision process Terms of Reference document can still be downloaded from the WHO website, here:

or open, here, on Dx Revision Watch:

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

ICD-11 Beta drafting platform

Go here for the public version of the ICD-11 Beta drafting platform.

According to Slide #4 of this WHO presentation on Slideshare, the Joint Linearization for Mortality and Morbidity and Statistics (JLMMS) was expected to be frozen at certain points during the review process.

If you are registered with the public Beta platform for increased access and interaction with the draft, there are dropdowns from the Info tab for Downloads and Frozen Releases, eg:

Linearization Print Versions

Simplified Linearization Outputs

Linearization Index Tabulations

Frozen Releases

You may find the frozen release downloads here

 

When viewing the ICD-11 Beta drafting platform bear in mind that the platform may still be subject to freeze and more recent proposals will have been made across all chapters.

From the Contributions tab, you can pull up the Proposals pages for specific terms or view the Proposals List. New proposals are added on a daily basis and date back to July 2014.

Proposals can be filtered according to Proposal Status (Saved; Submitted; External Review, Accepted, Implemented, Rejected etc.) or filtered by Proposal Type.

Before scrutinizing or quoting from the public version of the Beta draft, I strongly advise that you first check the Proposals List for more recent revisions since the public Beta drafting platform may not display the most recent proposals.

You may find later proposals for revisions to the text of definitions and other Content Model descriptors; additions or deletions to Inclusions, Exclusions, Synonyms; deletions or additions of entities; revisions to terminology; proposals for complex hierarchical changes etc. Please also read these Caveats.

Caveats: The ICD-11 Beta drafting platform is not a static document: as a work in progress, it is subject to daily edits and revisions, to field test evaluation and to approval by ICD Revision Steering Group and WHO classification experts. Not all new proposals may survive internal/external review or field testing. Chapter numbering, codes and sorting codes currently assigned to ICD categories may change as chapters, entities, content and parent/child hierarchies are reorganized. The public version of the Beta draft is incomplete; not all “Content Model” parameters display or are populated; the draft may contain errors and omissions of categories and Index terms.

 

Briefing paper on ICD-11 and PVFS, ME and CFS: Part 2

Post #316 Shortlink: http://wp.me/pKrrB-41q

Update: With regard to a new parent class: Functional clinical forms of the nervous system proposed for inclusion within the ICD-11 Diseases of the nervous system (Neurology) chapter, see Stone et al paper:

Functional disorders in the Neurology section of ICD-11: A landmark opportunity

Jon Stone, FRCP, Mark Hallett, MD, Alan Carson, FRCPsych, Donna Bergen, MD and Raad Shakir, FRCP

Neurology December 9, 2014 vol. 83 no. 24 2299-2301

doi: 10.1212/WNL.0000000000001063

Full free text:

http://www.neurology.org/content/83/24/2299.long

Full free PDF:

http://www.neurology.org/content/83/24/2299.full.pdf+html

 

As previously posted:

Part two 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 published September 29, 2014

 

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

Seven years into the development process and it’s still not known how ICD-11 intends to classify the three G93.3 terms.

Sub working groups were formed under TAG Neurology with responsibility for the restructured disease and disorder blocks proposed for ICD-11’s Diseases of the nervous system chapter.

It hasn’t been established which of the various sub working groups has responsibility for making recommendations for the revision of the G93.3 terms or who the members of the subgroup(s) and its external advisers are.

Neurology Topic Advisory Group (TAG) sub working groups:

Neurology TAG sub working groups

Source: Slide #16: Summary of progress, Neurology Advisory Group, Raad Shakir (Chair): http://www.hc2013.bcs.org/presentations/s1d_thu_1530_Shakir_amended.ppt

 

No journal papers, editorials, presentations or public domain progress reports have been published, to date, on behalf of TAG Neurology that discuss emerging proposals or intentions for the classification of the three G93.3 terms for ICD-11.

The public version of the Beta drafting platform displays no editing change histories or category notes. Until the three terms have been restored to the Beta draft the public is reliant on what information WHO/ICD Revision chooses to disclose, which thus far, has been minimal.

Currently, there is no information within the Beta draft for proposals for these three terms. The continued absence of these terms from the draft (now missing for over 18 months) is hampering professional and public stakeholder scrutiny, discourse and comment.

This is not acceptable for any disease category given that ICD Revision is being promoted by WHO’s, Bedirhan Üstün, as an open and transparent process and inclusive of stakeholders.

This next section summarizes the most significant changes since May 2010 for several iterations of the Neurology chapter, during the Alpha and Beta drafting phases, as displayed in the public version of the draft.

 

Tracking the progression of the G93.3 terms through the Alpha and Beta drafting stages

In May 2010: the ICD-10 G93 legacy parent class: Other disorders of brain was retired and a change in hierarchy for class Postviral fatigue syndrome recorded. See Notes Tree screenshot [12].

A Definition was inserted for Chronic fatigue syndrome. See Change history screenshot [13].

Chronic fatigue syndrome replaced Postviral fatigue syndrome as the new ICD Title term and now sat directly under parent class: Other disorders of the nervous system.

Benign myalgic encephalomyelitis was specified as an Inclusion term under Synonyms to new ICD Title term: Chronic fatigue syndrome. See Alpha draft screenshot [14].

Postviral fatigue syndrome was at that point unaccounted for in the Alpha draft.

By July 2012: 13 additional terms were now listed under Synonyms, including Postviral fatigue syndrome, and two terms imported from the yet to be implemented, ICD-10-CM (the ICD-10-CM Chapter 18 R53.82 codes: chronic fatigue syndrome nos and chronic fatigue, unspecified).

The Definition field was now blanked.

At this point, ICD Title term: Chronic fatigue syndrome was no longer displaying as a child category directly under parent class: Other disorders of the nervous system.

The listing for Chronic fatigue syndrome now appeared under a new “Selected Cause” subset, which displayed as a sub linearization within the Foundation Component. The purpose of this subset, which aggregated many terms from Neurology and other chapters, was not evident from the Beta draft.

By November 2012: ICD Revision had re-inserted a scrappy, revised Definition for Chronic fatigue syndrome. I have sourced this draft definition to an internal ICD Revision/Stanford Protege document (line 1983):

Chronic fatigue syndrome is characterized by extreme chronic fatigue of an indeterminate cause, which is disabling andt [sic] does not improve with rest and that is exacerbated by physical or mental activity.

 

Below is a screenshot from the Beta draft taken in July 2012, before a Definition for Title term, Chronic fatigue syndrome had been re-inserted.

(It isn’t evident in the screenshot, but the asterisk at the end of Benign myalgic encephalomyelitis displayed a hover text denoting its specification as the Inclusion term to ICD Title term, Chronic fatigue syndrome. Also not evident in this cropped screenshot is the listing of Postviral fatigue syndrome under Synonyms.)

July2512

Source: ICD-11 Beta drafting platform, July 25, 2012.

This “Selected Cause” sub linearization was later removed from the public Beta draft and some of the terms that had been listed under it were restored to the Neurology chapter and to other chapters. But ICD Title term, Chronic fatigue syndrome, its Inclusion term and list of Synonyms were not restored to any chapter.

Since February 2013: no listing can be found in any chapter of the public version of the Beta draft, under any linearization, for any of the terms, Postviral fatigue syndrome, Benign myalgic encephalomyelitis or Chronic fatigue syndrome, as uniquely coded ICD Title terms, or as Inclusion terms or Synonyms to Title terms, or in the ICD-11 Beta Index.

Since June 2013: My repeated requests for an explanation for the absence of these three terms from the Beta draft and for ICD Revision’s intentions for these terms were ignored by ICD Revision until July 2014, when a response was forthcoming from ICD Revision’s, Dr Geoffrey Reed.

(It is understood that Annette Brooke MP also received a response, in July, from WHO’s, Dr Robert Jakob, in respect of the joint organizations’ letter of March 18, for which Ms Brooke had been a co-signatory.)

 

What clarifications have been given?

Feb 12, 2014: An unidentified admin for the @WHO Twitter account replied to a member of the public: “Fibromyalgia, ME/CFS are not included as Mental & Behavioural Disorders in ICD-10, there is no proposal to do so for ICD-11.” A similar affirmation was tweeted by Gregory Hartl, head of public relations/social media, WHO.

 

July 24, 2014: Geoffrey Reed PhD (Senior Project Manager for revision of Mental and behavioural disorders) replied to Suzy Chapman, by email:

Dr Reed stated inter alia that the placement of ME and related conditions within the broader classification is still unresolved.

That he had no influence or control over this process; his authority being limited to coordinating recommendations related to conditions that should or should not be placed in the chapter on Mental and behavioural disorders.

That there has been no proposal and no intention to include ME or other conditions such as fibromyalgia* or chronic fatigue syndrome in the classification of mental disorders.

That the easiest way to make this absolutely clear will be through the use of exclusion terms. However, he would be unable to ask that exclusion terms are added to relevant Mental and behavioural disorders categories (e.g. Bodily Distress Disorder) until the conditions that are being excluded exist in the classification. That at such time, he would be happy to do that.

That since his purview does not extend to the section on classification of Diseases of the nervous system or other areas outside the Mental and behavioural disorders chapter, he was unable to provide any information related to how these conditions will be classified in other chapters.

That he was unable to comment about the management of correspondence by other TAG groups and signposted me to Dr Robert Jakob [the senior classification expert who had been copied into the joint organizations’ letter to WHO/ICD Revision, in March] whose role relates to the overall coordination of the classification.

 

*Fibromyalgia remains classified under ICD-11 Beta draft public version chapter “Diseases of the musculoskeletal system and connective tissue” under parent: Certain specified soft tissue disorders, not elsewhere classified.

Irritable bowel syndrome remains classified under ICD-11 Beta draft public version chapter “Diseases of the digestive system” under: Functional gastrointestinal disorders > Irritable bowel syndrome and certain specified functional bowel disorders.

 

In August, I submitted two FOI requests, one to the Scottish Health Directorate, one to the English Department of Health. The latter was not deemed specific enough in terms of named health agencies for a response to be generated and will require resubmission.

September 24, 2014: FOI request fulfilled by (SCOTLAND) ACT 2002 (FOISA), received from David Cline, Unit Head, Strategic Planning and Clinical Priorities Team, by email: 

The Quality Unit: Health and Social Care Directorates
Planning & Quality Division

[Addresses redacted]

Your ref:  FoI/14/01460

24 September 2014

REQUEST UNDER THE FREEDOM OF INFORMATION (SCOTLAND) ACT 2002 (FOISA)

Thank you for your request dated 27 August 2014 under the Freedom of Information (Scotland) Act 2002 (FOISA)…

 

Your request

Under the Freedom of Information (Scotland) Act 2002, please provide the following.

Please send me copies of all correspondence, emails, letters, minutes relating to:

Enquiries made by Scottish Health Directorate to World Health Organization (WHO), 20 Av Appia, CH-1211, Geneva, in respect of:

Classification of the three ICD-10 (International Classification of Diseases 10th edition) G93.3 coded disease terms in the forthcoming revision of ICD-10, to be known as ICD-11:

Postviral fatigue syndrome (Post viral fatigue syndrome; PVFS)

Benign myalgic encephalomyelitis (myalgic encephalomyelitis; myalgic encephalitis; ME);

Chronic fatigue syndrome (CFS; CFS/ME, ME/CFS)

During the period:

1] January 1, 2013 – December 31, 2013

2] January 1, 2014 – July 31, 2014

I also request copies of responses received from WHO in reply to enquiries made by Scottish Health Directorate during these periods in respect of the above ICD disease categories.

 

Response to your  request

Information held covering the time period indicated relates to an email exchange on 11 and 12 March 2014 as part of a request for advice in answering Ministerial correspondence.

On 11 March the World Health Organisation WHO were asked “I would be very grateful for your help in confirming the status of an element within the WHO’s ICD 11 regarding ME/CFS. On 25th February in the UK parliament, the Under-Secretary of State for Health informed the UK parliament that the WHO had publicy stated that there was no proposal  to reclassify ME/CFS in ICD-11…I would be very grateful if you can confirm that this is the case and if possible, provide a web link to the original wording so I can include this within the correspondence I am preparing”.

The WHO responded on 12 March; “The question regarding MS/CFS [sic] and ICD-11 has been asked recently by several different parties. At this point in time, the ICD-11 is still under development, and to handle this classification issue we will need more time and input from the relevant working groups. It would be premature to make any statement on the subject below.

The general information on ICD Revision can be accessed here: http://www.who.int/classifications/icd/revision/. The current state of development of ICD-11 (draft) can be viewed here (and comments can be made, after self registration): http://www.who.int/classifications/icd11 ”.

A further email on 12 March to the WHO asked; “It would be fair to say then …that work will continue on the draft with an expected publication in 2015?”.

WHO responded on 12 March; “Work on the draft will continue until presentation at the World Health Assembly in 2017. Before, reviews and field testing will provide input to a version that is available for commenting, as much as possible and proposals can be submitted online* with the mechanisms provided already.”

*Since the three terms are currently not accounted for within the Beta draft this impedes the submission of comments.

 

This is the sum total of what has been disclosed by WHO/ICD Revision in respect of current proposals for the classification of the three ICD-10 G93.3 terms, despite the fact that ICD-11 has now been under development for 7 years, and prior to the timeline extension in January 2014, the new edition had been scheduled for WHA approval and dissemination in 2015.

 

What might the working group potentially be considering? 

  • The terms may have been removed from the draft in order to mitigate controversy over a proposed change of chapter location, change of parent class, reorganization of the hierarchy, or over the wording of Definition(s). (Whether a term is listed as a coded Title term, or is specified as an Inclusion term to a coded term or listed under Synonyms to a coded term, dictates which of the terms is assigned a Definition. If, for example, CFS and [B]ME were both coded as discrete ICD Title terms, both terms will require the assigning of Definitions and other Content Model descriptors.)
  • TAG Neurology may be proposing to retain all three terms under the Neurology chapter, under an existing parent class that is still under reorganization, and has taken the three terms out of the linearizations in the meantime, or is proposing to locate one or more of the terms under a new parent class for which a name and location has yet to be agreed.
  • TAG Neurology may be proposing to locate one or more of these terms under more than one chapter, for example, under the Neurology chapter but dual parented under the Symptoms and signs chapter. Or multi parented and viewable under a multisystem linearization, if the potential for a multisystem linearization remains under discussion.
  • TAG Neurology may be proposing to retire one or more of these three terms (despite earlier assurances by senior WHO classification experts) but I think this unlikely. ICD-11 will be integrable with SNOMED CT, which includes all three terms, albeit with ME and BME listed as synonyms to coded CFS, with PVFS assigned a discrete SNOMED CT code.
  • Given the extension to the timeline, TAG Neurology may be reluctant to make decisions at this point because it has been made aware of the HHS contract with U.S. Institute of Medicine (IOM) to develop “evidence-based clinical diagnostic criteria for ME/CFS” and to “recommend whether new terminology for ME/CFS should be adopted.” Any new resulting criteria or terminology might potentially be used to inform ICD-11 decisions.

Other possibilities might be listing one or more of these terms under parent class, Certain specified disorders of the nervous system or under Symptoms, signs and clinical findings involving the nervous system, which is dual parented under both the Neurology chapter and the Symptoms and signs chapter.

All currently listed parent and child categories within the Neurology chapter can be viewed here:

Click on the small grey arrows next to 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.

http://apps.who.int/classifications/icd11/browse/f/en#/http://id.who.int/icd/entity/1296093776

 

There is a new parent class proposed for the ICD-11 Neurology chapter called, Functional clinical forms of the nervous system, which Dr Jon Stone has been working on [15] [17].

Under this new Neurology chapter parent class, it is proposed to relocate or dual locate a list of “functional disorders” (Functional paralysis or weakness; Functional sensory disorder; Functional movement disorder; Functional gait disorder; Functional cognitive disorder etc.) which in ICD-10 are classified under the Chapter V Dissociative [conversion] disorders section.

The rationale for this proposed chapter shift for Conversion disorders/functional disorders is beyond the scope of this briefing paper.

In a 2013 editorial, Prof Raad Shakir (Chair, TAG Neurology) briefly discusses the proposed reorganization of what he calls the “rag bag of diverse and disparate diseases” that is parent class, Other disorders of the nervous system [16].

He writes, “In addition, there will also be a section on Functional disorders of the nervous system, reflecting the growing diagnostic importance of such syndromes.” 

It’s not clear whether this reference, in 2013, to the inclusion of a new section for “Functional disorders of the nervous system” within the Neurology chapter relates to the relocation or dual location of those “functional disorders” currently classified under Dissociative [conversion] disorders within ICD-10 Chapter V, or whether Prof Shakir was referring to potential inclusion within the Neurology chapter of a section for “Functional somatic syndromes.” But I consider the former more likely.

There is currently no inclusion within any chapter for a specific parent class for “Functional somatic syndromes,” or “Functional somatic disorders” or “interface disorders” under which, conceivably, those who consider CFS, ME, IBS and FM to be “speciality driven” manifestations of a similar underlying functional disorder might be keen to see these terms aggregated.

I shall return to the subject of “interface disorders” in Part 3.

 

There remain 6 important questions to be answered:

• under which chapter(s) are PVFS, BME and CFS proposed to be located?
• under which parent classes?
• what hierarchies are proposed, in terms of coded Title terms, Inclusions, Synonyms?
• which of the terms are to be assigned definitions?
• where will definitions be sourced from?
• when will the terms be restored to the draft to enable scrutiny and comment?

 

Extract, ICD-11 document Known Concerns and Criticisms:

“It may be true that some advocacy groups may give inputs in line with their vested interests or object to the listings in ICD-11 Beta. When such public controversy occurs, it is better to have it in an open and transparent discussion…”

Having obscured these terms from the Beta drafting platform eighteen months ago, with no explanation, ICD Revision Steering Group and TAG Neurology, which are both accountable to WHO, have disenfranchised professional and advocacy stakeholders from scrutiny of, and participation in what is being touted as an open and transparent process.

For Part 1 of this briefing document: Part 1: Status of the ICD-11 development process

In Part 3, I shall be setting out what is currently known about the status of proposals for the revision of ICD-10’s Somatoform disorders for the core and primary care versions of 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.

 

References for Part 2

12 https://dxrevisionwatch.files.wordpress.com/2010/05/2icatnotegj92cfs.png

13 https://dxrevisionwatch.files.wordpress.com/2011/02/change-history-gj92-cfs.png

14 https://dxrevisionwatch.files.wordpress.com/2011/05/icd11-alpha1-17-05-11.png

15 http://apps.who.int/classifications/icd11/browse/f/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1614846095

16 Shakir R, Rajakulendran, S. The 11th Revision of the International Classification of Diseases (ICD) The Neurological Perspective JAMA Neurol. 2013;70(11):1353-1354. http://archneur.jamanetwork.com/article.aspx?articleid=1733323

17 Functional neurological disorders: The neurological assessment as treatment. Stone J. Neurophysiol Clin. 2014 Oct;44(4):363-73 http://www.ncbi.nlm.nih.gov/pubmed/25306077

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 https://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

+++
Terms of Reference:

Review of

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

Request for Expressions of Interest

+++
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?

WHO considers further extension to ICD-11 development timeline

Post #275 Shortlink: http://wp.me/pKrrB-3sc

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

Timeline slippage

Documents posted recently by the World Health Organization (WHO) indicate that ICD Revision is failing to meet development targets and a further extension to the ICD-11 timeline is under consideration.

ICD serves as the international health information standard for the collection, classification, processing and presentation of disease-related data in national and global health statistics.

The 10th edition (ICD-10) was adopted by the World Health Assembly in 1990.

The development process for the next edition (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 [1] [2].

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. In order to be ready for global implementation in 2015, the technical work on ICD-11 would need to be completed by 2012 [3].

The WHA approval date was subsequently shunted from 2014 to 2015 – four years later than originally planned and the current, projected implementation date is 2016+.
+++

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

ICD-11 is a very ambitious and under-resourced project. Given the scale of the undertaking, the technical complexity, the limited funding and human resources, the feasibility of the project reaching its targets by May 2015 has proved unrealistic.

I have written a number of times on this site that I did not envisage dissemination of ICD-11 by 2016 without some scaling back of the project’s scope – or an announcement, at some point this year, of a further extension to the timeline.

ICD-11 Revision Steering Group considers its options

WHO has recently posted a meeting materials document [5] and a slide presentation [6] which summarize, inter alia, ICD-11’s progress, current development status and timelines for finalization date and approval by WHO Governing Bodies.

ICD Revision is considering extending the timeline by up to a couple of years.

This 14 page document 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 can be downloaded here

or opened on Dx Revision WatchPDF: SA-2013-12-Add1-Health-WHO

It summarizes the status of the ICD Revision process under section headings:

1. Background: need and mandate
2. General organization structure of the multiple streams of work
3. Progress and current status
4. The remaining steps
5. Further maintenance of ICD after finalization
6. Timelines for the finalization date and approval by WHO Governing Bodies

Extracts from the document 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.

[…]

If WHO/ICD-11 Revision Steering Group does elect to postpone submission for WHA approval until May 2017, dissemination of ICD-11 may not be scheduled before 2018.

Once approved and released, adoption of ICD-11 won’t happen overnight. It may take several years before WHO Member States adopt ICD-11. Low resource and developing countries may also take longer to prepare for and transition to the new edition.

Note for US readers: According to Page 3332 of DHSS Office of Secretary Final Rule document (Federal Register / Vol. 74, No. 11 / Friday, January 16, 2009 / Rules and Regulations):

“…We [ICD-9-CM Coordination and Maintenance Committee] discussed waiting to adopt the ICD-11 code set in the August 22, 2008 proposed rule (73 FR 49805)…

“…However, work cannot begin on developing the necessary U.S. clinical modification to the ICD-11 diagnosis codes or the ICD-11 companion procedure codes until ICD-11 is officially released. Development and testing of a clinical modification to ICD-11 to make it usable in the United States will take an estimated additional 5 to 6 years. 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.” [7]

This projection, in early 2009, would have been based on the assumption that ICD-11 was anticipated to be finalized and submitted for WHA Approval by 2014 (now potentially shifting to 2017).

An additional two year delay in the finalization of the ICD-11 code sets would likely impact on the development process for a clinical modification of ICD-11 for US specific use, kicking adaptation and implementation of an ICD-11-CM even further down the road.

+++
This slide presentation, below, was uploaded to Slideshare on September 9 by Dr Bedirhan Üstün, Coordinator, Classification, Terminology and Standards, World Health Organization, and also sets out the postponement options now under consideration:

Slide presentation: 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?

http://www.slideshare.net/ustunb/icd-2013-qs-tag-26027668

Slide 29:

Ustun 29rule

Slide 30:

Ustun 30rule

Slide 34:

Ustun 34rule

Slide 35: [WHA Approval – options under consideration]

Ustun 35rule
+++

References

1. 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

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

3. Dr Geoffrey Reed, Ph.D., May 2009, personal correspondence.

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

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 Full document in PDF format

6. Slide presentation: ICD Revision: Where are we? Bedirhan Ustun, World Health Organization Classifications, Terminologies, Standards, ICD Revision: Quality Safety Meeting 2013, September 9-10, 2013 http://www.slideshare.net/ustunb/icd-2013-qs-tag-26027668

7. DHSS Office of Secretary Final Rule document (Federal Register / Vol. 74, No. 11 / Friday, January 16, 2009 / Rules and Regulations), Page 3332.

Round up: ICD11-PHC, ICD-11 Classification of Mood and Anxiety Disorders, Monograph: Public Health Aspects of Diagnosis and Classification of Mental and Behavioral Disorders, ASHA DSM-5 comments

Round up: ICD11-PHC; ICD-11 Classification of Mood and Anxiety Disorders; Monograph: Public Health Aspects of Diagnosis and Classification of Mental and Behavioral Disorders; ASHA DSM-5 comments

1] Paper: The primary health care version of ICD-11: the detection of common mental disorders in general medical settings By David P. Goldberg, James J. Prisciandaro, Paul Williams

2] The ICD-11 Classification of Mood and Anxiety Disorders: background and options (Guest Editors: Mario Maj, Geoffrey M. Reed), World Psychiatry, Volume 11, Supplement 1, June 2012

3] Monograph: Public Health Aspects of Diagnosis and Classification of Mental and Behavioral Disorders: Refining the Research Agenda for DSM-5 and ICD-11 By Shekhar Saxena, Patricia Esparza, Darrel A. Regier, Norman Sartorius

4] Submissions to DSM-5 public reviews for drafts one, two and three by The American Speech-Language-Hearing Association

Post #195 Shortlink: http://wp.me/pKrrB-2pa

This post relates to the World Health Organization’s ICD-11 and ICD11-PHC (Primary Care version), both currently under development. It does not apply to the existing ICD-10, ICD10-PHC or to the forthcoming US specific “clinical modification” of ICD-10, known as ICD-10-CM.

Note on ICD10-PHC and ICD11-PHC

The ICD10-PHC (Primary Care version) is a simplified version of the WHO’s International Classification of Diseases (ICD-10) for use in general practice and primary health care settings. This condensed classification system has rough but not exact equivalence to the main ICD-10 classification.

For example, the ICD10-PHC mental and behavioural disorders chapter lists and describes 25 disorders commonly managed within primary care as opposed to circa 450 classified within Chapter V of ICD-10.

A chart showing the grouping of categories adapted from the full ICD-10 version for the existing ICD10-PHC categories can be found here.

The revision of ICD10-PHC, ICD11-PHC, is currently under development.

Professor, Sir David Goldberg, M.D., Emeritus Professor, Institute of Psychiatry, King’s College, London, is a member of the DSM-5 Mood Disorders Work Group. Prof Goldberg also chairs the Consultation Group for Classification in Primary Care that is making recommendations for the mental and behavioural disorders section of ICD11-PHC.

The majority of patients with mental health problems are diagnosed and managed by general practitioners in primary care – not by psychiatrists and mental health specialists. ICD10-PHC is used in developed and developing countries in general medical settings and also used in the training of medical officers, nurses and multi purpose health workers.

Further information on ICD10-PHC and the development of the mental health disorders section of ICD11-PHC can be found in these two documents:

1] Goldberg, D. Guest editorial. A revised mental health classification for use in general medical settings: the ICD11–PHC 1. International Psychiatry, Page 1, February 2011.
http://www.rcpsych.ac.uk/pdf/IPv8n1.pdf

2] 21st Century Global Mental Health by Dr Eliot Sorel, Professor, George Washington University, Washington D.C.
Publication date: August, 2012: http://www.jblearning.com/catalog/9781449627874/
Page 51, Sample Chapter 2: http://samples.jbpub.com/9781449627874/Chapter2.pdf

ICD Revision publishes the names and bios of members of the ICD-11 Revision Steering Group, ICD-11 Topic Advisory Groups, and International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders.

But membership of the various sub working groups to the Topic Advisory Groups (TAGs), the names of external peer reviewers recruited by TAG Managing Editors for reviewing proposals and content and the membership of the advisory/consultation groups for the revision of the ICD Primary Care version have not been published by ICD-11 Revision.

The Abstract below lists members of the (WHO) Primary Care Consultation Group for the Revision of ICD-10 Mental and Behavioural Disorders.

1] Paper: The primary health care version of ICD-11: the detection of common mental disorders in general medical settings

http://www.ghpjournal.com/article/S0163-8343(12)00197-1/abstract

The primary health care version of ICD-11: the detection of common mental disorders in general medical settings

26 July 2012

David P. Goldberg, James J. Prisciandaro, Paul Williams

David P. Goldberg
Affiliations Primary Care Consultation Group, World Health Organization; and Institute of Psychiatry, KCL, London, UK

James J. Prisciandaro
Affiliations Department of Psychiatry, Medical University of South Carolina, Charleston SC, USA
Corresponding author.

Paul Williams
Affiliations Health Services & Population Research, Institute of Psychiatry, KCL, London, UK

Received 31 January 2012; accepted 19 June 2012. published online 26 July 2012.
Corrected Proof

Abstract

Background

The primary health care version of the ICD-11 is currently being revised.

Aim
To test two brief sets of symptoms for depression and anxiety in primary care settings, and validate them against diagnoses of major depression and current generalised anxiety made by the CIDI.

Method
The study took place in general medical or primary care clinics in 14 different countries, using the Composite International Diagnostic Interview adapted for primary care (CIDI-PC) in 5,438 patients. The latent structure of common symptoms was explored, and two symptom scales were derived from item response theory (IRT), these were then investigated against research diagnoses.

Results
Correlations between dimensions of anxious, depressive and somatic symptoms were found to be high. For major depression the 5 item depression scale has marked superiority over the usual 2 item scales used by both the ICD and DSM systems, and for anxiety there is some superiority. If the questions are used with patients that the clinician suspects may have a psychological disorder, the positive predictive value of the scale is between 78 and 90%.

Conclusion
The two scales allow clinicians to make diagnostic assessments of depression and anxiety with a high positive predictive value, provided they use them only when they suspect that a psychological disorder is present.

This article is partly based on the work of the World Health Organization (WHO) Primary Care Consultation Group for the Revision of ICD-10 Mental and Behavioural Disorders, of which the first author is Chair. Other members of the group include Michael Klinkman (GP, United States; Vice Chairman); Sally Chan (nurse, Singapore), Tony Dowell (GP, New Zealand) Sandra Fortes (psychiatrist, Brazil), Linda Gask (psychiatrist, UK), KS Jacob (psychiatrist, India), Tai-Pong Lam (GP, Hong Kong), Joseph Mbatia (psychiatrist, Tanzania), Fareed Minhas (psychiatrist, Pakistan), Marianne Rosendal (GP, Denmark), assisted by WHO Secretariat Geoffrey Reed and Shekhar Saxena. The views expressed in this article are those of the authors and, except as specifically noted, are not intended to represent the official policies and positions of the Primary Care Consultation Group or of the WHO.

Competing interests: David Goldberg is a consultant for Ultrasis and advises the World Health Organization and the American Psychiatric Association.

James Prisciandaro and Paul Williams have no competing interests

PII: S0163-8343(12)00197-1

doi:10.1016/j.genhosppsych.2012.06.006

+++
2] The ICD-11 Classification of Mood and Anxiety Disorders: background and options (Guest Editors: Mario Maj, Geoffrey M. Reed), World Psychiatry, Volume 11, Supplement 1, June 2012

The PDF of this publication is free.

Note regarding references within these commentaries to DSM-5 proposals: Some of these commentaries were written prior to the release of the third DSM-5 draft for public review, in May 2012, and quote draft proposals as they had stood for the second draft.

For example, the commentary Hypochondriasis in ICD-11 by D.J. Stein, on Page 100, sets out in narrative form the DSM-5 Somatic Symptom Disorder Work Group proposals and criteria for Complex Somatic Symptom Disorder as they had stood in May 2011 and are not the most recent iteration.

DSM-5 proposals have not been finalized. Proposals as they stood in May 2012 for the third and final public review may be subject to further change before DSM-5 is published in May 2013. Please refer to the DSM-5 Development website for the most recent proposals and criteria sets for the categories and proposed categories that are discussed in these commentaries.

http://www.wpanet.org/uploads/WPA-WHO_Collaborative_Activities/WP_ICD-11%20Supplement.pdf

July 2012

The ICD-11 Classification of Mood and Anxiety Disorders: background and options (Guest Editors: Mario Maj, Geoffrey M. Reed) World Psychiatry, Volume 11, Supplement 1, June 2012

Contents

The development of the ICD-11 classification of mood and anxiety disorders

M. Maj, G.M. Reed Page 3

How global epidemiological evidence can inform the revision of ICD-10 classification of depression and anxiety disorders

L.H. Andrade, Y.-P. Wang Page 6

Specifiers as aids to treatment selection and clinical management in the ICD classification of mood disorders

D.J. Miklowitz, M.B. First Page 11

Challenges in the implementation of diagnostic specifiers for mood disorders in ICD-11

M.B. First Page 17

Cultural issues in the classification and diagnosis of mood and anxiety disorders

S. Chakrabarti, C. Berlanga, F. Njenga Page 26

Bipolar disorders in ICD-11

S.M. Strakowski Page 31

Changes needed in the classification of depressive disorders: options for ICD-11

E. Paykel, L.H. Andrade, F. Njenga, M.R. Phillips Page 37

Differentiating depression from ordinary sadness: contextual, qualitative and pragmatic approaches

M. Maj Page 43

Severity of depressive disorders: considerations for ICD-11

J.L. Ayuso-Mateos, P. Lopez-García Page 48

Dysthymia and cyclothymia in ICD-11

M.R. Phillips Page 53

Psychotic and catatonic presentations in bipolar and depressive disorders

S. Chakrabarti Page 59

Mixed states and rapid cycling: conceptual issues and options for ICD-11

M. Maj Page 65

How should melancholia be incorporated in ICD-11?

D. Moussaoui, M. Agoub, A. Khoubila Page 69

Postpartum depression and premenstrual dysphoric disorder: options for ICD-11

M.L. Figueira, V. Videira Dias Page 73

Disruptive mood dysregulation with dysphoria disorder: a proposal for ICD-11

E. Leibenluft, R. Uher, M. Rutter Page 77

Generalized anxiety disorder in ICD-11

M.K. Shear Page 82

Agoraphobia and panic disorder: options for ICD-11

D.J. Stein Page 89

Specific and social phobias in ICD-11

P.M.G. Emmelkamp Page 94

Hypochondriasis in ICD-11

D.J. Stein Page 100

+++

3] Public Health Aspects of Diagnosis and Classification of Mental and Behavioral Disorders: Refining the Research Agenda for DSM-5 and ICD-11

Note: Substantial extracts from this DSM-5 and ICD-11 monograph can be previewed online on the Amazon site via the “LOOKINSIDE!” function. Greater access to preview content is available to Amazon account holders.  Extracts can also be previewed via Google:

Preview via Amazon “LOOKINSIDE!”:

http://www.amazon.com/Aspects-Diagnosis-Classification-Behavioral-Disorders/dp/0890423490#reader_0890423490

Preview via Google Books:

http://tinyurl.com/DSM5-ICD11-Monograph

Public Health Aspects of Diagnosis and Classification of Mental and Behavioral Disorders: Refining the Research Agenda for Dsm-5 and ICD-11

By Shekhar Saxena, Patricia Esparza, Darrel A. Regier, Norman Sartorius

(c) 2012

Paperback: 303 pages
Publisher: American Psychiatric Publishing; 1 edition (April 30, 2012)

Public Health Aspects of Diagnosis and Classification of Mental and Behavioral Disorders: Refining the Research Agenda for DSM-5 and ICD-11
[Paperback]

Shekhar Saxena (Author), Patricia Esparza (Author), Darrel A. Regier (Author), Benedetto Saraceno (Author), Norman Sartorius (Author)

Shekhar Saxena, M.D.,is Director of the Department of Mental Health and Substance Abuse at the World Health Organization in Geneva, Switzerland.

Patricia Esparza, Ph.D.,is Research Professor and clinical psychologist in the Department of Psychology and Counseling at Webster University in Geneva, Switzerland.

Darrel A. Regier, M.D., M.P.H.,is Director of the American Psychiatric Institute for Research and Education and Director of the Division of Research at the American Psychiatric Association in Arlington, Virginia; and Vice-Chair of the DSM-5 Task Force.

Benedetto Saraceno, M.D.,FRCPsych,is Professor of Psychiatry and Director of the World Health Organization Collaborating Center on Mental Health of the University of Geneva in Geneva, Switzerland.

Norman Sartorius, M.D., Ph.D.,is President of the Association for the Improvement of Mental Health Programs in Geneva, Switzerland.

Book Description
Publication Date: April 30, 2012 | ISBN-10: 0890423490 | ISBN-13:
978-0890423493 | Edition: 1

“Public Health Aspects of Diagnosis and Classification of Mental and Behavioral Disorders: Refining the Research Agenda for DSM-5 and ICD-11” provides a comprehensive summary of the current state of mental health classification in the United States and internationally, fostering a better understanding of primary research and clinical needs and facilitating the efforts of service planners, researchers and trainees to address current use of psychiatric diagnosis in the public health sector. The volume reflects the proceedings of a research planning conference convened by the APA and World Health Organization (WHO) that focused on public health aspects of the diagnosis and classification of mental disorders. Highly relevant to the ongoing development of DSM-5 and ICD-11, the book includes the background papers prepared and presented by the Conference Expert Groups. The resulting collection: – Discusses the current state of mental illness prevention efforts and the role of public health in supporting them–critical topics, given that development of effective strategies to reduce mental illness around the world depends on the accuracy with which risk and protective factors can be identified, defined, and understood. – Features international perspectives on public health implications of psychiatric diagnosis, classification, and service, providing viewpoints that are broad and more globally relevant. – Views mental health education, and awareness on a macro level, including its impact on social and economic policy, forensics and the legal system, and education. This approach facilitates the continued development of a research base in community health and promotes the establishment of programs for monitoring, treating, and preventing mental illness. – Addresses many fascinating and clinically relevant issues, such as those raised by the concept and the definition of mental disorders and how these impact psychiatric services and practice by individual providers.

This collection should prove useful to the advisory groups, task forces, and working groups for the revision of these two classifications, as well as for researchers in the area of diagnosis and classification, and more generally in public health.

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4] Submissions to DSM-5 public reviews for drafts one, two and three by The American Speech-Language-Hearing Association (ASHA)

The American Speech-Language-Hearing Association (ASHA) represents people with speech, language, and hearing disorders and advocates for services to help them communicate effectively.

ASHA submitted comments during all three DSM-5 draft comment periods:

ASHA submission April 2010 [PDF]; June 2011 [PDF]; June 2012 [PDF]

ASHA Letter sent June 2012 [PDF]

DSM-V Revisions To Move Forward (ASHA Leader article)

all documents available from this page:

http://www.asha.org/SLP/DSM-5/

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Key ICD-11 links and documents

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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