ICD-11 Revision Beta drafting process: stakeholder participation

ICD-11 Revision Beta drafting process: stakeholder participation

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

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

Update at August 2, 2012:

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

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Update at August 2, 2012:

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

An invitation to contribute to the future of dermatology

ICD-11 Update

By Robert J.G. Chalmers

ICD-11 draft is ready for comments and criticism

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

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When will ICD-11 be ready for dissemination?

Slipping targets

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

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

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

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

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ICD-11 still at the Beta drafting stage

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

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

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Launch of the Beta delayed

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

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

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

ICD-11 is a very ambitious project.

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

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

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

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

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Where can the Beta drafting platform be viewed?

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

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

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

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

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

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

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

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

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

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

Caveats

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

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

The Beta draft can be accessed here:

Beta draft Foundation Component (FC) view:

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

Beta draft Linearization Morbity (LM) view:

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

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

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Who are the stakeholders in ICD?

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

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

http://www.facebook.com/ICD11

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

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

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

www.who.int/classifications/icd11 

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How can stakeholders participate in the Beta process?

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

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

Interested stakeholders can register here

Registered stakeholders are permitted to:

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

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

Recent comments get aggregated here:

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

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

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

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

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

PowerPoint presentation slides in Posts #70 and #71:

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

ICD Revision Process Alpha Evaluation Meeting documents and PowerPoint slide presentations

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

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

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

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

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Recently issued documents around the Beta drafting process

Frequently Asked Questions About ICD-11

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

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

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

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

     ICD-11 Beta known concerns

ICD-11 Known Problems and Issues: General known issues

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

     ICD-11 General known issues

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The ICD-11 Content Model

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

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

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

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

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

Content Model Reference Guide January 2011  [MS Word]

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

Content Model Parameters

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Harmonization between ICD-11 and DSM-5

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

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

with the objective that

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

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

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

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

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

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References and additional ICD-11 related links and documentation

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

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

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

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

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

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

Key links

ICD-11 Beta drafting platform  |  Publicly viewable version

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

ICD-11 Revision Information  |
ICD-11 Timeline  |

ICD Information Sheet  |

Revision News  |
Steering Group  |
Topic Advisory Groups  |

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

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

WHO Publications

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

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

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

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

About the World Health Organization (WHO)

The WHO Family of International Classifications  

History of ICD

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What’s new in the ICD-11 Alpha drafting platform? (CFS, PVFS, ME)

What’s new in the ICD-11 Alpha drafting platform? (CFS, PVFS, ME)

Post #157 Shortlink: http://wp.me/pKrrB-22h

 

Screenshot: ICD-11 Alpha Browser Foundation view selected, logged in at April 10, 2012:

Chapter 6: Diseases of the nervous system

http://apps.who.int/classifications/icd11/browse/f/en#/http%3a%2f%2fwho.int%2ficd%23G93.3

Apr 09 – 11:02 UTC


 

ICD-11 Beta drafting platform to launch in May?

As reported in previous posts, according to the timeline, the ICD-11 Beta drafting platform is supposed to be launching this May.

ICD-11 Revision Steering Group has yet to announce whether the Beta platform remains on target for a May release and if so, on what date it will be launched – so I cannot give you a date yet.

Like the Alpha Drafting Browser, the Beta drafting platform will be a work in progress – not a final Beta draft. The final Beta isn’t scheduled until 2014, after the ICD-11 field trials have been undertaken.

When it does launch, the Beta platform is intended to be accessible to professionals and the public for viewing.

Registered or logged in users will have greater access to content and will be able to interact with the platform to read comments, comment on proposals and make suggestions, as part of the ongoing drafting process.  

In the meantime, the publicly viewable version of the Alpha drafting platform (known as the ICD-11 Alpha Browser) can still be accessed here:

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

The various ICD-11 Revision Topic Advisory Groups are carrying out their draft preparation work on a separate, more complex multi-author drafting platform that is accessible only to WHO and ICD Revision personnel.

 

Alpha drafting platform

As before, the publicly viewable version of the Alpha Browser should be viewed with the following caveats in mind:

the Alpha draft is a work in progress; it is incomplete; it may contain errors and omissions; it is in a state of flux and updated daily; textual content, codes and “Sorting labels” are subject to change as chapters are reorganized and content populated; the content has not been approved by Topic Advisory Groups, Revision Steering Group or WHO.

It is possible to register, or sign into the platform using existing accounts with several third party account providers such as Google, Yahoo and myOpenID, for increased access and functionality. Once signed in, Comments and Questions can be read and PDFs of the drafts of the top level linearizations can be downloaded from the Linearization tab.

See the Alpha Browser User Guide for information on how the Alpha Browser functions:

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

 

The ICD-11 “Content Model”

ICD-11 will be available in both print and online versions and unlike most chapters of ICD-10, will include descriptive content for ICD terms.

For the online version of ICD-11, all ICD entities will include a definition and a number of additional key descriptive fields – between 7 and 13 pre-defined parameters, populated according to a common “Content Model” (Content Model Reference Guide January 2011).

For example, ICD entity Title, Definition, Synonyms, Narrower Terms, Exclusions, Body Site, Body System, Signs and Symptoms, Causal Mechanisms, and possibly Diagnostic Criteria for some entities.*

*According to the iCAT User Google Group message board, these fields may have been revised since the January 2011 Content Model Reference Guide was published; Content Model parameters in the Beta draft may therefore differ from those currently displaying in the public Alpha drafting platform.

The print version will use a concise version of Definition due to space constraints.

In the Alpha Browser, not all these Content Model parameters display in the Foundation and Linearization views and not all of the parameters that have been listed for individual entities have had their draft text added yet, as some chapters are more advanced for the population of proposed content than others.

So the Alpha draft is still very patchy and many entities have no Definition and little or no other proposed content filled in.

With no “Category Discussion Notes” or “Change history” pop-up windows visible in the public version of the Alpha, the viewer cannot determine the rationales behind the reorganization of terms and hierarchies within the various chapters.

 

Chapter location and hierarchy for CFS, PVFS and (Benign) ME in ICD-11

I have been reporting since June 2010 that the proposals for ICD-11 Alpha Draft, as far as one could determine, appeared to be:

1] That a change of hierarchy had been recorded in a “Category Discussion Note”, dated May 1, 2010, between ICD-10 Title term “Postviral fatigue syndrome” and “Chronic fatigue syndrome”. (“Category Discussion Notes” and “Change History” pop-ups did display in the earlier iCAT version of the Alpha drafting platform.)

You can view a screenshot from June 2010 of that “Change history” record here:

https://dxrevisionwatch.files.wordpress.com/2010/06/change-history-gj92-cfs.png

The Definition field on the “Chronic fatigue syndrome” description panel in the current Alpha Browser is currently blank but in June 2010, the Definition had stood as in this contemporaneous screenshot:

https://dxrevisionwatch.files.wordpress.com/2010/05/2icatgj92cfsdef.png

2] That “Chronic fatigue syndrome” had been designated as an ICD-11 Title term within ICD-11 Chapter 6: Diseases of the nervous system, with the capacity for a Definition and up to 10 additional descriptive parameters.

3] That “Benign myalgic encephalomyelitis” had been specified as an Inclusion term to ICD-11 Title term “Chronic fatigue syndrome” but that the relationships between the three terms, PVFS, (B) ME and CFS had yet to be specified, as in this screenshot from June 2010:

https://dxrevisionwatch.files.wordpress.com/2010/05/2icatgj92cfsterms.png

 

What is currently showing in the Chapter 6 Foundation Component?

It isn’t possible to bring up a discrete ICD Title listing for either “Benign myalgic encephalomyelitis” or “Postviral fatigue syndrome” in either the Foundation Component or the Linearization.

In the Foundation view only, for Chapter 6: Diseases of the nervous system, “Chronic fatigue syndrome” is listed as a Title term with the ICD-10 legacy ID “ID:http://who.int/icd#G93.3”;

the Definition field is currently blank;

a list of terms has recently been added under “Synonyms”;

one term has recently been added under “Narrower Terms”.

(Note: there is a small asterisk at the end of term “Benign myalgic encephalomyelitis” which is listed at the top of the “Synonyms” list. The asterisk “Hover text” reads “This term is an inclusion term in the linearizations.”)

If you want to view the listing directly on the Browser site (note the “Comment” and “Questions” icons which open up pop-up windows next to terms for reading/commenting won’t display unless you have already registered and logged in) go here:

ICD-11 Alpha Browser Foundation view:

http://apps.who.int/classifications/icd11/browse/f/en#/http%3a%2f%2fwho.int%2ficd%23G93.3

ID:http://who.int/icd#G93.3

Chronic fatigue syndrome

Parent(s)

Selected cause is Remainder of diseases of the nervous system in Condensed and selected Infant and child mortality lists
Selected Cause is All other diseases in the Selected General mortality list
Selected cause is Diseases of the nervous system

Definition

This entity does not have a definition at the moment.

Synonyms

Benign myalgic encephalomyelitis *  [Ed: Hover text over asterisk reads: “This term is an inclusion term in the linearizations.”]
akureyri
akureyri disease
cfs – chronic fatigue syndrome
chronic fatigue syndrome nos   [Ed: from current proposals for ICD-10-CM, Chapter 18, R53.82]
chronic fatigue, unspecified   [Ed: from current proposals for ICD-10-CM, Chapter 18, R53.82]
epidemic neuromyasthenia
iceland disease
icelandic disease
me – myalgic encephalomyelitis
myalgic encephalomyelitis
myalgic encephalomyelitis syndrome
postviral fatigue syndrome
pvfs – postviral fatigue syndrome

Narrower Terms

neuromyasthenia

Body Site

Entire brain (body structure)
Brain structure (body structure)

Causal Mechanisms

Virus (organism)

 

What’s new in Chapter 5: Mental and behavioural disorders?

As reported in Dx Revision Watch post: http://wp.me/pKrrB-1Vx,  the category “Somatoform Disorders” in Chapter 5, Mental and behavioural disorders is currently renamed to “BODILY DISTRESS DISORDERS”, under which currently sit three new child categories:

5M0 Mild bodily distress disorder
5M1 Moderate bodily distress disorder
5M2 Severe bodily distress disorder.

Chapter 5 Linearization view:

http://apps.who.int/classifications/icd11/browse/l-m/en#/http%3a%2f%2fwho.int%2ficd%23F45

Chapter 5 Foundation view:

http://apps.who.int/classifications/icd11/browse/f/en#/http%3a%2f%2fwho.int%2ficd%23F45

(Click on the little grey arrows to display the child categories):

Child categories to parent “BODILY DISTRESS DISORDERS”:

http://apps.who.int/classifications/icd11/browse/f/en#/http%3a%2f%2fwho.int%2ficd%231905_dd0250d2_e8cd_4c48_a93f_7997cc1c8b07

BODILY DISTRESS DISORDERS

5M0 Mild bodily distress disorder
5M1 Moderate bodily distress disorder
5M2 Severe bodily distress disorder
5M3 Somatization disorder
5M4 Undifferentiated somatoform disorder
5M5 Somatoform autonomic dysfunction
5M6 Persistent somatoform pain disorder
      > 5M6.0 Persistent somatoform pain disorder
      > 5M6.1 Chronic pain disorder with somatic and psycological [sic] factors
5M7 Other somatoform disorders
5M8 Somatoform disorder, unspecified

None of these three new (proposed) categories have had any Definitions or other textual content added to the description panels on the right hand side of the Alpha Browser page since I first reported this change in February.

It is still not possible to determine what disorders ICD-11 intends might be captured by these three new (proposed) terms, should ICD-11 Revision Steering Group and WHO classification experts consider these terms to be valid constructs and approve their progression through to the Beta draft.

Because no “Change Notes” or “Change history” pop-up windows display in this version of the Alpha Drafting browser, it is not possible to determine:

whether ICD-11 is proposing to introduce three new terms – 5M0 Mild bodily distress disorder; 5M1 Moderate bodily distress disorder; 5M2 Severe bodily distress disorder, in addition to retaining existing ICD-10 terms, 5M3 thru 5M8;

how ICD Revision intends to define these (proposed) new terms at 5M0, 5M1, 5M2;

how these three (proposed) new terms would relate to the existing ICD-10 “Somatoform Disorders” categories which remain listed as child categories to “BODILY DISTRESS DISORDERS” (apart from “Hypochondriacal disorder” [ICD-10: F45.2], which is now listed as “5H0.5 Illness Anxiety Disorder” in the ICD-11 Alpha Draft).

(See Page 1 and 2 of my report: “Bodily Distress Disorders” to replace “Somatoform Disorders” for ICD-11?: http://wp.me/pKrrB-1Vx  )

 

References:

ICD-11 Revision: http://www.who.int/classifications/icd/revision/en/

ICD-11 Alpha Browser User Guide: http://www.who.int/classifications/icd/revision/caveat/en/index.html
Alpha Browser Foundation view: http://apps.who.int/classifications/icd11/browse/f/en#
Alpha Browser Linearization view: http://apps.who.int/classifications/icd11/browse/l-m/en#
“Bodily Distress Disorders” to replace “Somatoform Disorders” for ICD-11?: http://wp.me/pKrrB-1Vx

APA “Monitor” articles: ICD-11 and DSM-5; Frances, Rajiv Tandon on DSM-5; iCAT Analytics

1] ICD-11 (with contributions from WHO’s Dr Geoffery Reed) and DSM-5 articles in February edition of American Psychological Association’s “Monitor”

2] Academic article on DSM-5 by Rajiv Tandon, MD, Professor of Psychiatry, University of Florida

3] Allen Frances (who chaired the DSM-IV Task Force), Suzy Chapman and Dr Dayle Jones on DSM-5

4] Paper: Pragmatic Analysis of Crowd-Based Knowledge Production Systems with iCAT Analytics: Visualizing Changes to the ICD-11 Ontology

 

Post #137 Shortlink: http://wp.me/pKrrB-1QW

1] Two articles in the February edition of the American Psychological Association’s “Monitor”:

American Psychological Association

Monitor

Feature, February 2012, Vol 43, No. 2

Improving disorder classification, worldwide

Rebecca A. Clay  |  February 2012

With the help of psychologists, the next version of the International Classification of Diseases will have a more behavioral perspective.

Print version: page 40

What’s the world’s most widely used classification system for mental disorders? If you guessed the Diagnostic and Statistical Manual of Mental Disorders (DSM), you would be wrong.

According to a study of nearly 5,000 psychiatrists in 44 countries sponsored by the World Health Organization (WHO) and the World Psychiatric Association, more than 70 percent of the world’s psychiatrists use WHO’s International Classification of Diseases (ICD) most in day-to-day practice while just 23 percent turn to the DSM. The same pattern is found among psychologists globally, according to preliminary results from a similar survey of international psychologists conducted by WHO and the International Union of Psychological Science.

“The ICD is the global standard for health information,” says psychologist Geoffrey M. Reed, PhD, senior project officer in WHO’s Department of Mental Health and Substance Abuse. “It’s developed as a tool for the public good; it’s not the property of a particular profession or particular professional organization.”

Now WHO is revising the ICD, with the ICD-11 due to be approved in 2015. With unprecedented input from psychologists, the revised version’s section on mental and behavioral disorders is expected to be more psychologist-friendly than ever—something that’s especially welcome given concerns being raised about the DSM’s own ongoing revision process. (See “Protesting proposed changes to the DSM”.) And coming changes in the United States will mean that psychologists will soon need to get as familiar with the ICD as their colleagues around the world…

…”Since the rest of the world will be adopting the ICD-11 when it is released in 2015, the CDC will likely make annual updates to gradually bring the ICD-10-CM into line with the ICD-11 to avoid another abrupt shift. But the differences between the DSM and the ICD may grow even greater over time, says Reed, depending on the outcomes of the ICD and DSM revision processes.”

For more information about the ICD revision, visit the World Health Organization.

Rebecca A. Clay is a writer in Washington, D.C.

Read full article here

American Psychological Association

Monitor

February 2012, Vol 43, No. 2

Print version: page 42

Protesting proposed changes to the DSM

When President David N. Elkins, PhD, and two colleagues within APA’s Div. 32 (Society for Humanistic Psychology) heard about the proposed revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM), they were alarmed. But what could three people do?

Plenty, as it turns out.

Although their original aim was simply to educate the division’s members, Elkins, Secretary Brent Dean Robbins, PhD, and student representative Sara R. Kamens soon decided to share their concerns in an open letter to the American Psychiatric Association. Thinking it would pack more punch with a few more signatures, they posted it online last October.

The response astounded them. “Within two days, we had more than 1,500 signatures,” says Elkins. So far, more than 10,000 individuals and 40 mental health organizations have signed on, and media outlets as diverse as Nature, USA Today and Forbes have covered the controversy. APA, which has no official position on the controversy, urges its members to get involved in the debate (see APA’s statement in the January Monitor, page 10).

The open letter outlines three major concerns with the proposed draft of the DSM-5, set for publication in 2013…

Read full article here

2] Article by Rajiv Tandon, MD, Professor of Psychiatry, University of Florida:

Current Psychiatry

Vol. 11, No. 02 / February 2012

Getting ready for DSM-5: Part 1

The process, challenges, and status of constructing the next diagnostic manual

Rajiv Tandon, MD  |  February 2012
Professor of Psychiatry, University of Florida, Gainesville, FL

Discuss this article at www.facebook.com/CurrentPsychiatry

Work on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—scheduled to be published in May 2013—has been ongoing for more than a decade. Momentous advances in genetics and brain imaging since publication of DSM-IV in 1994 have generated optimism that an improved understanding of the neurobiologic underpinnings of psychiatric disorders might lead to a paradigm shift from the current descriptive classification system to a more scientific etiopathophysiological system similar to that used by other medical specialities.1

Some fear that any changes to our current classification system may be premature and could make an already complex system even more unwieldy.2 Scores of articles about the content and process of DSM-5 and several critiques and commentaries on the topic have been published. The American Psychiatric Association (APA) has made the DSM-5 process transparent by posting frequent updates to the DSM-5 Development Web site (www.dsm5.org), seeking feedback from the psychiatric community and the public, and presenting progress reports by members of the DSM-5 Task Force at scientific meetings.

There have been few discussions on the implications of DSM-5 from the practicing clinician’s vantage point, which I seek to present in this series of articles, the remainder of which will be published here, at CurrentPsychiatry.com…

Read on here

 

3] Allen Frances, MD, in Psychology Today and Psychiatric Times

Registration required for access to article on Psychiatric Times

DSM5 in Distress

PTSD, DSM 5, and Forensic Misuse
DSM 5 would lead to overdiagnosis in legal cases.

Allen Frances, MD | February 9, 2012

————————————————————

Documentation That DSM-5 Publication Must Be Delayed
because DSM 5 is so far behind schedule

Allen Frances, MD | February 7, 2012

Allen Frances, MD, who chaired the Task Force that had oversight of the development of DSM-IV, is a former chief of psychiatry at Duke University Medical Center and currently professor emeritus at Duke

Last week, I wrote that DSM-5 is so far behind schedule it can’t possibly produce a usable document in time for its planned publication date in May 2013.¹ My blog stimulated 2 interesting responses that illustrate the stark contrast between DSM-5 fantasy and DSM-5 reality. Together they document why publication must be delayed if DSM-5 is to be set right. The first email came from Suzy Chapman of Dx Revision Watch https://dxrevisionwatch.wordpress.com

Re DSM-5 delays, here is a telling statement made by Dr Darrel Regier, its Vice Chair, on March 9, 2010: “We have just released draft criteria on a website on February 10th at dsm5.org. And we’ll be having a field trial starting in July of this year. We’ll then have another revision based on field trial results going into a second revision or second field trial in July of 2011. As a result, we will not have our final recommendations for the DSM-V probably until early 2011.”  She continues,

Please note the dates. Dr Regier’s promised timetable has been missed by more than a year—we still don’t have final recommendations.

Dayle Jones, PhD, is head of the Task Force of the American Counseling Association that monitors DSM-5. She sent in a timeline comparing DSM-5 promised deadlines with actual delivery dates:

The DSM-5 academic/large clinic field trials were designed to have two phases. Phase 1 was first scheduled to begin in June 2009, but had to be postponed for a year because the criteria sets were not ready. The timetable for field trial completion was unrealistic from the start and not surprisingly the end dates have been repeatedly postponed from early 2010 to early 2011, and we’re now already into 2012 with no end in sight. Phase 2, originally scheduled for September 2011 to February 2012, was to re-test those diagnoses that did poorly in Phase 1 and had to be revised. The phase 2 trials were quietly canceled. We still don’t have results from the phase 1 field trials, but the APA leadership has warned us that we must accept reliabilities that are barely better than chance. Without the second stage, uncorrected problem diagnoses will be included in DSM-5.

The separate clinician field trial has been an even worse disaster. Clinicians were originally scheduled to be trained by August 2010, enrolling patients no later than late November 2010, and ending by February, 2011. Training was finally completed 18 months late in December 2011, which means the earliest these trials could possibly end is June 2012—well after most DSM-5 final decisions will have been made. Furthermore, of the over 5000 clinicians who registered to participate, only 70 (1.4%) have begun enrolling patients for the field trial. My guess is that like academic/large clinic Phase 2 field trial, poor planning and disorganization will force cancellation.

Dr Jones concludes,

In my opinion, there is no process and not enough time left to ensure that DSM-5 will attain high enough quality to be used by counselors. Fortunately, we can always bypass it by using ICD-10-CM.

Sobering stuff. Its constant procrastination has at last caught up with DSM-5. Having fallen so far behind schedule, DSM-5 abruptly dropped the second stage of field-testing—without public comment or justification or discussion of what would be the effects on quality and reliability. In fact, the second stage of the field trials was perhaps the most crucial step in the entire DSM-5 process—a last chance for sorely needed quality control to bring a lagging DSM-5 up to acceptable standards. The DSM-5 proposals that were weak performers in the first stage were supposed to be rewritten and retested in the second to ensure that they deserved to be included in the manual.

The American Psychiatric Association (APA) is now stuck with the most unpalatable of choices—protecting the quality of DSM-5 versus protecting the publishing profits to be gained by premature publication. Given all the delays, it can’t possibly do both—a quality DSM-5 cannot be delivered in May 2013.

All along, it was predictable (and predicted), that DSM-5 disorganization would lead to a mad, careless dash at the end. The DSM’s have become far too important to be done in this slapdash way—the high cost to users and the public of this rush to print is unacceptable. Unless publication is delayed, APA will be offering us official DSM-5 criteria that are poorly written, inadequately tested, and of low reliability. The proper alternative is clear: APA should delay publication of DSM-5 until it can get the job done right. Public trust should always trump publishing profits.

Let’s close with a worrying and all too illustrative quote from Dr Regier, just posted by Scientific American.² When asked if revisions to criteria in DSM-5 could be completed by the end of this year, he said “there is plenty of time.” I beg to differ—there is not nearly enough time if the changes are to be done based on a much needed independent scientific review and are to be tested adequately in Phase 2 of the field trial. Without these necessary steps DSM-5 will be flying blind toward the land of unintended consequences.

References
1. Frances A. APA should delay publication of DSM-5. January 31, 2012. Psychiatr Times.
http://www.psychiatrictimes.com/blog/frances/content/article/10168/2024394

2. Jabr F. Redefining autism: will new DSM-5 Criteria for ASD exclude some people? January 30, 2012. Sci Am. http://www.scientificamerican.com/article.cfm?id=autism-new-criteria  Accessed February 7, 2012.

 

4] Paper: Pragmatic Analysis of Crowd-Based Knowledge Production Systems with iCAT Analytics: Visualizing Changes to the ICD-11 Ontology

     Pragmatic Analysis – iCAT Analytics 2012

Pragmatic Analysis of Crowd-Based Knowledge Production Systems with iCAT Analytics: Visualizing Changes to the ICD-11 Ontology

http://kmi.tugraz.at/staff/markus/documents/2012_AAAI_iCATAnalytics.pdf

Jan P¨oschko and Markus Strohmaier, Knowledge Management Institute, Graz University of Technology, Inffeldgasse 21a/II, 8010 Graz, Austria

Tania Tudorache and Natalya F. Noy and Mark A. Musen, Stanford Center for Biomedical Informatics Research, 1265 Welch Road, Stanford, CA 94305-5479, USA

Abstract

While in the past taxonomic and ontological knowledge was traditionally produced by small groups of co-located experts, today the production of such knowledge has a radically different shape and form. For example, potentially thousands of health professionals, scientists, and ontology experts will collaboratively construct, evaluate and  maintain the most recent version of the International Classification of Diseases (ICD-11), a large ontology of diseases and causes of deaths managed by the World Health Organization. In this work, we present a novel web-based tool-iCAT Analytics-that allows to investigate systematically crowd-based processes in knowledge-production systems. To enable such investigation, the tool supports interactive exploration of pragmatic aspects of ontology engineering such as how a given ontology evolved and the nature of changes, discussions and interactions that took place during its production process. While iCAT Analytics was motivated by ICD-11, it could potentially be applied to any crowd-based ontology-engineering project. We give an introduction to the features of iCAT Analytics and present some insights specifically for ICD-11.

New: Online ICD-10 Version for 2010

New: Online ICD-10 Version for 2010

Post #106 Shortlink: http://wp.me/pKrrB-1jm

The information in this report refers only to the existing international WHO ICD-10 and not to the forthcoming ICD-11 or to any country specific, clinical modification of ICD-10.

New: Online ICD-10 Version for 2010

I reported some months ago that according to documentation from WHO-FIC meeting materials, it was understood that a version of ICD-10 for 2010 was planned to be published online by WHO, Geneva, earlier this year.

This would replace the ICD-10 online version for 2007 and incorporate all the annual updates to ICD-10 from 2007 to 2010.

This is now up online.

A searchable version of ICD-10 for 2010 is available at this URL:

http://apps.who.int/classifications/icd10/browse/2010/en

International Statistical Classification of Diseases and Related Health Problems 10th Revision

It is presented on a platform similar to the platform being used for the ICD-11 Alpha Draft, that is, a list of ICD-10 Chapters on the left side of the screen, arranged with hierarchical parent > child categories, with the category codings set out on the right side of the screen.

This is the URL for ICD Title term G93.3 Postviral fatigue syndrome:

http://apps.who.int/classifications/icd10/browse/2010/en#/G93.3

If “Chronic fatigue syndrome” is entered into the Search box, a drop down reads:

“Syndrome – fatigue – chronic – G93.3”

(Which is the way it is set out in Volume 3 The Alphabetical Index.)

Mouse hover over the orange square on the left of the dark blue drop down and the “Alt text” reads:

“Found in Index”

There is a User Guide for ICD-10 Version: 2010 but the platform is not difficult to navigate, just select a chapter and click on the little grey arrows to display parent class and Title term categories and their child categories – you can’t break anything:

http://apps.who.int/classifications/icd10/browse/Help

Those of us with websites that have URLs pointing to specific ICD-10 version for 2007 categories will need to adjust URLs for the new platform, as code specific URLs are pointing only to the ICD-10 Version: 2010 opening page, for example:

what displayed in ICD-10 version for 2007 at this path:

http://apps.who.int/classifications/apps/icd/icd10online/?gg90.htm+g933

would need updating to:

http://apps.who.int/classifications/icd10/browse/2010/en#/G93.3

and the Chapter V entry for the F40-48 categories:

http://www.who.int/classifications/apps/icd/icd10online/?gf40.htm+f480

would need updating to:

http://apps.who.int/classifications/icd10/browse/2010/en#/F40-F48

or

http://apps.who.int/classifications/icd10/browse/2010/en#/F45.0

to point to F45 Somatoform Disorders

or

http://apps.who.int/classifications/icd10/browse/2010/en#/F48.0

to point to F48.0 Neurasthenia.

Compiled by Suzy Chapman


Update on ICD-11 development: July 3, 2011

Update on ICD-11 development: July 3, 2011

Post #96 Shortlink: http://wp.me/pKrrB-1eb

The information in this mailing relates only to ICD-11, the forthcoming revision of ICD-10 that is scheduled for pilot implementation in 2015. It does not apply to the forthcoming US specific Clinical Modification of ICD-10, known as “ICD-10-CM”, scheduled for implementation in October 2013, or to Clinical Modifications of ICD-10 already in use.

Caveat (updated 18 September 2011): The screenshots below were a “snapshot” of the ICD-11 Alpha Browser as it had stood on May 17 and 19, 2011. The ICD-11 Alpha Browser is a work in progress and is updated by ICD Revision personnel on a daily basis. Information visible in the Alpha Browser is incomplete, will have changed since May 17, may be in a state of flux and may contain errors and omissions; the codes and temporary “Sorting labels” assigned to ICD parent classes and categories are subject to change as work on the draft progresses and as chapters are reorganized. Note that the screenshots below no longer reflect what can be seen in the draft, as it currently stands in September 2011.

Not all ICD-11 category terms and the data associated with them (which is in the process of being populated according to 13 common ICD-11 Content Model fields, that include Definitions, Inclusions, Exclusions, Causal Mechanisms and other parameters that will be used to describe ICD-11 entities) display in this version of the Alpha Browser platform. A separate, more layered electronic drafting platform is being used by the various ICD Revision Topic Advisory Group (TAG) managers and their workgroup members, accessible only to ICD Revision TAG personnel via a password protected log in. The multi author electronic platform which the Revision TAGs are working on displays Content Model fields that are not currently viewable by the public, though for some ICD categories, Definitions are now displaying in the public version, as the development of some chapters of the ICD-11 Alpha Browser is more advanced than others.

In the next month or two, ICD-11 Revision is planning to release a new drafting platform which will be accessible by the public and for which professionals and the public will be able to register online to submit comment. This new platform was originally scheduled for mid May, then July, but ICD Revision is slipping its targets. When the new platform is released, there will be an official channel of communication but the commenting process will not be like that of the DSM stakeholder review. For an idea of what is being planned for stakeholder involvement during the alpha and beta development stages, see the presentation slides in these two Dx Revision Watch posts from April 19, 2011:

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

Shortlink Post #70: http://wp.me/pKrrB-ZN

ICD Revision Process Alpha Evaluation Meeting documents and PowerPoint slide presentations

Shortlink Post #71: http://wp.me/pKrrB-10i

In the meantime, the version of the Alpha Draft currently visible to the public comes with WHO caveats and should not be relied upon and it does not reflect the screenshots below, as they had stood in May, this year. As soon as the new public platform is released, I will update, at the moment there is insufficient information to reliably determine proposals and I am seeing misreporting and outdated information being discussed on some forums.

For example, in June to November 2010, the iCAT Alpha Draft recorded a change in hierarchy for PVFS because its parent class “G93 Other disorders of brain” is removed, with ICD Title “Gj92 Chronic fatigue syndrome” listed as a child category of parent class, “GN Other disorders of the nervous system” (see this post for screenshots as they stood at that date).

But by May 2011, the “Sorting labels” had been revised and the public version of the alpha draft displayed “06L Other disorders of the nervous system” > “06L00 Chronic fatigue syndrome”. However, the 06L00 code has subsequently been reassigned to parent class “Disorders of autonomic nervous system”, and parent class, “[G93] Other disorders of brain” (an ICD-10 legacy parent class which had previously been proposed to be removed or retired) has since reappeared as a parent class at “06L02”.

“Chronic fatigue syndrome” is currently listed not at, or under “06L00”, or under parent class “06L02” [formerly parent class G93, under which had sat PVFS and (B)ME and a number of other child classes to G93], but is currently assigned the Sorting label “23A113.00” under:

23 Special tabulation lists for mortality and morbidity
  > 23A Tabulation list for mortality
     >> 23A113 Selected cause is Remainder of the nervous system in Condensed and selected Infant and  child mortality lists
         >>> 23A113.00 Chronic fatigue syndrome

(for which no rationale or “Discussion Note” is evident in the public version), together with a long list of other Chapter 6 categories listed under Special tabulation lists for mortality and morbidity.

I would advise against attempting to determine ICD-11 proposals based on the status of the information as it currently displays, the ambiguities, the lack of visible “Discussion Notes” which explain changes (which had been visible in the iCAT platform, last year) and given that input and organization of data on the multi editor platform is subject to daily revision by numerous ICD Revision personnel, is therefore in a state of flux and may contain technical errors and omissions due to software glitches and human error in data entry and operation of a complex electronic platform.

I wrote to WHO’s Sarah Cottler in September 2011 requesting clarifications. No response was received.

Click here for ICD Caveats

 

Screenshot from ICD11 Alpha  retrieved May 17 – 11.02 UTC    Chapter 6 Diseases of the nervous system: Foundation Tab selected

ICD11 Alpha Chapter 6

    »  http://apps.who.int/classifications/icd11/browse/f/en#/@_@who_3_int_1_icd_2_G93_3_3

Screenshot from ICD11 Alpha  retrieved May 19 – 11.02 UTC    Chapter 6: Linearizations Tab > Morbidity selected

    »  http://apps.who.int/classifications/icd11/browse/l-m/en#/@_@who_3_int_1_icd_2_G93_3_3

 

Slipping Timeline

In May, I reported that the revision of ICD-10 and development of ICD-11 is running about a year behind targets for the population of content and software development and that the ICD-11 Timeline for Alpha and Beta drafting has been adjusted [1]. In order to meet its revised schedule, the technical work on ICD-11 will need to be completed by 2013, the year the APA’s DSM-5 is slated for publication. 

Drafting platforms

In November 2010, the iCAT platform through which ICD-11 was being drafted was taken out of the public domain. In May, this year, an ICD-11 Alpha browser was released for public viewing [2], with a number of caveats [3].

This most recently published Alpha platform does not include many of the “Content Model” parameters, for example, no draft “Definitions” are included and neither are the  “Discussion Notes” and “Change Histories” that had been viewable in the iCAT, as it stood last June to November. You can see screenshots of the June to November 2010 version of the iCAT in this post [4].

For screenshots from the most recent Alpha Browser for:

Chapter 6: Diseases of the nervous system > 06L Other disorders of the nervous system > 06L00 Chronic fatigue syndrome

see this post [5] or pull up the Alpha Browser pages, here [6].

As you’ll see, ICD-10 Chapter VI (6) is undergoing reorganization and the parent class “G93 Other disorders of brain” under which “Postviral fatigue syndrome”, “Benign myalgic encephalomyelitis” and many other ICD-10 categories had sat is proposed to be removed. A change of hierarchy between “Postviral fatigue syndrome” and “Chronic fatigue sydrome” is recorded in a “Change History” note.

Reorganization of Chapter 6 Diseases of the nervous system

Chapter 6 categories for ICD-11 are currently assigned the codes 06A thru 06L02. It is not known what codes will eventually be assigned to the categories within ICD-11 Chapter 6. As you’ll see from the screenshots, “06L00 Chronic fatigue syndrome” is proposed to be classified under “06L Other disorders of the nervous system”, with “Benign myalgic encephalomyelitis” specified as an Inclusion term to “06L00 Chronic fatigue syndrome”.

Relationships between Inclusion terms are not specified within ICD-10, but they will be specified within ICD-11.

Go here for ICD-11 Chapter 5 “Neurotic, stress-related and somatoform disorders” > Somatoform Disorders and Neurasthenia:

http://apps.who.int/classifications/icd11/browse/f/en#/@_@who_3_int_1_icd_2_F45

http://apps.who.int/classifications/icd11/browse/f/en#/@_@who_3_int_1_icd_2_F48_3_0

Go here for ICD-11 Chapter 18 “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified” > Malaise and fatigue:

http://apps.who.int/classifications/icd11/browse/l-m/en#/@_@who_3_int_1_icd_2_R53

 

The Revision Steering Group (RSG) and the various ICD Revision Topic Advisory Groups (TAGs) and their external reviewers for content and proposals are using a more layered version of the platform on which they are undertaking the ongoing drafting process; their platform is currently accessible only to WHO, ICD Revision and IT technicians.

The public version of the ICD-11 Alpha Browser, which is being updated daily, is currently open for public viewing only – not for commenting on. But in July, ICD Revision is planning to open up the Alpha Browser for one year for public commenting and consultations.

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

ICD-11 Timeline

Compiled from the most recent Timelines [1] [7]:

May 2011: Alpha Browser opened up for public viewing [Reached]

July 2011: Alpha Browser opened up for public commenting

+1 year for Commentaries and consultations

May 2012: Beta version opened up to public and Field Trials Version

+2 years for Field trials

2014: Final version for public viewing

May 2015: Presentation of the final version for World Health Assembly (WHA) Approval

Stakeholder participation

The WHO will be engaging with stakeholders who express an interest in participating in the ICD revision process.

Individuals may register to:

Make comments

Make proposals to change ICD categories

Participate in field trials

Assist in translating

The drafting browsers will be open all year round, subject to continuous daily updates and open to all interested stakeholders – Health Care Providers, Information Managers etc. Proposals and feedback will be subject to structured peer review by the Topic Advisory Groups.

For more information on how stakeholder participation is being projected see presentation slides in these reports on my site [8] [9].

Registering for participation

It’s currently unclear which classes of stakeholder might be called upon to participate, and to what extent, during the Alpha drafting stage.

The Stakeholder Registration Form [10] currently appears geared for participation by medical and allied health professionals and administrators. Irrespective of whether the “Yes” or “No” field for the question “Are you a health care professional?” is selected, one is presented with the same options:

Register to become involved

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

WHO wants to know if you are interested in being involved in the ICD Revision. We will contact you as certain features are opened to the public.

What is your clinical profession?

Medicine

Psychology

Nursing

Counselling

Social Work

Health Information Manager

Coder

Which of the following describes your highest educational attainment? Pre-University; University Degree; Non-doctoral post graduate degree (e.g. Master’s;) Doctoral degree (PhD, post bachelor’s MD, or similar)

Are you interested in participating in:

Making proposals

Peer-reviewing

Field trials

I will check the form again, once the Alpha draft has been opened up for public comment, currently scheduled for July. It is anticipated that an Alpha browser using different software from that currently in use may be released in July. I will update when the browser is opened up for public comment.

The ICD-11 “Content Model”

The WHO’s, Dr Bedhiran Üstün, describes ICD-10 as a “laundry list”. One of the most significant differences between ICD-10 and the forthcoming ICD-11 will be the “Content Model”.

Content Model

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

The content model is a structured framework that captures the knowledge that underpins the definition of an ICD entity.

Represents ICD entities in a standard way

Allows computerization

Each ICD entity can be seen from different dimensions or “parameters”. E.g. there are currently 13 defined main parameters in the content model to describe a category in ICD (see below).

A parameter is expressed using standard terminologies known as “value sets”

Content Model Parameters

ICD Entity Title

Classification Properties

Textual Definitions

Terms

Body System/Structure Description

Temporal Properties

Severity of Subtypes Properties

Manifestation Properties

Causal Properties

Functioning Properties

Specific Condition Properties

Treatment Properties

Diagnostic Criteria

For more information on the application of the “Content Model” see document [11].

Definitions

There are no definitions inlcuded in any volume of ICD-10 for  “Postviral fatigue syndrome”, “Benign myalgic encephalomyelitis” or “Chronic fatigue syndrome”. WHO has never set out what it understands by these terms nor has it specified what ICD-10 understands the relationships between these three terms to be (see page: https://dxrevisionwatch.wordpress.com/icd-11-me-cfs/) but there will be definitions in ICD-11 and the relationships between Inclusion terms will be specified.

Definitions

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

All ICD entities will have definitions: key descriptions of the meaning of the category in human readable terms – to guide users

Limited definition in Print Version – 100 words

Detailed definitions ONLINE

Definitions will be compatible with:

– the Content Model

– Diagnostic Criteria

– across the whole classification and the versions

Versions of ICD-11 are planned for multiple settings:

Primary Care

Clinical Services

Research

Specialty Adaptations of ICD-11 are being planned for:

Children and Youth

Oncology

Mental Health

Neurology

Musculoskeletal

Dermatology

Dentistry

————————————–

Sources, references and further reading:

ICD-11 Revision on main WHO website

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

1] ICD-11 Revised Timeline

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

2] ICD-11 Alpha Browser Platform

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

3] ICD-11 Alpha Browser Caveats

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

4] Article: iCAT collaborative authoring platform, June to November 2010, screenshots and notes

https://dxrevisionwatch.wordpress.com/2010/06/07/pvfs-me-cfs-and-the-icd-11-alpha-draft-and-icat-collaborative-authoring-platform/

5] Article: ICD-11 Alpha Browser Platform, screenshots and notes for Chapter 6: Diseases of the nervous system > 06L Other disorders of the nervous system > 06L00 Chronic fatigue syndrome

https://dxrevisionwatch.wordpress.com/2011/05/19/icd-11-alpha-drafting-platform-launched-17-may-public-version/

6] ICD-11 Alpha Browser Platform: ICD-11 entity “06L00 Chronic fatigue syndrome”

Foundation:

http://apps.who.int/classifications/icd11/browse/f/en#/@_@who_3_int_1_icd_2_G93_3_3

Linearizations Morbidity:

http://apps.who.int/classifications/icd11/browse/l-m/en#/@_@who_3_int_1_icd_2_G93_3_3

7] ICD-11 Timeline: PowerPoint presentation (in PDF format)

http://unstats.un.org/unsd/class/intercop/expertgroup/2011/AC234-P32.PDF

8] Article: ICD Revision Process Alpha Evaluation Meeting documents and PowerPoint slide presentations

https://dxrevisionwatch.wordpress.com/2011/04/19/icd-revision-process-alpha-evaluation-meeting-presentations/

9] Article: ICD-11 Revision Steering Group struggling to meet targets for release of Beta Draft platform in May

https://dxrevisionwatch.wordpress.com/2011/04/11/icd-11-struggling-to-meet-targets-for-release-of-beta-draft-in-may/

10] Register for participation in ICD-11 Alpha drafting process

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

Stakeholder Registration form

https://spreadsheets.google.com/spreadsheet/viewform?formkey=dDVabnF1RFpTQkVnVEN2TXhVRm55MGc6MQ

[11] ICD-11 Content Model Reference Guide version January 2011

http://sites.google.com/site/icd11revision/home/documents

https://dxrevisionwatch.files.wordpress.com/2011/02/content20model20reference20guide20january2020111.doc

ICD Revision: WHO announces revised Timeline for ICD-11

ICD Revision: WHO announces revised Timeline for ICD-11

Post #79 Shortlink: http://wp.me/pKrrB-16e

The information in this report relates only to ICD-11, the forthcoming revision of ICD-10 that is scheduled for completion and pilot implementation in 2014/15. It does not apply to the forthcoming US specific Clinical Modification of ICD-10, known as ICD-10-CM.

The following has been published on the WHO’s website in the last couple of days. Note that the original timeline had scheduled presentation to the WHA (World Health Assembly) in May 2014, for pilot implementation of ICD-11 in 2014. This most recent timeline for ICD-11 Revision suggests that implementation is being postponed until 2015+.

A WHO news release (if issued) and details on how to access the drafting platform, will be posted as more information becomes available.

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

ICD Revision Timelines

May 2011

Open ICD-11 Alpha Browser to the public for viewing

July 2011

Open ICD-11 Alpha Browser to the public for commenting

May 2012

Open ICD-11 Beta to the public

ICD-11 Beta Information
WHO will engage with individuals from an outside community to participate in the ICD revision process.

Individuals will be allowed to:

Make comments
Make proposals to change ICD categories
Participate in field trials
• Assist in translating

May 2015
Present the ICD-11 to the World Health Assembly 

Related information:

Alpha and Beta drafting process:

ICD Revision Process Alpha Evaluation Meeting documents and PowerPoint slide presentations, April 19, 2011: http://wp.me/pKrrB-10i

ICD Revision Process Alpha Evaluation Meeting 11 – 14 April 2011: The Way Forward? April 19: 2011: http://wp.me/pKrrB-ZN

 

Key documents and references:

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

2] Key document: Content Model Reference Guide version January 2011

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