ICD-11 struggling to meet targets for release of Beta Draft in May

April 11, 2011 by

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

Post #69 Shortlink: http://wp.me/pKrrB-ZB

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, or to other Clinical Modifications of ICD-10, already in use.

Revision of the WHO’s ICD-10, the version of ICD in current use in the UK and over 110 countries worldwide, has been underway since 2007. The implementation date has already been shifted from 2012 to 2014/15.

A Beta Draft platform for ICD-11 had been scheduled for readiness by April, this year, for public release in May.

An ICD Revision Beta Requirements document states, “The Beta Phase will be open to [the] general public in May 2011 to enable structured input by interested parties subject to peer-review by relevant Technical Advisory Groups.”

But ICD Revision is evidently struggling to keep this project on track.

In October, last year, the Revision Steering Group’s “iCamp2” meeting acknowledged that a considerable amount of work needed to be done if ICD Revision if targets for a May 2011 release of a Beta Draft platform were going to be met.

According to an October iCamp2 PowerPoint presentation, Frequent Criticisms, and iCamp2 meeting videos, targets for the population of content for the Alpha Draft had not been reached: less than 80% of the Terminology Definitions had been uploaded to the iCAT and less than the 20% target for full Content Model completion for the thousands of diseases and disorders classified within ICD had been met.

The Revision Steering Group (RSG) identified a number of barriers to keeping this very technically ambitious project on track: lack of funding; the amount of time required for drafting definitions and population of textual content according to the complex ICD-11 “Content Model”; recruitment of external experts for reviewing proposals and generating content; familiarising the various Topic Advisory Group (TAG) members with informatics and the functionality of the iCAT (the collaborative authoring platform through which ICD-11 is being drafted); the paucity of face-to-face meetings for TAG managing editors and workgroup members, (scattered across the globe and undertaking these roles, by electronic means, in addition to their professional commitments), and difficulties facilitating interaction between the various Topic Advisory Groups where diseases overlap with other chapters.

If ICD Revision is already struggling to maintain targets, motivation and interaction between its various Topic Advisory Groups, then management of the project once the Beta drafting phase is reached and the process opened up to [the projected] thousands of stakeholders is going to present ICD-11 RSG and TAG managing editors with considerable challenges. The ICD-11 iCamp YouTube commentaries have an air of brittle optimism about them.

I have already predicted that come May 2011, we might anticipate some scaling back of plans and/or a possible shift in the release date for the Beta drafting platform (and potentially a further shift in the final ICD-11 implementation date) in response to recognition that the WHO may have significantly overestimated its capacity for obtaining funding and resources to fulfil this most ambitious vision by 2014.

 

Report of a WHO-FIC (WHO Family of International Classifications) Council conference call

http://www.who.int/classifications/network/Council_report_2011_16Feb.pdf

or open  here on Dx Revision Watch site.

This document is the Report of a WHO-FIC Council conference call which took place between 14:00-15:30 Geneva Time, on Wednesday, February 16, 2011. It confirms that ICD Revision is debating whether to go public in May with a Beta drafting platform that falls short of targets for completion or whether to revise its schedule.

From Page 6

“ICD-11 Beta Draft and Timeline

“In the context of the review of preparations for the ICD-11 Beta release, there was a set of arguments for and against a postponement of the beta release.

“The status was summarized as in the slide below.

“In discussion the WHO FIC Council Members commented:

• It is essential to have a good product that goes out to the general public.
• Extra time is needed for the cross-cutting TAGs as most substantive review is starting lately.
• On the other hand, having no public input into the process is of concern.

“Wider input is necessary; and public and transparency input was a goal of the revision process. 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 may be a better solution.

“WHO thanked the Council for their valuable input and contribution to the decision-making process. The TAG input is going on and the RSG has to review the topic as well. Given the current stage and pace of work, however, it is unlikely that the ICD-11 will be fulfilling the criteria for a beta version in April – either in terms of content or the software preparations. The financial situation of WHO requires more austere measures rather than a full-scale RSG meeting as planned in 11-15 April. Accordingly a decision will be made and conveyed to all stakeholders.”

 

I will update if and when ICD Revision issues an information release on its decision about the Beta Drafting platform and clarifies its intentions for the extent of public participation, or when more information becomes available.

In November, the iCAT electronic authoring platform through which the Alpha Draft was being developed was taken out of the public domain. The server for the improved version of the iCAT, which provides the platform for drafting the Beta is sitting behind a password, here: http://icat.stanford.edu/.

Access and editing rights are currently restricted to WHO, Revision Steering Group, the various ICD-11 Topic Advisory Group managing editors and members, reviewers of content and proposals and IT technicians. But it was envisaged that at the Beta stage, the drafting platform would be opened up for public access and to interested stakeholders who register for limited imput.

The Alpha and Beta drafts are “works in progress”. Proposals as they stood in the iCAT collaborative drafting platform in November, last year, are that all three terms, PVFS, (B)ME and Chronic fatigue syndrome should be classified within ICD-11 Chapter 6: Diseases of the nervous system [1].

A meeting was expected to be held in Geneva, this week, and I will post further information as it becomes available on the ICD Revision Google site.

 

References:

1] PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring Platform (Report with screenshots from the Alpha drafting stage iCAT)

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

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

Filed under Clinical Modification, iCAT, ICD on YouTube, ICD revision process, ICD-10, ICD-10-CM, ICD-11, ICD-11 Beta Draft, ICD-11 consultation, ICD-11 revision docs, WHO (World Health Organization)

Online Version of ICD-10 for 2011?

April 11, 2011 by

Online Version of ICD-10 for 2011?

Post #68 Shortlink: http://wp.me/pKrrB-Zr

The information in this mailing relates only to ICD-10, the current version of the WHO’s International Classification of Diseases in use in the UK and over 100 countries worldwide. It does not relate to the forthcoming international revision of ICD-10, which will be ICD-11.

Nor does it relate to the country specific Clinical Modifications of ICD: ICD-9-CM; the forthcoming ICD-10-CM: ICD-10-CA (Canada); ICD-10-GM (Germany); ICD-10-AM (Australia); ICD-10-TM (Thailand).

The ICD-10 Updating process

The International Conference for the Tenth Revision of the ICD held in Geneva in 1989 recommended that “…WHO should endorse the concept of an updating process between revisions and give consideration as to how an effective updating mechanism could be put in place”.

The three volumes of ICD-10 were published between 1992 and 1994 and came into use in WHO Member States from 1995.

Two separate bodies were established to manage the updating process: the Mortality Reference Group (MRG) and the Updating and Revision Committee (URC).

The concept for the MRG was developed in 1997, and it began making decisions regarding the application and interpretation of ICD for mortality in 1998. The MRG also makes recommendations on proposed ICD updates to the URC.

The URC was established in 2000 and receives proposals from the MRG and members through the WHO Collaborating Centres for the Family of International Classifications (WHO FIC). The URC considers the proposals and submits recommendations on proposed updates to the Heads of Collaborating Centres who, in turn, make recommendations to WHO.

Updates to the published volumes of ICD-10 are approved annually at the October meetings of Heads of WHO Collaborating Centres for the Family of International Classifications and are available as annual lists of changes. The lists indicate the source of recommendation and implementation date and they are published in PDF format (from 1996 to 2007) on this page:

http://www.who.int/classifications/icd/icd10updates/en/index.html

According to this “List of Official ICD-10 Updates” page, all major changes that were scheduled for 2009 were postponed to 2010.

This PDF document:

http://www.who.int/classifications/network/Council_report_2011_16Feb.pdf

or here:

https://dxrevisionwatch.com/wp-content/uploads/2011/04/council_report_2011_16feb.pdf

is the Report of a WHO FIC Council conference which took place on 16 February 2011.

On Page 3 of this public domain document it records:

“4. Ongoing business

“Posting of Updates for ICD-10: So far, the URC has submitted all relevant files to WHO. Following the WHO review, the updates will be published on WHO web site latest by 31 March 2011.

“Posting of Updates for ICF is scheduled before 31 March 2011.

“Online Version of ICD-10 for 2011: The meeting suggested that it is necessary to have an official reference for the extensive changes to ICD that occurred in 2010.

“The relevant files are available to WHO and such a version will be put online.”

[Note: The update files do not appear to have been uploaded to the ICD site yet.]

The above suggests that WHO envisages publishing an Online Version of ICD-10 for 2011 that would replace the current version for 2007, which can be accessed here:

http://apps.who.int/classifications/apps/icd/icd10online/

Note this would not be the replacement for ICD-10, but an online version of the Tabular List that incorporates the annual updates to ICD-10. ICD-11 is not scheduled for implementation until 2014/15 and is still at the Alpha drafting stage.

There is no evidence to suggest any changes within ICD-10 to the current classifications, codings and indexing for PVFS, (B)ME and Chronic fatigue syndrome and according to the ICD-11 iCAT drafting platform, proposals for ICD-11 are that all three terms should be classified within ICD-11 Chapter 6: Diseases of the nervous system.

However, I do want to alert patients, advocates and those who maintain websites that according to this recent WHO FIC document, there is a possibility that the ICD 10th Revision, Version for 2007 may be replaced, this year, by a version for 2011 that incorporates the annual updates.

I will provide more information if and when an online version for 2011 is published.

References:

1] International Classification of Diseases (ICD)
http://www.who.int/classifications/icd/en/

2] ICD Classifications updating process
http://www.who.int/classifications/icd/updates/en/index.html

3] List of Official ICD-10 Updates
http://www.who.int/classifications/icd/icd10updates/en/index.html

4] International Statistical Classification of Diseases and Related Health Problems 10th Revision Version for 2007 (the current version)
http://apps.who.int/classifications/apps/icd/icd10online/

Filed under Clinical Modification, ICD-10, ICD-10-CM, ICD-11, WHO (World Health Organization), WHO Collaborating Centre

ICD-10 coding error in Hansard

April 11, 2011 by

ICD-10 coding error in Hansard

Post #67 Shortlink: http://wp.me/pKrrB-Zi

The information in this mailing relates only to ICD-10, the current version of the WHO’s International Classification of Diseases that is used in the UK and in over 100 countries worldwide.

It does not relate to the forthcoming US specific Clinical Modification of ICD-10, which is known as “ICD-10-CM”; nor does it relate to the Clinical Modifications: ICD-10-CA (Canada); ICD-10-GM (Germany); ICD-10-AM (Australia); ICD-10-TM (Thailand).

In February, the Countess of Mar tabled a House of Lords Written Question which contained an error relating to ICD-10 codings. This was published in Hansard when a Written Response was provided.

In March, I wrote to the Assistant Registrar, Office of the Parliamentary Commissioner for Standards, House of Commons, to enquire whether there was any mechanism through which factual errors published in Hansard might be addressed.

My enquiry was forwarded to Ms Judith Brooke, House of Lords Table Office, who responded on 5 April. Ms Brooke’s response was that the Table Office assists members in the drafting of questions and amendments can be made with the agreement of the member concerned. However, the factual accuracy of information presented in a question is the responsibility of the member. As the question has now been answered and published in Hansard there is no formal route for correcting it. Ms Brooke suggested that the matter might be drawn to the attention of the Countess of Mar.

It is understood that Dr Charles Shepherd (Trustee and Honorary Medical Adviser, The ME Association) has discussed, or intends to discuss this matter with Lady Mar.)

Since there is no mechanism for inserting amendments to factual errors in Hansard, I am setting out a clarification below:

The full Written Question and Written Response provided by Earl Howe (Parliamentary Under-Secretary of State, Department of Health) can be read here on Hansard.

The Written Question had included the statement:

“…in light of the fact that the WHO International Classification of Diseases 10 lists ME as a neurological disease with post viral fatigue syndrome (PVFS) under G93.3 and CFS as a mental health condition under F48.0 and that the latter specifically excludes PVFS, whether they will adhere to that classification.”

This statement is incorrect.

“Chronic fatigue syndrome” is not listed in ICD-10 as a mental health condition.

“F48.0” is the Chapter V: Mental and behavioural disorders coding for “Neurasthenia” and “Fatigue syndrome”

The “International Statistical Classification of Diseases and Related Health Problems 10th Revision Version for 2007” (The Tabular List) can be accessed online here:

http://apps.who.int/classifications/apps/icd/icd10online/

The codings and text for F48.0 are here:

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

The Exclusions to F48.0 are:

asthenia NOS ( R53 )
burn-out ( Z73.0 )
malaise and fatigue ( R53 )
postviral fatigue syndrome ( G93.3 )
psychasthenia ( F48.8 )

In ICD-10, Chronic fatigue syndrome is not listed in the Tabular List under any chapter but appears in Volume 3: The Alphabetical Index, where it is indexed to code G93.3 – the same code at which “Postviral fatigue syndrome” and “Benign myalgic encephalomyelitis” are classified.

ICD-10 Volume 3: The Alphabetical Index is not published by the WHO online but an unauthorised electronic copy can be accessed here:

(Page 528, top right-hand column)

http://www.scribd.com/doc/7350978/ICD10-2006-Alphabetical-Index-Volume-3

Scanned images of the index entry for Chronic fatigue syndrome in Volume 3: The Alphabetical Index can be viewed here:

http://www.meactionuk.org.uk/G93-3-ICD-10-index.jpg   (whole page)
http://www.meactionuk.org.uk/G93-3-ICD-10-index-closeup.jpg   (close up)

Classifications and codings for PVFS, ME and CFS in ICD-10 are set out clearly on these pages of my site:

https://dxrevisionwatch.wordpress.com/icd-11-me-cfs/
https://dxrevisionwatch.wordpress.com/icd-11-me-cfs/2/

The Countess of Mar and Earl Freddie Howe are both Patrons to the Young ME Sufferers Trust.

Filed under Clinical Modification, Hansard, ICD-10, ICD-10-CM, WHO (World Health Organization)

Next meeting of Chronic Fatigue Syndrome Advisory Committee (CFSAC) (US)

March 29, 2011 by

Next meeting of the Chronic Fatigue Syndrome Advisory Committee (CFSAC) (US)

Post #66 Shortlink: http://wp.me/pKrrB-YY

The next meeting of the Chronic Fatigue Syndrome Advisory Committee (CFSAC) takes place on Tuesday and Wednesday, 10 and 11 May 2011. A copy of the Agenda for this meeting will be posted as soon as it becomes available.

“Members of the public will have the opportunity to provide oral testimony at the May 10-11, 2011, meeting if pre- registered.”

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. 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.

CFSAC Notices

http://www.hhs.gov/advcomcfs/notices/index.html

CFSAC Roster

http://www.hhs.gov/advcomcfs/roster/index.html

CFSAC Meetings

Agenda; Minutes; Presentations; Recommendations

http://www.hhs.gov/advcomcfs/meetings/index.html

Recommendations to the Secretary of Health and Human Services

http://www.hhs.gov/advcomcfs/recommendations/index.html

 

May 10-11, 2011 CFSAC Meeting

PDF: http://edocket.access.gpo.gov/2011/pdf/2011-6702.pdf

Html: http://edocket.access.gpo.gov/2011/2011-6702.htm

[Federal Register: March 22, 2011 (Volume 76, Number 55)]
[Notices]
[Page 15982]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr22mr11-88]

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Meeting of the Chronic Fatigue Syndrome Advisory Committee
———————————————————-

AGENCY: Department of Health and Human Services, Office of the Secretary, Office of the Assistant Secretary for Health.

ACTION: Notice.

SUMMARY: As stipulated by the Federal Advisory Committee Act, the U.S. Department of Health and Human Services is hereby giving notice that the Chronic Fatigue Syndrome Advisory Committee (CFSAC) will hold a meeting. The meeting will be open to the public.

DATES: The meeting will be held on Tuesday and Wednesday, May 10 and 11, 2011. The meeting will be held from 9 a.m. until 5 p.m. on May 10, 2011, and 9 a.m. until 4:30 p.m. on May 11, 2011.

ADDRESSES: Department of Health and Human Services; Room 800, Hubert H. Humphrey Building; 200 Independence Avenue, SW., Washington, DC 20201. For a map and directions to the Hubert H. Humphrey building, please visit http://www.hhs.gov/about/hhhmap.html .

FOR FURTHER INFORMATION CONTACT: Wanda K. Jones, DrPH; Executive Secretary, Chronic Fatigue Syndrome Advisory Committee, Department of Health and Human Services; 200 Independence Avenue, SW., Hubert Humphrey Building, Room 712E; Washington, DC 20201. Please direct all inquiries to cfsac@hhs.gov .

SUPPLEMENTARY INFORMATION: CFSAC was established on September 5, 2002.
The Committee shall advise and make recommendations to the Secretary, through the Assistant Secretary for Health, on a broad range of topics including (1) the current state of knowledge and research and the relevant gaps in knowledge and research about the epidemiology, etiologies, biomarkers and risk factors relating to CFS, and identifying potential opportunities in these areas; (2) impact and implications of current and proposed diagnosis and treatment methods for CFS; (3) development and implementation of programs to inform the public, health care professionals, and the biomedical academic and research communities about CFS advances; and (4) partnering to improve the quality of life of CFS patients.

The agenda for this meeting is being developed. The agenda will be posted on the CFSAC Web site,
http://www.hhs.gov/advcomcfs when it is finalized. The meeting will be broadcast over the Internet as a real-time streaming video. It also will be recorded and archived for on demand viewing through the CFSAC Web site.

[Ed: the real-time streaming also has real-time auto transcription.]

Public attendance at the meeting is limited to space available.

Individuals must provide a government-issued photo ID for entry into the building where the meeting is scheduled to be held. Those attending the meeting will need to sign-in prior to entering the meeting room.

Individuals who plan to attend and need special assistance, such as sign language interpretation or other reasonable accommodations, should notify the designated contact person at cfsac@hhs.gov in advance.

Members of the public will have the opportunity to provide oral testimony at the May 10-11, 2011, meeting if pre- registered.

Individuals who wish to address the Committee during the public comment session must pre-register by Monday, April 18, 2011, via e-mail to cfsac@hhs.gov . Time slots for public comment will be available on a first-come, first- served basis and will be limited to five minutes per speaker; no exceptions will be made. Individuals registering for public comment should submit a copy of their oral testimony in advance to cfsac@hhs.govprior to the close of business on Monday, April 18, 2011.

If you do not submit your written testimony by the close of business Monday, April 18, 2011, you may bring a copy to the meeting and present it to a CFSAC Support Team staff member. Your testimony will be included in a notebook available for viewing by the public on a table at the back of the meeting room.

Members of the public not providing public comment at the meeting who wish to have printed material distributed to CFSAC members for review should submit, at a minimum, one copy of the material to the Executive Secretary, at cfsac@hhs.gov prior to close of business on Monday, April 18, 2011. Submissions are limited to five typewritten pages. If you wish to remain anonymous, please notify the CFSAC support team upon submission of your materials to cfsac@hhs.gov

All testimony and printed material submitted for the meeting are part of the official meeting record and will be uploaded to the CFSAC Web site and made available for public inspection. Testimony and materials submitted should not include any sensitive personal information, such as a person’s social security number; date of birth; driver’s license number, State identification number or foreign country equivalent; passport number; financial account number; or credit or debit card number. Sensitive health information, such as medical records or other individually identifiable health information, or any non-public corporate or trade association information, such as trade secrets or other proprietary information also should be excluded from any materials submitted.

Dated: March 18, 2011.
Wanda K. Jones,
Executive Secretary, Chronic Fatigue Syndrome Advisory Committee.
[FR Doc. 2011-6702 Filed 3-21-11; 8:45 am]
BILLING CODE 4150-42-P

Previous two meetings:

May 10, 2010 Meeting

Agenda

Minutes

Presentations

Recommendations

Videocast    [RealPlayer is required to view]

CFSAC Recommendations – May 10, 2010

http://www.hhs.gov/advcomcfs/recommendations/05102010.html

• The Secretary should ask the blood community to defer indefinitely from donating any blood components, any person with a history of chronic fatigue syndrome.

• The Secretary should recognize the special challenges of ensuring that CFS is part of any efforts to train or educate health care providers under health reform.

• The Secretary should direct CMS, AHRQ, and HRSA to collaborate on developing a demonstration project focused on better value and more efficient and effective care for persons with CFS. This can be a public-private effort, and monitoring outcomes and costs should be part of the overall evaluation.

• The Secretary should ask the Designated Federal Officer to explore adding a web-based meeting to conduct CFSAC business.

• CFSAC rejects proposals to classify CFS as a psychiatric condition in U.S. disease classification systems. CFS is a multi-system disease and should be retained in its current classification structure, which is within the “Signs and Symptoms” chapter of the International Classification of Diseases 9-Clinical Modification (ICD 9-CM).*

*DFO Note: The ICD 10-CM is scheduled for implementation on October 1, 2013. In that classification, two mutually exclusive codes exist for chronic fatigue [sic]:

post-viral fatigue syndrome (in the nervous system chapter), and
chronic fatigue syndrome, unspecified (in the signs and symptoms chapter).

HHS has no plans at this time to change this classification in the ICD 10-CM.

October 12, 2010 Science Day
October 13-14, 2010

Agenda

Minutes

Presentations

Recommendations

Videocast     [RealPlayer is required to view]

CFSAC Recommendations – October 13-14, 2010

http://www.hhs.gov/advcomcfs/recommendations/1012-142010.html

The specific recommendations articulated by the Committee are:

• Develop a national research and clinical network for ME/CFS (myalgic encephalomyelitis/CFS) using regional hubs to link multidisciplinary resources in expert patient care, disability assessment, educational initiatives, research and clinical trials. The network would be a resource for experts for health care policy related to ME/CFS.

• Engage the expertise of CFSAC as HHS moves forward to advance policy and agency responses to the health crisis that is ME/CFS.

• Adopt the term “ME/CFS” across HHS programs.

Memo from Secretary Sebelius to Christopher Snell, CFSAC Chair, on the October 2010 Meeting

http://www.hhs.gov/advcomcfs/sebelius_memo.pdf

Filed under American Psychiatric Association (APA), CFSAC meetings, Clinical Modification, DSM revision process, DSM-5, ICD-10, ICD-10-CM, ICD-11, WHO (World Health Organization), WHO Collaborating Centre

ICD-11 Training videos, transcripts and Key Revision documentation

March 9, 2011 by

New ICD-11 Training videos, video transcripts and Key Revision documentation

Post #65 Shortlink: http://wp.me/pKrrB-YI

The information in this post relates only to the development of ICD-11. It does not relate to the development of the forthcoming US specific “Clinical Modification” of ICD-10, known as “ICD-10-CM”.

A WHO ICD Revision meeting was held in Ankara, Turkey, at the end of February. The ICD Revision Paediatrics Topic Advisory Group (TAG) met to discuss “Diagnostic issues on Children and Youth”.

A number of meeting documents and videos have been posted on the ICD Revision site which are general background documents to the ICD-11 development process and not specific to the work of TAG Paediatrics or the focus of the Ankara meeting.

The two training videos (“ICD-11 Content Model Training” and “iCAT Training”) are now also available on YouTube. The training videos are aimed at those currently involved with the ICD-11 Revision process as WHO staff, IT technicians and the chairs, managing editors, members and external reviewers of the ICD-11 Topic Advisory Groups but will be of general interest to those following the development of ICD-11.

Content Model

One of the main differences between ICD-10 and ICD-11 will be the amount of textual content associated with ICD categories. In ICD-10, there is no textual content, definitions or descriptions for any of the three terms, PVFS, ME, CFS, and the relationship between these terms is not specified within ICD-10.

But the ICD-11 Content Model contains 13 parameters that may be used to describe ICD entities and these parameters are discussed in the training video. So if you are not familiar with the extent of the potential for textual content describing categories within ICD-11, this video sets this out. In the References is the URL for the latest version of the “Content Model Reference Guide” document.

The 13 Parameters through which an ICD-11 category can be described are:

1. ICD Entity Title; 2. Classification Properties; 3. Textual Definition(s); 4. Terms; 5. Body Structure Description; 6. Temporal Properties; 7. Severity Properties; 8. Manifestation Properties; 9. Causal Properties; 10. Functioning Properties; 11. Specific Condition Properties; 12. Treatment Properties; 13. Diagnostic Criteria.

iCAT

The second video describes the operation of the iCAT collaborative drafting platform through which the alpha and beta drafts are being developed. The platform is currently behind a password and accessible only to ICD Revision personnel who have editing rights, but it is understood that after the Beta Drafting stage has been reached, the iCAT should be accessible to stakeholders for limited input.

The iCAT had been in the public domain up until early November for public viewing only and I have some relevant screenshots of the population of content as it stood in the iCAT, at that point, here:

PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring Platform: http://wp.me/pKrrB-KK

ICD-11 Training videos:

1] Content Model Training Video, YouTube:

Duration: 20: 38 mins

An MS Word document of the Content Model Training Video Script can be downloaded here:

Transcript of Content Model Training Video

 

2] iCAT Training Video, YouTube:

Duration: 29:12 mins

An MS Word document of the iCAT Training Video Script can be downloaded here:

Transcript of iCAT Training Video

References:

1] Ankara Paediatrics meeting 28 February-1 March 2011
Background documents page and Agenda

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

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

4] iCAT Drafting Platform browser
(Access and editing rights currently restricted to WHO and ICD Revision, TAG members and IT personnel):

Filed under iCAT, ICD on YouTube, ICD revision process, ICD-10, ICD-10-CM, 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)

Ian Swales, MP amends his report on gov policy on CFS and ME (Three Parliamentary errors)

March 3, 2011 by

Ian Swales, MP amends his report on government policy on CFS and ME (Three Parliamentary errors)

Post #63 Shortlink: http://wp.me/pKrrB-Y7

On 2 February 2011, Ian Swales (Lib Dem, Redcar) addressed a Parliamentary Adjournment Debate on ME. During that debate, the Health Minister, Paul Burstow, had stated that the World Health Organisation (WHO) uses the composite term CFS/ME for this condition.

This was incorrect. The WHO does not use the composite terms “CFS/ME” or “ME/CFS”.

In a Parliamentary Written Answer to Mr Swales, dated 16 February, the Health Minister corrected his error [1].

Mr Burstow had clarified:

“…During the Westminster Hall debate, on 4 February 2011, I said that the World Health Organisation uses the composite term CFS/ME for this condition*. This was incorrect.

“The World Health Organisation classes benign myalgic encephalomyelitis and post viral fatigue syndrome under the same classification G93.3 ‘diseases of the nervous system’; subheading ‘other disorders of the brain’.

“The report of the CFS/ME Working Group to the Chief Medical Officer, in January in 2002, suggested that the composite term CFS/ME be used as an umbrella term for this condition, or spectrum of disease. This term is also used by the National Institute for Health and Clinical Excellence for their clinical guidelines.

“We do, however, intend to seek further advice on our classification and will update the hon. Member in due course.”

[Note that although Health Minister, Paul Burstow, gave the date of Ian Swales’ Adjournment Debate as “4 February” in his Written Answer of 16 February, the Debate took place on 2 February 2011.]

On 17 February, Mr Swales published a report on his website which went out under the title “Swales wins battle with Government on ME”. This report had claimed:

“Ian Swales MP’s fight for better treatment of myalgic encephalomyelitis (ME) continues as he succeeds in getting the Government to recognise ME and Chronic Fatigue Syndrome (CFS) as different illnesses.”

But Mr Swales had misinterpreted the content of the Written Answer he had received from the Health Minister.

 

This has caused much confusion amongst ME and CFS patients.

Advocates have raised this misunderstanding with Mr Swales and with his Parliamentary Researcher.

Today, an amended report has been published on Mr Swales’ website under the same URL and date, but with a new title – this time it is called:

“Swales corrects Minister on World Health Organisation definition of ME”

I am appending both versions.

To recap, because this is important, and because there is a further error:

Paul Burstow, Health Minister, incorrectly stated on 2 February, during an Adjournment Debate, that the WHO uses the composite term CFS/ME for this condition. That error was corrected by Mr Burstow in his Written Answer of 17 February.

Ian Swales, MP, then claimed in a website report that he had succeeded in getting the government to recognise ME and Chronic Fatigue Syndrome (CFS) as different illnesses. This was a misinterpretation of Mr Burstow’s own correction and clarification. Mr Swales’ Parliamentary Office has now amended his report.

The Countess of Mar, meanwhile, tabled a Written Question of her own for which a response was provided on 1 March, by Earl Howe [3].

The Countess of Mar had tabled:

“To ask Her Majesty’s Government, further to the statement by the Minister of State for Health, Paul Burstow, on 2 February (Official Report, Commons, col. 327) that the World Health Organisation (WHO) described myalgic encephalomyelitis (ME) as Chronic Fatigue Syndrome/myalgic encephalomyelitis (CFS/ME) and that this was the convention followed by the Department, in light of the fact that the WHO International Classification of Diseases 10 lists ME as a neurological disease with post viral fatigue syndrome (PVFS) under G93.3 and CFS as a mental health condition under F48.0 and that the latter specifically excludes PVFS, whether they will adhere to that classification.”

The response received on 1 March, was:

Earl Howe (Parliamentary Under Secretary of State (Quality), Health; Conservative)

“The department will continue to use the composite term chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) for this condition, or spectrum of disease, as suggested by the Chief Medical Officer in his 2002 report. We recognise the condition as neurological in nature.”

But the Countess of Mar’s Written Question also contains an error.

In the International version of ICD-10 (the version used in the UK and over 110 other countries, but not in the US which uses a “Clinical Modification” of ICD-9), CFS is not classified as a mental health condition under F48.0.

Chronic fatigue syndrome is listed in ICD-10 Volume 3: The Alphabetical Index, where it is indexed to G93.3, the same code as Postviral fatigue syndrome.

So in International ICD-10, Postviral fatigue syndrome, Benign myalgic encephalomyelitis and Chronic fatigue syndrome are all three coded or indexed to G93.3 under “G93 Other disorders of brain”, in Chapter VI (6): Diseases of the nervous system.

In International ICD-10, the Mental and behavioural disorders chapter is Chapter V (5). 

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

Chapter V (5) Mental and behavioural disorders

Neurotic, stress-related and somatoform disorders are coded between (F40-F48)

Neurasthenia
Fatigue syndrome

are classified under (F40-F48) at F48.0, which specifically Excludes

malaise and fatigue ( R53 )

and

postviral fatigue syndrome ( G93.3 )

So now you know what UK government policy is and that Mr Swales had misled himself.

The forthcoming US specific ICD-10-CM

Perhaps the focus can now return to more pressing issues – like the fact that in the US, a Partial Code Freeze is looming for the forthcoming US specific version of ICD-10, known as “ICD-10-CM”.

Under longstanding proposals, the committees developing ICD-10-CM intend to retain Chronic fatigue syndrome in the R codes, and code it under R53 Malaise and fatigue, at R53.82 Chronic fatigue syndrome (NOS), but propose to code for PVFS and ME in Chapter 6, under G93.3.

The R codes chapter (which will be Chapter 18 in ICD-10-CM) is the chapter for

“Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)”

“This chapter includes symptoms, signs, abnormal results of clinical or other investigative procedures, and ill defined conditions regarding which no diagnosis classifiable elsewhere is recorded.”

Coding CFS patients under R53.82 will consign them to a dustbin diagnosis: there are no guarantees that clinicians will use the unfamiliar ME code or that insurance companies will reimburse for G93.3. It will make patients more vulnerable to the proposals of the DSM-5 Somatic Symptom Disorders Work Group. It will mean that ICD-10-CM will be out of line with at least four versions of ICD-10, including the Canadian “Clinical Modification”, and also out of line with the forthcoming ICD-11, where all three terms are proposed to be coded in Chapter 6 Diseases of the nervous system.

There are only seven months left before the 1 October Code Freeze and the clock is ticking.

 

Here is the first version of Mr Swales’ website report, followed by his amended version.

Version One:

http://ianswales.com/en/article/2011/455560/swales-wins-battle-with-government-on-me

Swales wins battle with Government on ME

February 17, 2011 3:45 PM

Ian Swales MP’s fight for better treatment of myalgic encephalomyelitis (ME) continues as he succeeds in getting the Government to recognise ME and Chronic Fatigue Syndrome (CFS) as different illnesses.

During Ian’s recent parliamentary debate on ME he argued that the Government needs to distinguish between Chronic Fatigue Syndrome and ME to provide better treatment for the different illnesses.

However, Health Minister Paul Burstow MP responded by saying that the World Health Organisation classifies Chronic Fatigue Syndrome and ME as the same illness.

Following an outcry from the ME community about this statement, Ian challenged the Minister on his definition of CFS/ME. The Minister admitted that the definition he used in the debate was “incorrect”.

Commenting, Ian Swales MP said:

“I am pleased that the Government has now recognised that ME and Chronic Fatigue Syndrome are two different illnesses.

“After the debate I received a lot of correspondence from the ME community about the Government’s definition of CFS/ME, so after doing some more research on the matter I decided it was right to clarify this point with the Minister. I know they will be reassured by this news.

“I hope that approaching ME as a distinct condition will help lead to better, more effective treatment for sufferers through better analysis of their possible different causes and symptoms.”

[Ends]

Version Two:

http://ianswales.com/en/article/2011/455560/swales-wins-battle-with-government-on-me

Swales corrects Minister on World Health Organisation definition of ME

February 17, 2011 3:45 PM

Ian Swales MP’s fight for better treatment of myalgic encephalomyelitis (ME) continues as he succeeds in getting the Government to acknowledge that the World Health Organisation does not use the composite term CFS/ME for the condition.

During Ian’s recent parliamentary debate on ME he argued that the Government needs to distinguish between Chronic Fatigue Syndrome and ME to provide better treatment for the different illnesses.

However, Health Minister Paul Burstow MP responded by saying that the World Health Organisation “uses the composite term CFS/ME for the condition”.

Following an outcry from the ME community about this statement, Ian challenged the Minister on his definition of CFS/ME. The Minister admitted that his statement was “incorrect”.

Commenting, Ian Swales MP said:

“I am pleased that the Minister has acknowledged the error he made in the debate.

“After the debate I received a lot of correspondence from the ME community about the Government’s definition of CFS/ME, so after doing some more research on the matter I decided it was right to clarify this point with the Minister. I know they will be reassured by this news.

“I will continue my campaign to get more effective treatment for sufferers of ME through better analysis of its causes and symptoms.”

[Ends]

The text of the Adjournment Debate can be read here, on Hansard

 
Myalgic Encephalomyelitis
4.13 pm

References:

[1] Written Answer: Paul Burstow to Ian Swales, 16 February 2011, 16 Feb 2011 : Column 864W:
http://www.publications.parliament.uk/pa/cm201011/cmhansrd/cm110216/text/110216w0004.htm

[2] Amended Ian Swales website report:
http://ianswales.com/en/article/2011/455560/swales-wins-battle-with-government-on-me

[3] Written Answer: Earl Howe to The Countess of Mar, 01 March 2011:
http://www.theyworkforyou.com/wrans/?id=2011-03-01a.297.1

Hansard for above:
http://www.publications.parliament.uk/pa/ld201011/ldhansrd/text/110301w0001.htm#11030162000766

[4] Hansard, House of Lords Debate: Myalgic Encephalomyelitis, 22 January 2004:
http://www.publications.parliament.uk/pa/ld200304/ldhansrd/vo040122/text/40122-12.htm

[5] Current codings in ICD-10 for Postviral fatigue syndrome; [Benign] myalgic encephalomyelitis and Chronic fatigue syndrome:
https://dxrevisionwatch.wordpress.com/icd-11-me-cfs/

Filed under Clinical Modification, DSM-5, DSM-5 draft proposals, Functional Somatic Syndrome (FSS), ICD-10, ICD-10-CM, ICD-11, ICD-11 Alpha Draft, WHO (World Health Organization), WHO Collaborating Centre

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