ICD-11 Alpha Drafting platform launched 17 May (public version)

May 19, 2011 by

ICD-11 Alpha Drafting platform launched 17 May (public version)

Post #81 Shortlink: http://wp.me/pKrrB-16N

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

Changes to Alpha Draft since May 17, 2011:

May 19 – 11:02 UTC : Code/sorting label assigned to Parent class “Other disorders of the nervous system” changed from 06N to 06L.

Screenshot from ICD11 Alpha  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  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

 

Four new pages were published on the WHO’s main website on 17 May – the revised Timeline for ICD-11, the announcement of an Alpha Draft browser, a Registration form and a Caveat. Yesterday, I posted the revised ICD-11 Revision Timeline.

What can be seen for PVFS, (B)ME and CFS in the public Alpha Draft?

For the Alpha browser, go to this page:

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

Here it states:

The International Classification of Diseases 11th Revision is due by 2015

ICD is the international standard to measure health & health services

• Mortality statistics
• Morbidity statistics
• Health care costs
• Progress towards the Millenium Development Goals
• Research

– Alpha draft is updated daily as the work progresses
– It is intended to show the new features to stakeholders early
– Commenting will be available in July 2011

The link for the alpha browser is:

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

This is the link to a page for “Caveats”

“Read more on what to expect in the ICD-11 Alpha Draft”

ICD-11 Alpha Draft Caveats

ICD-11 alpha draft is:

• Incomplete
• May contain errors, omissions or imperfections
• The work in different chapters are at different stages
• The alpha drafting work is going on by the WHO, Revision Steering Group and Topic Advisory Groups
• The alpha draft is going to be updated on a daily basis
• The alpha draft is NOT TO BE USED for CODING at this stage
• The alpha draft has not yet been approved by the Topic Advisory Groups, Revision Steering Group or WHO

Click here to access the public Alpha Draft browser

Poke around and open the Parent and Child categories and the Tabs – you cannot edit or break anything.

This new interface is not as detailed or as easy to navigate as the software version of the iCAT collaborative drafting platform that was in the public domain up until November, last year. Less information is visible, for example, some of the paramenter tabs, including “Definitions”. (Compare with what could be seen in this iCAT screenshot from last June.)

This is a public draft and another platform is being used by ICD Revision for ongoing drafting. The public draft will be updated as the work of the various Topic Advisory Groups and working groups progresses. ICD Revision has not reached its targets for the generation of content and population of “Content Model” fields across all chapters and this draft is not as far forward as ICD Revision had projected for a May 2011 release.

Though viewable now, the Alpha drafting browser is not planned to be open for public comment until July, this year. It’s not yet clear which classes of public stakeholder will be able to participate in the drafting process, come July, or to what extent.

If you are interested in the proposed public comment, interaction and input processes for the Alpha and Beta drafting stages, see this DSM-5 and ICD-11 Watch post for meeting presentation slides.

Summary

First a caveat: It had been anticipated that a Beta drafting platform would be released in May, this year. WHO has cited lack of content and underdeveloped software for delaying the launch of a Beta drafting platform.

This public version of an Alpha drafting platform is a “work in progress”; not all disease and disorder categories may have been entered into the draft and proposed textual content is in the process of being authored and reviewed by the various Topic Advisory Groups, ICD Revision Steering Group and external peer reviewers.

From what can be seen, today, 19 May:

06L00 Chronic fatigue syndrome

is proposed to be coded within Chapter 6 Diseases of the nervous system (the Neurology chapter), as an ICD Title category, under the Parent class, 06L Other disorders of the nervous system.

Benign myalgic encephalomyelitis is specified as an Inclusion to 06L00 Chronic fatigue syndrome.

“Causal mechanisms” for 06L00 Chronic fatigue syndrome are cited as “Virus (organism)”.

The relationship between ICD Title category 06L00 Chronic fatigue syndrome and Inclusion term Benign myalgic encephalomyelitis is not yet specified, ie whether for ICD-11, “Benign myalgic encephalomyelitis” is proposed to be specified as a Synonym , Subclass or other relationship to “06L00 Chronic fatigue syndrome”.

Many categories within the draft are waiting for their Inclusion terms to be specified, not just the three terms of interest to us.

For explanation of Inclusions and other “Content Model” parameter terms, see: iCAT Glossary or the key ICD-11 Content Model document.

6 Inclusions

Details: Inclusion terms appear in the tabular list [Ed: ICD Volume 1] of the traditional print version and show users that entities are included in the relevant concept. All of the ICD-10 inclusion terms have been imported and accessible in the iCat. These are either synonyms of the category titles or subclasses which are not represented in the classification hierarchy. Since we have synonyms as a separate entity in our ICD-11 content model, the new synonyms suggested by the users should go into the synonyms section. In the future, iCat will provide a mechanism to identify whether an inclusion is a synonym or a subclass.”

 

What is the proposed relationship between PVFS and CFS?

Postviral fatigue syndrome is not accounted for in the “Foundations” or “Linearizations > Morbidity” listings.

In ICD-10, Postviral fatigue syndrome is an ICD Title category under G93 Other disorders of brain. I cannot confirm, but it may be that due to the hierarchy  change, “Postviral fatigue syndrome” is proposed to be subsumed under “06L00 Chronic fatigue syndrome” with “06L00 Chronic fatigue syndrome” becoming the ICD Title category, because “G93.3 Postviral fatigue syndrome” has lost its ICD-10 Parent category.

At the moment, there is not sufficient information displaying to determine what the intention is. Last June, I requested a clarification from Dr Raad Shakir, chair of Topic Advisory Group for Neurology, but no clarification has been forthcoming.

In the iCAT initial drafting platform, last November, where “Postviral fatigue syndrome” was referenced within a “Category Note” and specified as an Exclusion to Chapter 5 and Chapter 18,  it was referenced as:

“G93.3 Postviral fatigue syndrome -> Gj92 Chronic fatigue syndrome”

[“Note: Gj92” is a “Sorting label” assigned for the initial Alpha drafting process, not an eventual ICD-11 code.]

 

“Change history” note from May 2010

In ICD-10, “Postviral fatigue syndrome” is a Title code at G93.3 under Parent category “G93 Other disorders of brain”. “Benign myalgic encephalomyelitis” sits under “G93.3 Postviral fatigue syndrome” (relationship unspecified).

As previously reported, an iCAT “Change history” note, dated 1 May 2010, records a “Change in hierarchy for class: G93.3 Postviral fatigue syndrome because its parent category (G93 Other disorders of brain) is removed.”

This would leaves the existing ICD-10 G93.3 Title category, “Postviral fatigue syndrome” and “Benign myalgic encephalomyelitis” that sits beneath it, and also the G93.3 index entry for Chronic fatigue syndrome with no parent category.

Note that the removal of the parent “G93 Other disorders of brain” affects many other categories also classified under G93 in ICD-10 which have also been assigned new parents under the reorganization of Chapter 6 (VI).

Screenshot of “Change history” Note from May 2010

 

Exclusions

No Exclusions have been specified yet for “06L00 Chronic fatigue syndrome”.

“Postviral fatigue syndrome” is specified as an Exclusion to the following ICD-11 chapters:

Chapter 5 “05E06 Other neurotic disorders > 05E06.00 Neurasthenia”
Chapter 18 “18GF General symptoms and signs > 18F03 Malaise and fatigue.”

(Chapter 18 is the “R code” chapter of ICD-10; ICD-10-CM proposes to retain CFS under R53 Malaise and fatigue at R53.82 Chronic fatigue, unspecified, as “Chronic fatigue syndrome NOS”, with the Exclusion: Postviral fatigue syndrome G93.3.)

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

http://apps.who.int/classifications/icd11/browse/f/en#/@_@who_3_int_1_icd_2_F40-F48

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

http://apps.who.int/classifications/icd11/browse/l-m/en#/@_@who_3_int_1_icd_2_XVIII

 

Congruency with DSM-5 proposals for revision of DSM-IV “Somatoform Disorders”

There is no obvious mirroring of the radical proposals currently being put forward by the DSM-5 Somatic Symptom Disorders Work Group to rename “Somatoform Disorders” to “Somatic Symptom Disorders” and combine a number of existing somatoform categories under a new rubric, “Complex Somatic Symptom Disorder”.

 

Registering for involvement

There is a Registration form here

This form appears to be aimed at recruiting medical health professionals for putting their names down to be contacted at some point to “Make comments; Make proposals to change ICD categories; Participate in field trials; Assist in translating“. It’s not clear whether or at what point in the Alpha/Beta drafting processes involvement might be extended to non professional stakeholders.

Register to become involved

ICD-11 Registration

“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.”

[Fields are: Family name*; First name*; Email address*; Organization or Company*; LinkedIn ID; Are you a health care professional?* Yes/No. Continue…]   *Required fields

 

Related information

1] ICD11 Alpha browser

2] ICD Revision Process Alpha Evaluation Meeting documents and PowerPoint slide presentations

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

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

Filed under ICD revision process, ICD-10, ICD-11, ICD-11 Alpha Draft, ICD-11 Beta Draft, ICD-11 consultation, ICD-11 revision docs, Somatic Symptom Disorder, Somatoform Disorders, WHO (World Health Organization)

ICD Revision: WHO announces revised Timeline for ICD-11

May 18, 2011 by

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

Filed under American Psychiatric Association (APA), iCAT, ICD revision process, ICD-10, ICD-11, ICD-11 Alpha Draft, ICD-11 Beta Draft, ICD-11 consultation, ICD-11 revision docs, WHO (World Health Organization)

Live streaming of CFSAC Meeting (US) today, 10-11 May

May 10, 2011 by

Live streaming of CFSAC Meeting (US) today, 10-11 May

Post #76 Shortlink: http://wp.me/pKrrB-14n

Chronic Fatigue Syndrome Advisory Committee (CFSAC)
May 10-11, 2011
Room 800, Hubert H. Humphrey Building
200 Independence Ave, S.W.
Washington, D.C. 20201

A reminder that Day One of the two day spring CFSAC meeting will be streaming live today.

A copy of the Meeting Agenda is published in this post:

CFSAC Spring 2011 Meeting Agenda (May 10-11): http://wp.me/pKrrB-126

Public and Written Testimonies can be read and downloaded from this page of the CFSAC website:

http://www.hhs.gov/advcomcfs/meetings/presentations/05102011.html

The meeting proceedings can be watched live at this page (Requires Windows Media Player version 9 or higher or Silverlight Player installed): http://nih.granicus.com/ViewPublisher.php?view_id=26

The archived videocasts have had simultaneous subtitles.

The meeting opens at 9.00am Washington D.C. time (which is around 5 hours time difference with UK).  So streaming should commence  about five minutes before 2.00pm UK time (usually the microphones are switched off until just before the meetings starts, so anticipate video only until the meeting is called to order).

ICD-10-CM proposed coding issue

I am very pleased that the issue of the proposed coding for CFS in the forthcoming ICD-10-CM (a US specific “Clinical Modification” of ICD-10 scheduled for implementation in October 2013 and subject to a partial code freeze, in October 2011) has been placed back on the agenda and that an hour’s time has been tabled for discussion of this important item.

Discussion of ICD-10-CM is tabled to start at 1.15pm Washington D.C. time (6.15pm UK time).

1:15 p.m. Discussion of International Classification of Diseases-Clinical Modification (ICD-CM) concerns     Committee Members

During the Public Testimony sessions, US patient and patient advocate, Mary Schweitzer, Ph.D., will be speaking about the CDC and also references the ICD-10-CM coding issue:

http://www.hhs.gov/advcomcfs/meetings/presentations/publictestimony_201105_schweitzer.pdf

[…]

NCHS, within CDC, is overseeing the development of ICD-10-CM. We need to keep CFS in the same code as in ICD-10 – under neurology, at G93.3. That’s where it is in WHO’s index to ICD-10 – adopted by over one hundred nations. It’s also under G93.3 in the tabular versions of the clinical modifications produced by Canada, Germany, and Australia. It should not be placed in R53.82, under “vague signs and symptoms.” We would be the only nation to have CFS in R53.82. Why?

A one page handout outlining the ICD-10-CM coding issue is being circulated at the meeting and can be read here: CFSAC Handout ICD-10-CM 10 May 2011

Filed under CFIDS Association, CFSAC meetings, Clinical Modification, DSM revision process, ICD-10, ICD-10-CM, ICD-11, ICD-11 Alpha Draft, Professor Peter White, WHO (World Health Organization), WHO Collaborating Centre

CFSAC Spring 2011 Meeting Agenda (May 10-11)

April 29, 2011 by

CFSAC Spring 2011 Meeting Agenda (May 10-11)

Post #72 Shortlink: http://wp.me/pKrrB-126

The Agenda for the next meeting of the Chronic Fatigue Syndrome Advisory Committee (CFSAC) has been issued and can be read on the CSFSAC website here and below.

Transcripts of some Public and Written Testimonies for the May meeting can be read on this page of the CFSAC website.

“The Chronic Fatigue Syndrome Advisory Committee (CFSAC) provides advice and recommendations to the Secretary of Health and Human Services via the Assistant Secretary for Health of the U.S. Department of Health and Human Services on issues related to chronic fatigue syndrome (CFS). These include:

  • factors affecting access and care for persons with CFS;
  • the science and definition of CFS; and
  • broader public health, clinical, research and educational issues related to CFS.

“Administrative and management support for CFSAC activities is provided by the Office of the Assistant Secretary for Health (OASH). However, staffing will continue to be provided primarily from the Office on Women’s Health, which is part of OASH.

“Dr. Wanda K. Jones, Principal Deputy Assistant Secretary for Health in OASH, will continue in her role as the Designated Federal Officer for CFSAC.”

I am pleased to see that discussion of concerns around the proposed coding of CFS for the forthcoming US specific “Clinical Modification” of ICD-10, which is known as “ICD-10-CM”, has been tabled for further discussion, at 1.15pm on Day One of  the meeting.

CFSAC Spring 2011 Meeting Agenda (May 10-11)

Day One

9:00 a.m.

Call to Order
Opening Remarks

Dr. Christopher Snell
Chair, CFSAC

Roll Call, Housekeeping

Dr. Wanda Jones
Designated Federal Official

9:15 a.m.

Agency Updates and Progress on Recommendations: CDC, HRSA, AHRQ, FDA, CMS

Ex-Officio Members

10:00 a.m.

State of the Knowledge Workshop- Outcomes and Committee Discussion

Dennis Mangan, NIH
Committee Members

11:00 a.m.

Break

11:15 a.m.

Public Comment

Public

12:15 p.m.

Subcommittee Lunch

Subcommittee Members

1:15 p.m.

Discussion of International Classification of Diseases-Clinical Modification (ICD-CM) concerns

Committee Members

2:15 p.m.

Committee Discussion

Committee Members

3:15 p.m.

Break

3:30 p.m.

Public Comment

Public

4:30 p.m.

Committee Discussion and Plans for Day 2

Committee Members

5:00 p.m.

Adjourn

 

Day Two

9:00 a.m.

Call to Order
Opening Remarks:

Dr. Christopher Snell
Chair, CFSAC

Roll Call, Housekeeping:

Dr. Wanda Jones
Designated Federal Official

9:15 a.m.

Welcome Statement from the Assistant Secretary for Health

Dr. Howard K. Koh

9:30 a.m.

Social Security Administration: Presentation on Disability

John Federline, SSA

10:00 a.m.

ERISA and Insurance Issues for CFS Patients (Tentative)

Department of Labor (TBD)

11:00 a.m.

Break

11:15 a.m.

Committee Discussion

Committee Members

12:00 p.m.

Subcommittee Lunch

Subcommittee Members

1:00 p.m.

Public Comment

Public

2:00 p.m.

Break

2:15 p.m.

Committee Discussion: Finalize Recommendations

Committee Members

4:30 p.m.

Adjourn

Related information

[1] Post: Next meeting of the Chronic Fatigue Syndrome Advisory Committee (CFSAC) (US): http://wp.me/pKrrB-YY

[2] Post: CFS orphaned in the “R” codes in US specific ICD-10-CM: http://wp.me/pKrrB-V4

[3] International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). Note: The 2011 release of ICD-10-CM is now available and replaces the December 2010 release:
http://www.cdc.gov/nchs/icd/icd10cm.htm

[4] US “Clinical Modification” ICD-10-CM. This article clarifies any confusion between ICD-10, ICD-11 and the forthcoming US Clinical Modification, ICD-10-CM: http://wp.me/pKrrB-Ka

[5] Chronic Fatigue Syndrome Advisory Committee (CFSAC). The Chronic Fatigue Syndrome Advisory Committee (CFSAC) provides advice and recommendations to the Secretary of Health and Human Services via the Assistant Secretary for Health of the U.S. Minutes of meetings, Recommendations and meeting videocasts:
http://www.hhs.gov/advcomcfs/meetings/index.html

Filed under CFSAC meetings, Clinical Modification, ICD-10, ICD-10-CM, ICD-11, ICD-11 Alpha Draft, ICD-11 Beta Draft, WHO (World Health Organization)

ICD Revision Process Alpha Evaluation Meeting presentations

April 19, 2011 by

ICD Revision Process Alpha Evaluation Meeting documents and PowerPoint slide presentations

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

The information in this mailing 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.

ICD Revision Process Alpha Evaluation Meeting

An ICD Revision Process Alpha Evaluation Meeting was held, last week, in Geneva. See this post on DSM-5 and ICD-11 Watch site for more information and commentary: http://wp.me/pKrrB-ZN

The Agenda for the meeting can be read here: ICD11 April 2011 Meeting Agenda Word .docx

Following this meeting, it is anticipated that ICD Revision Steering Group may make a public announcement within the next few weeks of how it intends to proceed in light of the fact that the timeline for transition from the Alpha to Beta drafting phases has slipped.

The meeting Agenda and PowerPoint slides suggest that ICD Revision is working towards making a version of the drafting platform publicly available around 16 May, this year, but that this may be a compromise on previous plans and possibly a “hybrid” between the Alpha and Beta drafting phases.

Earlier timelines had approval by World Health Assembly (WHA) slated for May 2014, with pilot implementation of ICD-11 in March 2014. One presentation slide now suggests approval by WHA in 2015.

It’s unconfirmed, but if this is the case, WHO may have already decided to shift WHA endorsement and dissemination of ICD-11 by 12 months, to 2015. This would mean that DSM-5 would have been put to bed and published two years prior to ICD-11 implementation.

From the meeting Agenda:

“Future Phases:

a. iCAT continued alpha development and evaluation ( 2010-11)

b. iCAT beta phase ( 2012-2015)

c. iCAT continuous maintenance phase ( 2015+)”

In November, last year, the iCAT collaborative authoring platform through which ICD-11 is being drafted was taken out of the public domain. A revised version of the software on which the platform runs is currently sitting on a Standford server, behind a password, accessible only to ICD Revision. This, or a similar version, may be made publicly accessible (or accessible to those who register for access) from mid May.

There has been discussion is earlier ICD Revision documents of a hierarchy of stakeholder input – but there is nothing much on this in the meeting presentations, for which ICD Revision has published only slides – not transcripts.

Coming up on DSM-5 and ICD-11 Watch:

ICD-11 proposals for PVFS, ME and Chronic fatigue syndrome

Until some form of Alpha/Beta transition drafting platform is back in the public domain, it won’t be evident how much further forward the population of content for Chapter 6 Diseases of the nervous system has progressed since last November. As more information becomes available, I will update, and I will be posting a summary of how things stood in the iCAT last November, in Post #72.

ICD Revision Process Alpha Evaluation Meeting presentations

There are five presentations published for this meeting: the following three may be of interest to those following the development of ICD-11:

(The 2007 MS PowerPoint viewer is required to view PowerPoint presentations which have been created in .pptx format. A MS .pptx viewer can be downloaded for free from the Microsoft site.)

Open full PowerPoint Presentation:”The Way Forward Questions Options” [.ppt]: TheWayForwardPP

Selected slides from “The Way Forward Questions Options”

Slide 2

Slide 3

Slide 5

Slide 6

Slide 12

Slide 17

Open full PowerPoint Presentation:”The Way Forward Questions Options” [.pptx]: TheWayForwardPP

——————

Open full PowerPoint Presentation: “Proposal for the ICD Beta Platform, Stanford team” [.ppt]: iCATBetaStanford[1]

Selected slides from “Proposal for the ICD Beta Platform, Stanford team”

Slide 5

Slide 11

Slide 12

Slide 41

Slide 42

Slide 43

Slide 44

Slide 45

Slide 46

Slide 51

Open full PowerPoint Presentation: “Proposal for the ICD Beta Platform, Stanford team” [.ppt]: iCATBetaStanford[1]

——————

Open full Can Celik PowerPoint Presentation: “Public Tooling” [.pptx]: Ppt0000069 CanCelic 

Selected slides from Can Celik’s PowerPoint Presentation: “Public Tooling”

Slide 4

Slide 7

Slide 10

Slide 11

Slide 12

Slide 13

Slide 14

Slide 15

Open full Can Celik PowerPoint Presentation: “Public Tooling” [.pptx]: Ppt0000069 CanCelic 
 

Key documents and references:

1] ICD Revision Process Alpha Evaluation Meeting Agenda and background documents

2] Report, WHO FIC Council conference call, 16 February 2011, PDF format

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

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

5] PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring Platform (DSM-5 and ICD-11 Watch report with screenshots from the iCAT): http://wp.me/pKrrB-KK

Filed under DSM revision process, iCAT, ICD revision process, ICD-10, ICD-11, ICD-11 Alpha Draft, ICD-11 Beta Draft, ICD-11 consultation, ICD-11 revision docs, WHO (World Health Organization)

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

April 19, 2011 by

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

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

The information in this mailing relates only to ICD-11, the revision of ICD-10 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 Way Forward?

ICD-11 Revision maintains a website on a Google platform where key documents, agendas for iCAMP and workgroup meetings, background documents and presentations can be viewed and downloaded. Minutes or summaries of meetings aren’t usually posted publicly:

ICD-11 Revision: http://sites.google.com/site/icd11revision/home

An ICD Revision Process Alpha Evaluation Meeting was held in Geneva, last week, between 11-14 April, for discussing the status of the revision of ICD-10 and development of ICD-11, for both content and software development, and reviewing the ICD revision “Roadmap” and Timeline.

A copy of the Meeting Agenda can be downloaded from the ICD-11 Revision site here or opened on DSM-5 and ICD-11 Watch site here: ICD11 April 11 Meeting Agenda. There are some interesting comments in the Agenda Appendix on project funding, lack of resources, project management and lines of communication.

There are five PowerPoint presentations available to download from this page.

If you are interested in the ICD Revision process, in general, then I suggest visiting the site and viewing or downloading the following three presentations – these are slides only, with no notes or transcripts.

(The 2007 MS PowerPoint viewer is required to view presentations that have been created in .pptx format. A .pptx viewer can be downloaded free from the Microsoft site.)

.ppt file: The Way Forward

.pptx file: Can Celik’s Presentation: Public Tooling

.pptx file: Stanford’s Presentation: iCAT Beta

These three presentations can also be opened in the next post on DSM-5 and ICD-11 Watch site and selected slides have been posted here:

Post #71: ICD Revision Process Alpha Evaluation Meeting documents and presentations

 

“Community engagement”

In mid 2009, ICD Revision launched a number of platforms as channels of communication with the public and maintains a YouTube Channel, Facebook site, Twitter and blog. The ICD-11 blog has not been updated since October 2009 and queries left on the Facebook site by members of the public may take several months before a response is provided or may receive no response, at all.

The YouTube videos made to accompany various Geneva meetings can also be accessed on the ICD Revision YouTube page of my site. The two most recent videos give an overview of the iCAT drafting process and the extent of the ICD-11 “Content Model” – the 13 parameters through which ICD-11 categories can be described.

 

Visibility of iCAT drafting platforms

Following last week’s ICD Revision Process Alpha Evaluation Meeting, it is anticipated that ICD Revision may make a public announcement, within the next few weeks, clarifying how it intends to proceed in light of the fact that the timeline for the Beta drafting phase is slipping.

The meeting Agenda and PowerPoint slides suggest that ICD Revision is working towards making a version of the drafting platform publicly available around 16 May, this year, but that this may represent a compromise on previous plans and may be a “hybrid” between the Alpha and Beta drafting phases.

From the Agenda:

“Future Phases:

a. iCAT continued alpha development and evaluation ( 2010-11)

b. iCAT beta phase ( 2012-2015)

c. iCAT continuous maintenance phase ( 2015+)”

Earlier timelines had projected endorsement by the World Health Assembly (WHA) and pilot implementation of ICD-11 in the spring of 2014. But one presentation slide suggests approval by WHA in 2015.

It’s unconfirmed, but if the “Milestones” timeline has been revised to accommodate a later release of a Beta drafting phase platform and later publication of a Beta Draft, then WHO may have already decided to shift the pilot implementation date for ICD-11 by 12 months, to 2015.

That would mean that by the time ICD-11 is ready for dissemination, the American Psychiatric Association’s DSM-5 would have already been put to bed and out in print two years prior to ICD-11 implementation.

It is intended that for ICD-11, all three volumes will be electronically published and capable of continuous updating in response to scientific developments (unlike ICD-10 where there are annual updates); there will also be electronic translations and print editions. The three volumes of ICD-11 are intended to be integrable with each other and also with some other classification systems. 

The drafting platforms are based on Web 2.0 applications and it is proposed that there will be stakeholder and end user participation in the Beta drafting phase.

The IT work and software development for the various alpha and beta drafting platforms and final product platforms is enormously complex; there is also the potential for far more textual content in ICD-11 than there was in ICD-10 and overall, this revision project represents a huge undertaking by an under-resourced organization.

 

The ICD-11 Alpha/Beta drafting process

Topic Advisory Group (TAG) Managing Editors overseeing the revision of the various chapters of ICD-10 have responsibility for recruiting external experts, via networking. The function of the external experts is to peer review proposals being made by TAG members or submitted by external professional bodies and institutions and to review or assist with the generation of textual content.

[In late 2009, I approached the WHO’s Dr Robert Jakob to enquire whether and at what stage the names of external peer reviewers would be identified in the drafting platforms, as visible to the public. I also asked whether the reviewing of proposals as they progressed through the Workflow review system would be a transparent process that could be monitored by the public. Neither query produced a response from Dr Jakob.]

So there are many lines of communication to be maintained between WHO classification experts, IT consultants and technicians, Revision Steering Group members, TAG Managing Editors, TAG members and external experts. There is an ICD-11 Collaborative Authoring Workflow chart here: workflow-2.

At the Beta drafting stage, the proposal is that TAG Managing Editors will continue to recruit external peer reviewers to assist workgoups with reviewing of categories, proposals and generation of content, but that versions of the Beta drafting platform would be opened up to the public for viewing, and interested stakeholders would be able to register for limited input and interaction.

Stakeholders (or preferably, communities of stakeholders) would not have editing rights, per se, but the proposal is that they would comment on proposals, “score” proposals and make evidence-based suggestions which the TAG groups would then consider for approval, which would then be incorporated into the draft or rejected.  There has also been discussion of a “hierarchy” of levels of input according to professional status of stakeholders. How ICD Revision plans to verify the credentials of professionals isn’t clear, nor is it defined what would consitute a stakeholder “community”.

No static Beta Draft for public review and comment

Rather than release a static Beta draft for professional and public scrutiny in a feedback exercise for a pre-determined review period (as DSM-5 has already done and is scheduled to do again in August-September), the proposal appears to be for longer term feedback during an alpha/beta transition drafting phase on dynamic content that would be continuously updated, for example, on a four weekly cycle, to reflect the progress being made by the various Topic Advisory Groups in entering proposals for changes and populatation of textual content, and in response to external input.

So managing editors and members of the Topic Advisory Groups (mostly international clinicians and researchers juggling this work on top of their “day jobs”) are faced with maintaining lines of communication, largely via electronic means, between workgroup chairs, fellow workgroup members, external peer reviewers and WHO classification experts whilst also considering input from professional bodies, and working in the background on the drafting platform, while stakeholders are commenting and feeding suggestions into the process via the public versions of the drafting platforms. 

[Some organizations and professional bodies have been compiling and submitting proposals via an ICD Revision Proposal Form, since late 2009. There is no publicly available list of which institutions and bodies have been invited to submit proposals, which have responded, or where their submissions for changes to ICD-10 can be scrutinised, but copies of these submissions occasionally turn up online, having been published in the organs of these organizations.]

Selected slides from “Proposal for the ICD Beta Platform, Stanford team”:

Slide 11

Slide 12

Slide 42

Slide 43

Slide 45

Slide 46

 

“…who will do all this work?”

Presentations and video clips of the WHO’s Dr. Bedirhan Üstün suggest a man buzzed up on information and internet technology: “cloud sourcing”, portals, public commenting and “scoring” of proposals, wikis, blogs,  internal and public “user communities”, drawing in the involvement of “Wikipedians” and other existing “editing communities” (one questions whether Dr Üstün has any experience of how Wikipedia functions and the problems inherent with some Wikipedia admins and editors, particularly in relation to editing of controversial scientific and medical areas), message boards, Facebook integration, “community engagement”…

But as the closing slide of one of last week’s presentations ruefully comments, “And just a small detail: who will do all this work?” [6]

ICD Revision and its IT and informatics advisors seem eager to use these internet applications because they exist, without having given due consideration to whether the WHO can fund, manage and sustain this level of public participation and interaction or whether this is the best way to approach the revision of the ICD.

How does ICD Revision intend to finance and recruit the personnel needed to manage the opening up of the drafting process to multiple platforms for stakeholder participation, given WHO’s limited resources when already, no-one can evidently be spared to even keep the ICD-11 blog updated or to respond to queries that members of the public have posted on ICD Revision’s existing public platforms and where Topic Advisory Group Chairs approached for brief clarifications are not always providing a response nine months down the line?

Who is going to pull this most ambitious project back down to earth?

Insufficient funding allocated and no Project Manager

From the Appendix to the April meeting Agenda:

“TAGs were supposed to be self-financed.  The TAG chair was supposed to have funding to carry out their revision work.”

“As this is a core WHO activity, we should have regular budget funds for this project.  The scale of this project is too big not to have funding for a project manager.”

“Additionally, ALL relevant WHO departments should have designated some financial and some human resources to this project as part of the collaborative effort.”

“…communication between the TAGs is growing, and it is beginning to become overwhelming in addition to clinical responsibilities.”

 

ICD-11 proposals for PVFS, ME and Chronic fatigue syndrome

Until some form of Alpha/Beta transition drafting platform is back in the public domain, it won’t be evident how much further forward the population of content for Chapter 6 Diseases of the nervous system has progressed since last November. As more information becomes available, I will update, and I will be posting a summary of how things stood in the iCAT last November in Post #72.

The meeting Agenda, selected slides and three of the PowerPoint presentations can be viewed/opened from Post #71, on DSM-5 and ICD-11 Watch site, here:

ICD Revision Process Alpha Evaluation Meeting documents and presentations

 

Key documents and related posts:

1] ICD Revision Process Alpha Evaluation Meeting Agenda and background documents

2] Report, WHO FIC Council conference call, 16 February 2011, PDF format

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

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

5] PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring Platform (DSM-5 and ICD-11 Watch report with screenshots from the iCAT): http://wp.me/pKrrB-KK

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

Filed under iCAT, ICD revision process, ICD-10, ICD-10-CM, ICD-11, ICD-11 Alpha Draft, ICD-11 Beta Draft, ICD-11 consultation, ICD-11 in the media, ICD-11 revision docs, WHO (World Health Organization)

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