Update to Letter to key Revision personnel re Continued absence of the ICD-10 G93.3 terms from the ICD-11 Beta drafting platform

Post #324 Shortlink: http://wp.me/pKrrB-46A

Update at February 23, 2016: Since no proposals and rationales for the ICD-10 G93.3 legacy terms were released in September or December 2015, I contacted ICD’s Dr Robert Jakob, again. Dr Jakob told me on February 2, 2016 that “[ICD-11 Revsion is] still working on the extensive review and the conclusions.”

This report is an update to Post #322:

Continued absence of the ICD-10 G93.3 terms from the ICD-11 Beta drafting platform: Letter to key Revision personnel

Eight years into the revision process and stakeholders still don’t know how ICD Revision proposes to classify the ICD-10 G93.3 legacy terms for ICD-11.

In ICD-10, the (G93.3) Title term is Postviral fatigue syndrome; Benign myalgic encephalomyelitis is the Inclusion term under G93.3; Chronic fatigue syndrome is included in the Index only, and indexed to the G93.3 code [1].

By 2012, the public version of the ICD-11 Beta draft had the three terms listed as in the screenshot, below – still under the Diseases of the nervous system chapter, but with a change of relationship between the three terms.

At that point, Chronic fatigue syndrome was being proposed as a new ICD Title term; Benign myalgic encephalomyelitis* was specified as the Inclusion term (indicated in the draft by hover text over the asterisk which is not displaying in this screenshot).

Postviral fatigue syndrome, previously designated as Title code in ICD-10, was now located under Synonyms, in a list of alternative and historical terms imported from other terminology systems and health informatics sources, including two terms specific to Chapter 18: Symptoms, signs etc. of the U.S. ICD-10-CM clinical modification [4].

Beta12

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

 

In early 2013, ICD Revision removed the entry for Chronic fatigue syndrome and its associated terms from the public version of the Beta draft; from that point on, none of the terms were accessible in any Linearization.

(In the version of the Beta that the public sees, there are no holding pens viewable for categories “Needing a decision to be made” and no tab for “Category Notes and Decisions” which might indicate the rationale for the temporary or permanent absence of a category from the draft.)

Although a Change History function was incorporated into the public Beta in March, no Change History is available for these terms. The Topic Advisory Group (TAG) for Neurology has published no progress reports on emerging proposals for scrutiny and discussion.

So for over 2 years, now, stakeholders have been unable to monitor evolving proposals for the classification of these G93.3 legacy entities within ICD-11. The continued absence of these terms hinders submission of comments and suggestions on proposed chapter location(s), parent classes, hierarchies, inclusions, exclusions, definitions or other Content Model descriptive text.

 

Request for release of information on current status of proposals

On June 8, I sent a letter to Bedirhan Üstün (WHO/ICD Revision Coordinator), Cc’d to key ICD Revision personnel and the recently assembled ICD Revision Project Management Team, requesting an update on the status of proposals for these terms and their restoration to the draft [5]. Read letter here

On Friday, June 19, Anneke Schmider (WHO Technical Officer, ICD Revision Project Manager) facilitated a conference call with myself and Dr Robert Jakob (WHO ICD classifications, ICD Revision Steering Group) in which Dr Jakob responded to my letter, having obtained a progress report from TAG Neurology.

NB: It was not the purpose of this discussion to advance my own views on how these terms should be represented within ICD-11 but to elicit clarifications on the current status of proposals.

 

Summary of main points from our discussion:

TAG Neurology retains responsibility for these three terms.

None of the sub-working groups that sit under TAG Neurology has specific responsibility for these terms.

TAG Neurology is still reviewing the literature and has yet to reach consensus about where to classify these terms within ICD-11.

Dr Jakob says he can be “crystal clear” that there is no proposal to classify the ICD-10 G93.3 legacy terms under the Mental and behavioural disorders chapter.

JakobJune155

The ICD-11 principle of multiple parenting was discussed in general terms: multiple parenting allows the same disease to be expressed in two (or more) places in the ICD-11 linearizations. A disease or disorder category will be located under a primary parent class within one chapter but may also be searchable under a secondary (or tertiary) parent within another chapter, whilst retaining the code assigned in the primary location. (See ICD-11 Multiple parenting Slides 42-48)

Because TAG Neurology is still working towards consensus, Dr Jakob would not be drawn on the following:

whether relocating one or more of these terms from the Diseases of the nervous system to an alternative chapter(s) was under consideration;

whether retaining one or more of these terms within the Diseases of the nervous system chapter but secondary parenting under an alternative chapter(s) was under consideration;

what existing parent classes were being considered for locating these terms under;

whether the creation of any new parent classes was being considered for these terms;

whether any changes in the relationship between the three terms, as they had stood in the Beta draft in early 2013, have already been agreed or remain under consideration (ie any changes to which of the terms are identified as ICD Title terms, which are specified as Inclusion terms and which are listed as Synonyms).

which of the terms are proposed to be assigned a Definition and other Content Model descriptive text and where definition(s) would be sourced from.

It remains unclarified, therefore, whether ICD-11 intends to define CFS discretely from BME. Also unclarified: whether exclusions for these terms are proposed to be inserted under categories such as Bodily distress disorder; Fatigue [previously Malaise and fatigue in ICD-10]; and a proposed new Diseases of the nervous system parent term, Functional clinical forms of the nervous system (a proposal that TAG Mental Health opposes).

I have already submitted requests via the Proposal Mechanism that PVFS, BME and CFS are inserted under Exclusions to Bodily distress disorder, and Fatigue.

 

With regard to a date by which we might anticipate proposals being released:

The Beta draft was frozen on May 31, 2015. The Beta Comment facility is open and stakeholders can register to comment on the draft or submit formal proposals for changes and enhancements to proposals via the Proposals Mechanism. Another frozen release is expected in August. (But while TAG Neurology’s proposals remain absent from the Beta and unpublished elsewhere, stakeholders are in no position to comment on the TAG proposals or submit suggestions for modifications to TAG proposals.)

Dr Jakob says that in September 2015, ICD Revision plans to post various materials relating to the development process on the WHO/ICD website for public scrutiny, this to possibly include rationales, and documents relating to the abridged Primary Care version of ICD-11.

If TAG Neurology’s proposals for the G93.3 legacy terms are not ready for September release, then Dr Jakob projected their release towards the end of December 2015.

The target date for presentation of ICD-11 for World Health Assembly (WHA) approval is currently proposed for May 2018. There would be a period for public review and comment prior to presentation for adoption.

I will update on the status of proposals for these terms as soon as further information becomes available.

It is regrettable that stakeholders are little better informed than they were two years ago.

 

Bodily stress syndrome (S3DWG); Bodily stress syndrome (PCCG)

My longstanding concerns regarding the proposals of the WHO Working Group on Somatic Distress and Dissociative Disorders (S3DWG) for the revision of the ICD-10 Somatoform disorders and the alternative proposals of the ICD-11 Primary Care Consultation Group (PCCG) were beyond the scope of my letter to Dr Üstün and my discussions with Dr Jakob in response to that letter.

However, I advised Dr Jakob that my concerns around proposals for the S3DWG’s “Bodily distress disorder” and the Primary Care Consultation Group’s “Bodily stress syndrome” have been discussed with ICD Revision’s, Dr Geoffrey Reed, and in formal submissions via the Proposals Mechanism and Beta Comment facility for the consideration of TAG Mental Health [6][7].

 

References and related posts

1 ICD-10 Version: 2015 Chapter VI Diseases of the nervous system, G93.3

2 ICD-11 Beta drafting platform (Public version)

Frozen release at May 31, 2015

3 ICD-11 Beta Proposal Mechanism (Registration required for access)

4 Briefing paper on ICD-11 and PVFS, ME and CFS: Part 2, Dx Revision Watch

5 Continued absence of the ICD-10 G93.3 terms from the ICD-11 Beta drafting platform: Letter to key Revision personnel, Dx Revision Watch

6 Personal correspondence; ICD-11 Beta Proposal Mechanism.

7 Comment submitted to ICD-11 Topic Advisory Group for Mental Health re: Bodily distress disorder, Suzy Chapman

 

Save

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

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

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

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

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

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

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

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

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

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

or open, here, on Dx Revision Watch:

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

ICD-11 Beta drafting platform

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

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

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

Linearization Print Versions

Simplified Linearization Outputs

Linearization Index Tabulations

Frozen Releases

You may find the frozen release downloads here

 

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

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

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

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

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

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

 

Call for Expressions of Interest to review the ICD revision process

Post #312 Shortlink: http://wp.me/pKrrB-3Yw

(If the consulting team that secures the ICD Revision interim assessment contract extends their outreach to include analysis of advocate stakeholder views and experience of interacting with the revision process, I shall be happy to discuss key concerns.)

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

Deadline for expressions of interest is July 31, 2014. Following the selection process, WHO will inform the contracted party by 15 August 2014.

Lead time is four months

Target date for the completed first draft of the deliverable is by 10 October 2014. Due date for the completed final product submitted to WHO will be 15 December 2014 latest.

“WHO keeps the right to publicize the report and its contents as a whole or in parts.”

+++

Call for Expressions of Interest to review the ICD revision process

+++
Terms of Reference:

Review of

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

Request for Expressions of Interest

+++
Table of Contents

(…)

1. INTRODUCTION

WHO Office of the Assistant Director General, Health Systems and Innovation, solicits expressions of interest from a suitable Contractor(s) to conduct an interim assessment of the 11th Revision for International Classification of Disease (ICD) to carry out the following work:

1.1 Objective of the Request

WHO Office of the Assistant Director General, Health Systems and Innovation, solicits expressions of interest from a suitable Contractor(s) to carry out the following work:

1. Conduct an interim assessment of the 11th Revision for International Classification of Disease (ICD) in terms of:

Progress towards the goals of the Revisions
• Process and mechanisms put in place for the ICD revision
Project resources (financial & human) in relation to the proposed outcomes of the revision
• Project Plans and proposed timeline for the completion of ICD 11 for 2017
• Organization for maintenance and updates of ICD beyond 2017

2. Analyze the relevance and effectiveness of the planned features of ICD 11 in meeting the needs of the key stakeholders in WHO Member States including its:

a. Use in Mortality statistics – e.g. Cause of Death statistics, Verbal Autopsy, others…
b. Use in Morbidity statistics – e.g. Discharge summaries, Case-mix groupings, others…
c. Use in Primary Care – in low and intermediate resource settings…
d. Use in Clinical Care – for diagnosis, guidance, quality and safety indicators
e. Use in Scientific Research for epidemiology, genetic studies and other

3. Compile an assessment report summarizing the findings and making recommendations for improvement.

Potential contractors are requested to state the reason why they consider themselves suitable for this work and explain how they will respond to the requirements stated in this request with (a) a proposed draft work plan; (b) timeline; (c) budget with annotation.

1.2 Deadline for Expressions of Interest

Expressions of interest must be submitted on or before July 31, 2014 in order to be considered. The description of the contracting agency and curriculum vitae of the proposed team members, and proposed methods for assessment and timeline should be attached to the expressions of interest (see also 2.3). A point of contact for inquiries should be identified. WHO may contact the parties for further clarification. WHO will inform the contracted party following the selection process by 15 August 2014.

(…)

+++
Full document here:

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

or open PDF on Dx Revision Watch here:

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

 

Annex I to this document (Page 12) contains a Summary of the ICD Revision Process

“This document summarizes the ICD Revision Process, in particular, in terms of the timelines for the finalization date and submission to WHO Governing Bodies. Following various consultations with the WHO Member States and relevant international stakeholders, it was decided decided to postpone the submission to WHA to 2017 May in various consultations with the WHO Member States and relevant international stakeholders taking into account [sic]*: the developmental stage of ICD 2013 Beta, and allowing for reasonable time to complete the remaining tasks: reviews; additional proposals; field trials; translations; and the transition preparations.”

Section 2 (Page 23) sets out ICD Revision Process: Tasks for Beta Phase and Finalization 2013-2017

Annex II contains The Detailed List of Multiple Stakeholders to be contacted

*I guess no-one at WHO reviewed and edited this document before posting it?

Extension to timeline official: ICD-11 rescheduled for 2017

Post #292 Shortlink: http://wp.me/pKrrB-3H9

Update at February 8, 2014: ICD Revision has now updated its Timeline page:

May 2017 Present the ICD-11 to the World Health Assembly”

ICD-11_20177

In the last day or so, edited text on two WHO webpages confirms a decision by ICD Revision to postpone release of ICD-11 by a further two years, from 2015 to 2017.

From WHO site: “The International Classification of Diseases 11th Revision is due by 2017”

Also ICD Information Sheet: “…The development phase will continue for three years and ICD-11 will be finalized in 2017.”

And from a note accompanying a slide presentation: “…Now ICD 11 is scheduled in 2017 and ICD-10-CM can be made as a National Linearization.” Bedirhan Üstün, January 29, 2014 [1]

ICD-11 Revision has yet to issue a formal announcement or news release or update its Timeline page to reflect this decision.

There are no reports on the revised schedule on ICD-11 on Facebook or Twitter @WHOICD11 – all very low key.

Delaying the release of ICD-11 has been under consideration for several months.

+++
Slipping targets

The development process for ICD-11 began in April 2007, with ICD-11 scheduled for dissemination by 2012 and the timelines for the development of ICD-11 and DSM-5 running more or less in parallel [2,3].

Early on in the revision process, the ICD-11 dissemination date was extended. By 2009, the final draft was scheduled for World Health Assembly (WHA) approval in 2014. The WHA approval date was subsequently shunted to 2015 – four years later than originally planned.

ICD-11 is now scheduled for finalization in 2017.

Rationales for extending the timeline:

Pages 8-10: Committee for the Coordination of Statistical Activities, Twenty-second Session 4-6 September 2013, Items for discussion and decision: Item 8 of the provisional agenda, 3 September 2013 [4].

Slide presentation, Bedirhan Üstün, September 9-10, 2013, Slides 29-35: [5].

+++
Related reports from Dx Revision Watch

January 22, 2014: WHO Collaborating Centre confirms Revision Steering Group seriously considering extension to ICD-11 timeline: http://wp.me/pKrrB-3E8

September 15, 2013: WHO considers further extension to ICD-11 development timeline: http://wp.me/pKrrB-3sc

+++
References

1. Slideshare: AHIMA ICD-10 ICD-11 switch to ICD-10-CM in the USA, presentation note, Bedirhan Üstün, Coordinator at World Health Organization, January 29, 2014

2. Agenda Item No. 25: Revision of the International Classification of Diseases (ICD-10) and Involvement of Psychology International Union of Psychological Science Committee on International Relations Action, March 28–30, 2008
IUPsyS Mar 08 Agenda Item 25 ICD-10

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

4. Committee for the Coordination of Statistical Activities, Twenty-second Session 4-6 September 2013, Items for discussion and decision: Item 8 of the provisional agenda, 3 September 2013, Pages 8-10:
http://unstats.un.org/unsd/accsub/2013docs-22nd/SA-2013-12-Add1-Health-WHO.pdf

5. Slide presentation: ICD Revision: Where are we? Bedirhan Üstün, World Health Organization Classifications, Terminologies, Standards, ICD Revision: Quality Safety Meeting 2013, September 9-10, 2013, Slides 29-35:
http://www.slideshare.net/ustunb/icd-2013-qs-tag-260276686

WHO Collaborating Centre confirms Revision Steering Group seriously considering extension to ICD-11 timeline

Post #289 Shortlink: http://wp.me/pKrrB-3E8

Update at January 30, 2014:

ICD-11 Revision has confirmed that a decision has now been taken to postpone ICD-11 by a further two years, from 2015 to 2017.

From WHO site: “The International Classification of Diseases 11th Revision is due by 2017”

+++
Information in this report relates to the development of the World Health Organization’s ICD-11. It does not apply to the forthcoming US specific, NCHS developed, clinical modification of ICD-10, known as ICD-10-CM.

Ustun 34

Source: Slide 34: Where are we? What remains to be done? Shall we have ICD WHA submission in 2015 or later? B Üstün, World Health Organization Classifications, Terminologies, Standards ICD Revision: Quality Safety Meeting, September 2013

+++
The December newsletter of the WHO Collaborating Centre for the Family of International Classifications (FIC) in the Netherlands reports that ICD-11 Revision Steering Group (RSG) is reviewing options for a further extension to the ICD-11 development timeline [1]:

Newsletter on the WHO-FIC, Volume 11, Number 2, 2013, Latest News, Page 3 [PDF]

The Revision Steering Group and WHO Secretariat seriously consider amending the timeline of submitting the ICD-11 for endorsement by the World Health Assembly to allow more time for field testing in multiple countries and settings, and following up on resulting edits. WHO currently discusses options and scenarios with stakeholders.

This announcement from WHO-FIC’s Marijke de Kleijn-de Vrankrijker reinforces information and resources provided in my September report (WHO considers further extension to ICD-11 development timeline) – that ICD-11 Revision is failing to meet development targets and delaying submission of ICD-11 for WHA for approval until 2016, or alternatively, extending the timeline by a further two years, for WHA approval in 2017, is under consideration.

+++

ICD-11 already four years behind original targets

The revision of ICD-10 and development of the structure for ICD-11 began in 2007. WHO’s original goal had been to complete the revision and release of ICD-11 by 2011-12, Archived documents [2] [3].

By 2009, the date for submission of ICD-11 for WHA approval had been extended to 2014. The launch of the public version of the Beta drafting platform was later postponed from May 2011 to May 2012.

The current projection for submission of ICD-11 for approval to WHA is May 2015, with dissemination in 2015+ [4].

Mayo’s Christopher Chute, MD, chairs the ICD-11 Revision Steering Group. According to Chute, in this paper published in March 2012, publication of ICD-11 is “expected around 2016″:

Chute CG, Huff SM, Ferguson JA, Walker JM, Halamka JD. There Are Important Reasons For Delaying Implementation Of The New ICD-10 Coding System. Health Aff March 2012 DOI: 10.1377/hlthaff.2011.1258
+++

ICD Revision considers its options

In September, WHO posted this meeting materials document [5] and this slide presentation [6]. The document summarized, inter alia, ICD-11’s progress, current development status, timelines for finalization date and approval by WHO Governing Bodies, and rationales and options for a further shift in the timeline.

You can read extracts from the document and view slides setting out the options currently under consideration in this report: WHO considers further extension to ICD-11 development timeline, selected of which I am appending to this post.

The earliest ICD-11 might be ready for dissemination is late 2015/16 – which may require some further scaling back of the project’s goals.

But if ICD-11 Revision Steering Group does elect to postpone submission for World Health Assembly approval until May 2017, dissemination of ICD-11 may not be viable before 2018.

I will update this post if and when WHO or ICD-11 Revision Steering Group publish a statement of clarification on the WHO website or issue a news release, or if other information becomes available that confirms a revision to the timeline.

Implementation date

I’ve noted some confusion in reporting and comments around ICD-11 approval by WHA and dissemination and implementation dates.

Unlike the U.S. specific ICD-10-CM, there is no mandatory date by which Member States must switch from using ICD-10 to ICD-11.

World Health Assembly adoption of ICD-11 and ICD-11 implementation dates are separate. WHA adoption enables official use for countries who wish to move on to the next edition. But Member States using ICD-10 will transition to the next version at their own convenience [6].

Once approved, prepared for implementation and released, global adoption of ICD-11 isn’t going to happen overnight. It may take several years before WHO Member States transition from ICD-10 to ICD-11. Low resource and developing countries may take longer to prepare for and transition to the new edition.

The annual update process for ICD-10 will continue during the creation of ICD-11.

Extracts from document [5] setting out the rationale and options for postponement of WHA Approval:

[…]

3. Progress and Current Status of ICD Revision:

[…]

BETA PHASE:

At this point in time, 1 September 2013, an ICD2013 Beta version has been produced for review purposes and field trials after 6 years of drafting phases.

The current ICD 2013 Beta version has relatively stable classification lists (i.e. linearizations) for Mortality and Morbidity recording. It will be reviewed by the specific Mortality Reference Group and the Morbidity Reference Group to see how well it fits the purpose and proposed transition from ICD‐10.

In addition, the Beta version has planned processes for:

(i) Systematic international scientific peer review (ii) Submission of additional proposals from public groups and scientists (iii) Conducting field trials for its applicability and reliability (iv) Production support in multiple languages (translations) starting with WHO official languages (v) Preparations for transitions from ICD‐10 to ICD‐11.

[…]

6. Timelines

The current ICD Revision Process timeline foresees that the ICD is submitted to the WHA in 2015 May and could then be implemented. Between now and 2015, there remains 20 months to conduct the remaining tasks summarized above as: 1. Reviews, 2. Additional Proposals, 3. Field Trials, 4. Translations, and 5. Transition Preparations.

Given the technical requirements these steps could be expedited in the next 20 months. The experience obtained thus far, however, suggests that this timeframe will be extremely tight for paying due diligence to the work especially in terms of: appropriate consultations with expert groups; communication and dissemination with stakeholders; and sufficient time for field testing in multiple countries and settings, and carrying out the resulting edits.

WHO Secretariat would like to discuss this with all stakeholders and evaluate the possible options:

a. Keep ICD submission to WHA to 2015 as originally planned and implementation / adoption date may be free by any Member State (current position – no change).

b. Postpone submission to WHA to a later year to allow longer time for field trials and other transition preparations.

[…]

In conclusion:

(a) WHO Secretariat could produce an ICD 2015 ready including Mortality and Morbidity Linearizations, Reference Guide and Index with the appropriate resolution to go to the World Health Assembly. This timeframe, however, is extremely tight for paying due diligence to the work especially in terms of: appropriate consultations with expert groups; and sufficient time for field testing in multiple countries and settings, and carrying out the resulting edits

(b) If the timeline is advanced to 2016, there will be more time to have ICD 2016 version with more translations and incorporations of some field tests results.

(c) If the timeline is advanced to 2017, ICD 2017 will be ready with most Field Test results incorporated and maintenance scheme tested.

[…]

Slide presentation: B Üstün, World Health Organization Classifications, Terminologies, Standards, ICD Revision: Quality Safety Meeting 2013 September 9-10

Where are we? What remains to be done? Shall we have ICD WHA submission in 2015 or later?

Slide 34:

Ustun 34rule

Slide 35: [WHA Approval timeline – options under consideration]

Ustun 35rule

+++

References:

1. Newsletter on the WHO-FIC, Volume 11, Number 2, 2013, Latest News, Page 3. WHO Collaborating Centre for the Family of International Classifications (FIC) in the Netherlands.

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

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

4. ICD-11 Timeline: http://www.who.int/classifications/icd/revision/timeline/en/index.html

5. Committee for the Coordination of Statistical Activities, Twenty-second Session 4-6 September 2013, Items for discussion and decision: Item 8 of the provisional agenda, 3 September 2013, Pages 8-10: http://unstats.un.org/unsd/accsub/2013docs-22nd/SA-2013-12-Add1-Health-WHO.pdf

6. Slide presentation: ICD Revision: Where are we? Bedirhan Üstün, World Health Organization Classifications, Terminologies, Standards, ICD Revision: Quality Safety Meeting 2013, September 9-10, 2013, Slides 29-35: http://www.slideshare.net/ustunb/icd-2013-qs-tag-260276686

WHO considers further extension to ICD-11 development timeline

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

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

Timeline slippage

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

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

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

The development process for the next edition (ICD-11) began in April 2007, with ICD-11 scheduled for dissemination by 2012 and the timelines for the development of ICD-11 and DSM-5 running more or less in parallel [1] [2].

Early on in the revision process, the ICD-11 dissemination date was extended. By 2009, the final draft was scheduled for World Health Assembly (WHA) approval in 2014. In order to be ready for global implementation in 2015, the technical work on ICD-11 would need to be completed by 2012 [3].

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

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

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

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

ICD-11 Revision Steering Group considers its options

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

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

This 14 page document Committee for the Coordination of Statistical Activities, Twenty-second Session 4-6 September 2013, Items for discussion and decision: Item 8 of the provisional agenda can be downloaded here

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

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

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

Extracts from the document setting out the rationale and options for postponement of WHA Approval:

[…]

3. Progress and Current Status of ICD Revision:

[…]

BETA PHASE:

At this point in time, 1 September 2013, an ICD2013 Beta version has been produced for review purposes and field trials after 6 years of drafting phases.

The current ICD 2013 Beta version has relatively stable classification lists (i.e. linearizations) for Mortality and Morbidity recording. It will be reviewed by the specific Mortality Reference Group and the Morbidity Reference Group to see how well it fits the purpose and proposed transition from ICD‐10.

In addition, the Beta version has planned processes for:

(i) Systematic international scientific peer review
(ii) Submission of additional proposals from public groups and scientists
(iii) Conducting field trials for its applicability and reliability
(iv) Production support in multiple languages (translations) starting with WHO official languages
(v) Preparations for transitions from ICD‐10 to ICD‐11.

[…]

6. Timelines

The current ICD Revision Process timeline foresees that the ICD is submitted to the WHA in 2015 May and could then be implemented. Between now and 2015, there remains 20 months to conduct the remaining tasks summarized above as: 1. Reviews, 2. Additional Proposals, 3. Field Trials, 4. Translations, and 5. Transition Preparations.

Given the technical requirements these steps could be expedited in the next 20 months. The experience obtained thus far, however, suggests that this timeframe will be extremely tight for paying due diligence to the work especially in terms of: appropriate consultations with expert groups; communication and dissemination with stakeholders; and sufficient time for field testing in multiple countries and settings, and carrying out the resulting edits.

WHO Secretariat would like to discuss this with all stakeholders and evaluate the possible options:

a. Keep ICD submission to WHA to 2015 as originally planned and implementation / adoption date may be free by any Member State (current position – no change).

b. Postpone submission to WHA to a later year to allow longer time for field trials and other transition preparations.

[…]

In conclusion:

(a) WHO Secretariat could produce an ICD 2015 ready including Mortality and Morbidity Linearizations, Reference Guide and Index with the appropriate resolution to go to the World Health Assembly. This timeframe, however, is extremely tight for paying due diligence to the work especially in terms of: appropriate consultations with expert groups; and sufficient time for field testing in multiple countries and settings, and carrying out the resulting edits

(b) If the timeline is advanced to 2016, there will be more time to have ICD 2016 version with more translations and incorporations of some field tests results.

(c) If the timeline is advanced to 2017, ICD 2017 will be ready with most Field Test results incorporated and maintenance scheme tested.

[…]

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

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

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

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

“…However, work cannot begin on developing the necessary U.S. clinical modification to the ICD-11 diagnosis codes or the ICD-11 companion procedure codes until ICD-11 is officially released. Development and testing of a clinical modification to ICD-11 to make it usable in the United States will take an estimated additional 5 to 6 years. We estimated that the earliest projected date to begin rulemaking for implementation of a U.S. clinical modification of ICD-11 would be the year 2020.” [7]

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

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

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

Slide presentation: World Health Organization Classifications, Terminologies, Standards

ICD Revision: Quality Safety Meeting 2013 September 9-10

Where are we? What remains to be done? Shall we have ICD WHA submission in 2015 or later?

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

Slide 29:

Ustun 29rule

Slide 30:

Ustun 30rule

Slide 34:

Ustun 34rule

Slide 35: [WHA Approval – options under consideration]

Ustun 35rule
+++

References

1. Agenda Item No. 25: Revision of the International Classification of Diseases (ICD-10) and Involvement of Psychology International Union of Psychological Science Committee on International Relations Action, March 28–30, 2008 IUPsyS Mar 08 Agenda Item 25 ICD-10

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

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

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

5. Committee for the Coordination of Statistical Activities, Twenty-second Session 4-6 September 2013, Items for discussion and decision: Item 8 of the provisional agenda, 3 September 2013 Full document in PDF format

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

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

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