Allen Frances and Robert Spitzer on DSM-5 Scientific Review Work Group and DSM-5 Field Trials and deadlines

December 18, 2010 by

Allen Frances, MD and Robert Spitzer, MD write to the APA Board of Trustess re DSM-5 Scientific Review Work Group; Frances on DSM-5 Field Trials and deadlines

Post #54 Shortlink: http://wp.me/pKrrB-Ru

On 10 December 2009, the American Psychiatric Association (APA) issued a news release announcing a revised timeline for the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The anticipated release date for DSM-5 was being shifted from May 2012 to May 2013.

According to the DSM-5 Development Timeline:

[Timeline superceded by revised Timeline]

But field trials are barely underway.

Allen Frances, MD, currently professor emeritus at Duke, had chaired the DSM-IV Task Force. Frances maintains the blog DSM5 in Distress at Pyschology Today and also writes for Psychiatric Times where he’s been documenting and commenting on the development of DSM-5 since June 2009. Robert Spitzer had chaired the DSM-III Task Force.

Links to two recent commentaries by Allen Frances on DSM-5 deadlines and a joint letter by Frances and Spitzer to the APA Board of Trustees in response to the APA’s appointment of a DSM-5 Scientific Review Work Group, below:

DSM5 in Distress

The DSM’s impact on mental health practice and research.
by Allen Frances, M.D.

Letter To Board Of Trustees of the American Psychiatric Association sent December 6, 2010

Published on December 13, 2010

We are delighted that you have appointed a DSM-5 Scientific Review Work Group and charged it with assessing the quality of evidence supporting the DSM 5 proposals. This is great news, probably the last hope to weed out proposals that could do great harm to the Association, our field, and to our patients. Our relief and hope are tempered only by several problems with the process as you have established it:

CONTINUED SECRECY: Given all of the negative publicity surrounding the DSM-5 confidentiality agreements, we are amazed to see the following statement in the charge to the Scientific Review committee: “Deliberations and reports to the BOT will be confidential. The existence of the committee (work group) will be public.” Why on earth is this case? What is the possible harm of making this esteemed committee’s final report public? While we can appreciate the need for the committee to be able to deliberate candidly and not feel constrained by the possibility that every aspect of their deliberations will be made public, it is essential that the final report containing the committee’s assessment of the scientific merits of the proposals be made public.

COMPOSITION OF WORK GROUP: The announcement makes an ambitious claim, namely, that this review will be equivalent to an independent NIMH peer review. This desirable standard cannot possibly be met by the DSM-5 Scientific Review Work Group as you have constituted it. The people chosen are all well-respected, but all but two of the committee members have been involved with DSM 5 or its oversight. To have credibility, a review committee must be completely unattached to the work that has already been done on DSM 5. Preferably, APA should contract out the review process to experts in evidence based medicine who would be both fully independent and also able to apply the standards of scientific proof used across all medical specialties. At the very least, the membership of the committee needs to be broadened to guarantee both the reality and the appearance of a truly unbiased and independent review process.

CHARGE: Although labeled a “Scientific Review Work Group”, the charge needs to go beyond just being a scientific review and include a thorough risk/ benefit analysis of all suggestions. That such an analysis is planned in suggested by the statement in the charge that “issues of clinical utility, public health, and potential impact on patients should also be considered.” We applaud this plan to conduct a risk/benefit analysis but are concerned that such a review requires broader experience in primary care, public policy, health economics, and forensics that goes beyond the current composition of the Workgroup. At a minimum, close consultation with such experts should be part of the planned review process.

METHOD: It appears the assessments will be limited to evidence already generated by the work groups, with no check to determine if their reviews have been comprehensive and balanced. Since there was no standard operating procedure in the literature review process, the work group reviews are variable in quality and method. A recheck to ensure that all pertinent references have been included is necessary.

TIMING: This scientific review is occurring unbelievably late in the DSM 5 process- it should have been completed more than a year ago, not after the field trials have already begun. There is little purpose to be doing expensive field testing on proposal likely to be eliminated because of limited scientific support. Every step in the DSM 5 process has missed its deadline, sometimes by a year or more. We are concerned that the momentum of the DSM 5 process and limited time left for its review will result in the rushed inclusion of proposals that are both risky and unsupported by evidence.

All these serious concerns notwithstanding, The DSM 5 Scientific Review Work Group has our very best wishes. It is in a key position to do a great service for our field and for our patients and to save APA from further embarrassment.

Robert Spitzer and Allen Frances

DSM5 in Distress

The DSM’s impact on mental health practice and research.
by Allen Frances, M.D.

DSM 5 Field Trials-Part 1 Missed Deadlines Have Troubling Consequences
DSM 5 is falling far behind its schedule.

Published on November 15, 2010

This is a sad tale of completely unrealistic timetables, poorly executed work effort, consistently missed deadlines, and what will undoubtedly be a rushed and botched DSM 5. It all started at the annual meeting of the American Psychiatric Association in May 2009, when the DSM 5 leadership blithely announced it was ready to begin field testing in the early summer of 2009…

…It was patently obvious from the moment of its announcements that the new DSM 5 field test timetable was also a product of fantasy that would not be met in the real world. First off, it should have been clear that the field trials could not possibly start on time two months after their announcement. Recruiting the sites, training the personnel, gaining human rights approvals, and pilot testing always take at least six months. Predictably, we are already in mid Nov 2010 and it is still not at all clear when the DSM 5 field tests will actually begin to enroll patients at all its sites.

Read full commentary: DSM 5 Field Trials-Part 1 Missed Deadlines Have Troubling Consequences

DSM5 in Distress

The DSM’s impact on mental health practice and research.
by Allen Frances, M.D.

The DSM 5 Field Trials, Part 2: Asking The Wrong Question Will Lead To Irrelevant Answers
A waste of talent, time, and money.

Published on November 23, 2010

…Field tests also fail to account for the pressures that will lead to systematic, future misuse-especially the drug company marketing of mental disorders that leads to over-diagnosis.

…What do I mean? DSM 5 has made a number of radical suggestions for change, particularly the inclusion of many new diagnoses at the threshold of normality. These have the potential to reclassify as mentally disordered tens of millions of people currently considered normal. The only relevant questions are the overall rates of these disorders in the general population and the risks of false negative over-diagnosis.

…At the end of the DSM 5 field trials, we will have no idea whatever whether its suggestions will create false epidemics of misidentified pseudo-patients.

Read full commentary: Part 2: Asking The Wrong Question Will Lead To Irrelevant Answers

ICD-11

Implementation of the WHO’s ICD-11 is scheduled for 2014. Earlier this year, I asked ICD Revision to clarify for stakeholders whether any form of Alpha Draft for ICD-11 will be placed in the public domain, when this will be released and in what formats. 

In October, ICD Revision stated via its Facebook site, that there will be no publication of an ICD-11 Alpha Draft for public scrutiny and that a public Beta Draft is still targeted for May 2011.

ICD-11 targets also slipping 

According to the September iCamp2 meeting PowerPoint presentation, Frequent Criticisms and this iCamp2 YouTube, targets for the population of content for the ICD-11 Alpha Draft had not been reached.   

Less that 80% of 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 at that point. [The Content Model identifies the basic properties needed to define any ICD concept (unit, entity or category) through the use of multiple parameters.] Not all Topic Advisory Groups were at a similar developmental stage and ICD-11 Beta Plans were behind schedule.   (See Post #48)

International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders

The APA participates with the WHO in the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders and the DSM-ICD Harmonization Coordination Group.

The International Advisory Group for the Revision of the ICD-10 Chapter for Mental and Behavioural Disorders (currently ICD-10 Chapter V but will be Chapter 5 in ICD-11) was constituted by the WHO with the primary task of advising the WHO on all steps leading to the revision of the mental and behavioural disorders classification in ICD-10, in line with the overall ICD revision process.

The Group is chaired by Steven E Hyman, MD, Harvard University, Cambridge, Massachusetts. Steven E Hyman, MD is also a member of the APA’s DSM-5 Task Force.

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

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

with the objective that

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

The Advisory Group has published no Summary Reports of its meetings since its fourth meeting in December 2008. A fifth meeting of the group was held on 28 – 29 September 2009.  Over a year later, no Summary Report has been published for that meeting. It is uncomfirmed whether any meetings of the Advisory Group were held in 2010.

Topic Advisory Group for Neurology

The lead WHO Secretariat for Topic Advisory Group (TAG) for Neurology is Dr Tarun Dua, Management of Mental and Brain Disorders, Department of Mental Health and Substance Abuse, WHO, Geneva.

The TAG for Neurology is chaired by Raad Shakir, MD, Imperial College London. For further information on TAG Neurology see this page.

Filed under American Psychiatric Association (APA), Clinical Modification, Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 draft proposals, DSM-5 in the media, DSM-V, ICD-10-CM, ICD-11, ICD-11 Alpha Draft, Psychiatric Times, WHO (World Health Organization)

No publication of an ICD-11 Alpha Draft for public scrutiny

November 19, 2010 by

There will be no publication of an ICD-11 Alpha Draft for public scrutiny

Post #53 Shortlink: http://wp.me/pKrrB-QL

For some time now, I have been trying to establish whether ICD Revision intends to release any form of ICD-11 Alpha Draft for public scrutiny. An Alpha Draft had originally been scheduled for May 2010.

On 6 August, ICD Revision on Facebook had stated:

“The ICD-11 Alpha Drafting process has been ongoing since the first iCamp that was held in Geneva, Switzerland in September 2009. A draft print version will be available in September 2010.”

On 29 September, I asked:

“Clarification would be welcomed on whether an Alpha Draft will be available this month for internal use only or whether it is intended for public viewing, and if for public viewing, in what format(s)?”

which received no response.

On 6 October, I asked, again:

“On 6 August, ICD Revision on Facebook stated that “A draft print version will be available in September 2010”. Other than what can be seen on the iCAT collaborative authoring platform, will ICD Revision please clarify for stakeholders, whether any form of Alpha Draft for ICD-11 is going to be placed in the public domain, when this will now be released, and in what formats?”

On 15 October, ICD Revision on Facebook responded: 

“Indeed a print version is available but as an alpha draft it is not for public consumption. Public draft ( beta draft) was and (is still) targeted for MAY 2011. iCAT authoring platform is not open to public and should be only seen by designated authors. — This is not something opaque. any project of this size and complexity has to pass through stages. In May 2011 more user-friendly software and easy-to-view options will be available…”

At that point, it was in fact the case that both the iCAT authoring platform server and the iCAT demo and training platform had been viewable by the public, although only WHO, ICD Revision Steering Group, ICD Revision IT technicians and Topic Advisory Groups (TAGs) had editing access.

The iCAT production server is at: http://icat.stanford.edu/
The iCAT demo and training platform is at: http://icatdemo.stanford.edu/

In early November, access to viewing the iCAT and the iCAT demo platform was closed to the public. 

Topic Advisory Group (TAG) members now require a password login for both browsing and editing the iCAT or importing data and the public can no longer view the iCAT and the population of ICD Title Categories and Content, at all.

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

The Development, Evolution, and Modifications of ICD-10: Challenges to the International Comparability of Morbidity Data

October 29, 2010 by

The Development, Evolution, and Modifications of ICD-10: Challenges to the International Comparability of Morbidity Data

Post #52 Shortlink: http://wp.me/pKrrB-QX

Keywords
ICD, WHO, morbidity, ICD-10 clinical modifications, administrative data

Medical Care

POST AUTHOR CORRECTIONS, 25 October 2010
doi: 10.1097/MLR.0b013e3181ef9d3e
Original Article: PDF Only

The Development, Evolution, and Modifications of ICD-10: Challenges to the International Comparability of Morbidity Data

Published Ahead-of-Print

Abstract

Background: The United States is about to make a major nationwide transition from ICD-9-CM coding of hospital discharges to ICD-10-CM, a country-specific modification of the World Health Organization’s ICD-10. As this transition occurs, the WHO is already in the midst of developing ICD-11. Given this context, we undertook this review to discuss: (1) the history of the International Classification of Diseases (a core information “building block” for health systems everywhere) from its introduction to the current era of ICD-11 development; (2) differences across country-specific ICD-10 clinical modifications and the challenges that these differences pose to the international comparability of morbidity data; (3) potential strategic approaches to achieving better international ICD-11 comparability.

Literature Review and Discussion: A literature review and stakeholder consultation was carried out. The various ICD-10 clinical modifications (ICD-10-AM [Australia], ICD-10-CA [Canada], ICD-10-GM [Germany], ICD-10-TM [Thailand], ICD-10-CM [United States]) were compared. These ICD-10 modifications differ in their number of codes, chapters, and subcategories. Specific conditions are present in some but not all of the modifications. ICD-11, with a similar structure to ICD-10, will function in an electronic health records environment and also provide disease descriptive characteristics (eg, causal properties, functional impact, and treatment).

Conclusion: The threat to the comparability of international clinical morbidity is growing with the development of many country-specific ICD-10 versions. One solution to this threat is to develop a meta-database including all country-specific modifications to ensure more efficient use of people and resources, decrease omissions and errors but most importantly provide a platform for future ICD updates.

(C) 2010 Lippincott Williams & Wilkins, Inc.

Ed note: The forthcoming US “Clinical Modification”, ICD-10-CM, is country specific; it does not apply outside the US.

Current proposals for the US Clinical Modification ICD-10-CM, which is scheduled for implementation in October  2013, propose classifying Chronic fatigue syndrome in ICD-10-CM Chapter 18 at R53.82.

The proposed U.S. classification ICD-10-CM separates CFS and Postviral fatigue syndrome into mutually exclusive categories. “Chronic fatigue, unspecified | Chronic fatigue syndrome not otherwise specified” appear in Chapter XVII under R53.82.

“Postviral fatigue syndrome | Benign myalgic encephalomyelitis” appear in Chapter VI under G93.3.

The Chronic Fatigue Syndrome Advisory Committee (CFSAC) had previously recommended CFS to be placed under the same neurological code as ME and PVFS, G93.3.

For the most recent ICD-10-CM proposals see:

CDC site: International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) [1]:

http://www.cdc.gov/nchs/icd/icd10cm.htm

The Zipped file for the “2010 ICD-10-CM Tabular List of Diseases & Injuries” is not that easy to locate on the CDC site.

A non Zipped PDF of the most recent proposals can be downloaded here:

http://www.cms.gov/ICD10/12_2010_ICD_10_CM.asp#TopOfPage

http://www.cms.gov/ICD10/Downloads/6_I10tab2010.pdf

Page 325:

G93.3 Postviral fatigue syndrome
Benign myalgic encephalomyelitis
Excludes1: chronic fatigue syndrome NOS (R53.82)

Page 1165:

R53.82 Chronic fatigue, unspecified
Chronic fatigue syndrome NOS
Excludes1: postviral fatigue syndrome (G93.3)

The Canadian Clinical Modification (ICD-10-CA) has all three terms classified in Chapter VI: Diseases of the nervous system at G93.3:

Version 2009 ICD-10-CA Tabular List, Volume 1 PDF (4.9MB):

http://secure.cihi.ca/cihiweb/en/downloads/ICD-10-CA_Vol1_2009.pdf

Other disorders of the nervous system

(G90-99)

[…]

G93 Other disorders of brain

[…]

G93.3 Postviral fatigue syndrome
Includes: Benign myalgic encephalomyelitis
Chronic fatigue syndrome

Excludes: fatigue syndrome NOS (F48.0)

[1] Although this release of ICD-10-CM is now available for public viewing, the codes in ICD-10-CM are not currently valid for any purpose or use.

[2] More information on US “Clinical Modification” ICD-10-CM here, on DSM-5 and ICD-11 Watch site: http://wp.me/pKrrB-Ka

Filed under Clinical Modification, ICD revision process, ICD-10, ICD-10-CM, ICD-11, ICD-11 in the media, WHO (World Health Organization)

Web Protégé: Supporting the Creation of ICD-11 and iCAMP2 YouTubes

October 26, 2010 by

Web Protégé: Supporting the Creation of ICD-11 and iCAMP2 YouTubes

Post #51 Shortlink: http://wp.me/pKrrB-Qv

http://iswc2010.semanticweb.org/pdf/502.pdf

Web Protégé: Supporting the Creation of ICD-11

Sean M. Falconer, Tania Tudorache, Csongor Nyulas, Natalya F. Noy, Mark A. Musen

Stanford Center for Biomedical Informatics Research, Stanford University, US

1 Introduction

The International Classification of Diseases (ICD) is a public global standard that organizes and classifes information about diseases and related health problems [4]. Health offcials use ICD in all United Nations member countries to compile basic health statistics, to monitor health-related spending, and to inform policy makers. In the United States, use of the ICD is also a requirement for all medical billing. ICD has therefore a major impact on many aspects of health care all over the world.

In 2007, the WHO initiated the 11th revision of ICD. Several ambitious goals were set for this version (details in [2]). One such goal is to allow the ICD to become a multi-purpose classification for a much larger number of usages. Previous versions of ICD were strictly classification hierarchies used for statistical purposes. To meet the new revision goals, ICD-11 will use OWL to create a rich formal representation. Another key diference between ICD-11 and previous versions is that the development process of ICD-11 will use a Web-based open process powered by collaboration and social features. That is, similar to Wikipedia, the WHO hopes that a large number of medical experts will contribute to the content of ICD-11.

Our group has been working closely with the WHO to provide the technical support for these ambitious goals. We have created a customized version of Protégé specifcally designed to support the ICD authoring process. In [2], we discuss in detail the use of Semantic Web technologies for the revision of ICD. Our demo will showcase features of the customized Protégé such as content creation and collaboration. For the remainder of this paper, we present the architecture and highlight features of the user interface…

Full document

————–

iCamp2: 27 September – 1 October 2010

http://sites.google.com/site/icd11revision/home/face-to-face-meetings/icamp2-2010   

The iCamp2 meeting, scheduled for April but postponed due to volcanic ash cloud disruption of air traffic, was held between 27 September – 1 October, in Geneva.   

iCamp2
27 September – 1 October 2010 Geneva, Switzerland WHO Headquarters   

RSG 2010 [Revision Steering Group]
30 September – 1 October 2010 Geneva, Switzerland WHO Headquarters   

The revised Agenda for the meeting can be read here in html on the ICD Revision site.   

Download here as a Word document from the ICD Revision site or open here iCamp2 Agenda September 2010 on DSM-5 and ICD-11 Watch site.   

I will post a link for the minutes, summary or note of this meeting when these are available on the ICD Revision site.

There are two ICD-11 iCamp2 on YouTube   

ICD-11 ICAMP2 Day 5 

WHOICD11’s Channel  | 21  October 2010  |  9.53 mins

iCAMP2 Day 2   

WHOICD11’s Channel  | 29 September 2010  |  7:32 mins    

 

Related information

ICD Revision iCamp2 meeting, new documents and status of the ICD-11 Alpha Draft

Filed under iCAT, ICD on YouTube, ICD revision process, ICD-10, ICD-11, ICD-11 Alpha Draft, ICD-11 revision docs, WHO (World Health Organization), Wikipedia

ICD-11 revision: where are we now? Ontology-driven tools and the web platform: Meeting abstract

October 7, 2010 by

ICD-11 revision: where are we now? Ontology-driven tools and the web platform: Meeting abstract

Post #49 Shortlink: http://wp.me/pKrrB-PW

A PDF of an associated slide presentation by JM Rodrigues et al can be downloaded here:

http://tinyurl.com/ICD-11revision-Rodrigues

 

This article is part of the supplement:

Patient Classification Systems International: 2010 Case Mix Conference, Munich, Germany. 15-18 September 2010.

http://www.biomedcentral.com/bmchealthservres/10?issue=S2

BMC Health Services Research

Volume 10
Suppl 2

http://www.biomedcentral.com/1472-6963/10/S2/A7

PDF: http://www.biomedcentral.com/content/pdf/1472-6963-10-S2-A7.pdf

Open access

Meeting abstract

ICD-11 revision: where are we now? Ontology-driven tools and the web  platform

J Rodrigues¹²
1 SSPIM, CHU Saint etienne, Saint Etienne, France
2 WHO FIC Collaborative Centre, WHO FIC Collaborative Centre, Paris, France

corresponding author email

from 26th Patient Classification Systems International (PCSI) Working Conference

Munich, Germany. 15-18 September 2010
BMC Health Services Research 2010, 10(Suppl2):
A7doi:10.1186/1472-6963-10-S2-A7

The electronic version of this abstract is the complete one and can be found online at: http://www.biomedcentral.com/1472-6963/10/S2/A7

Published: 6 October 2010

© 2010 Rodrigues; licensee BioMed Central Ltd.

Introduction

ICD is the international de facto standard classification for most epidemiological and many health-care and clinical uses. Originally designed to record causes of death, the usage of ICD has been extended to include morbidity classification, reimbursement, and several other specialty areas such as oncology and primary care. The current 10th edition of ICD was endorsed by the World Health Assembly in 1990 and has been periodically updated over the years. Recently, the World Health Assembly decided to develop a completely new version named the 11th revision.

Methods

In previous revisions of ICD, specialty experts and national representatives of WHO collaborative-classification centers proposed additions and changes to the codes (using lists of codes for creating new drafts). In contrast, the development of ICD-11 aims to create an information infrastructure and workflow processes that utilize knowledge engineering and management techniques that are supported by software.

Instead of just codes, titles, and associated rules and indices, the information infrastructure will enable a more detailed definition of disease and health conditions, as well as the use of reference terminologies and ontologies, review of best scientific evidence, and field trials of draft standards.

In terms of workflow, the information infrastructure should support the collaborative development of new content and proposed changes, rigorous review and approval processes, and the creation of draft classifications for field testing. The ICD revision process was initially the work of Topic Advisory Groups (TAG) that had been set up for various specialty areas. The ICD-11 revision process will eventually be opened up for comments and suggestions from interested parties on the Internet.

Lastly, the final output will be multiple for different use cases such as mortality, morbidity and primary care, which can be mapped with ontology-driven tools

Results

The content model is made up of three different parts:

A) Descriptive Characteristics
ICD Concept Title
Hierarchy, Type and Use
Textual Definition
Terms
Index Terms
Synonyms
Inclusion Terms
Exclusion Terms

B) Clinical Description
Manifestation Properties
Signs & Symptoms
Findings
Temporal Properties
Severity Properties
Functional Properties
Treatment Properties
Diagnostic Rules
Reason For Encounter

C) Formal Characteristics
Body Structure
Morphologic Abnormality
Causal Properties
Mechanisms/ Agents
Risk Factors
Genomic Characteristics
Dysfunction

The web platform named ICAT has been developed by a team of Stanford University to allow a collaborative population of the content model by their different tags.

The ICD-11 content model is still evolving, but the main components have been specified. A detailed guide describes the expected content and usage of each component. It is the document that records the shared understanding  of the content model.

The OWL content model realizes the informal description in the guide and formalizes the three-layer  conceptualization of the original UML model.

Conclusions

The ICD-11 content model is very much a work in progress. Consensus formulation of several components such as temporal properties, severity properties, and diagnostic criteria is not yet available. From the view point of case mix, the new tools will provide an ICD of better quality for morbidity, thus allowing better mapping between diagnosis systems and, as a result of this, better mapping across case-mix systems based on diagnosis coding.

[Abstract Ends]

Update on status of ICD-11 Alpha Draft in previous post on DSM-5 and ICD-11 site:

ICD Revision iCamp2 meeting, new documents and status of the ICD-11 Alpha Draft

2 October 2010

Shortlink Post #48: http://wp.me/pKrrB-O9

Reference material:

PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring Platform, 7 June 2010, Post # 46: http://wp.me/pKrrB-KK

[1] ICD-11 Revision Project Plan – Draft 2.0 (v March 10):
Describes the ICD revision process as an overall project plan in terms of goals, key streams of work, activities, products, and key participants: ICD Revision Project Plan
http://www.who.int/classifications/icd/ICDRevisionProjectPlan_March2010.pdf

[2] User Manual [Content Model User Guide, 53 pp Word doc]  Key ICD-11 document
Identifies the basic properties needed to define any ICD concept (unit, entity or category) through the use of multiple parameters. Open here on DSM-5 and ICD-11 Watch: User Manual 20.09.10

[3] iCAT production server:
http://sites.google.com/site/icd11revision/home/icat
iCAT production server: http://icat.stanford.edu/

[4] iCAT Glossary
http://apps.who.int/classifications/apps/icd/icatfiles/iCAT_Glossary.html

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

iCamp2 meeting and status of ICD-11 Alpha Draft

October 2, 2010 by

ICD Revision iCamp2 meeting, new documents and status of the ICD-11 Alpha Draft

Post #48 Shortlink: http://wp.me/pKrrB-O9

The information in this update relates only to proposals for ICD-11.   

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

Post #45 is intended to clarify any confusion between ICD-10, ICD-11 and the forthcoming US specific “Clinical Modification”, ICD-10-CM.

See: US “Clinical Modification” ICD-10-CM

iCamp2: 27 September – 1 October 2010

http://sites.google.com/site/icd11revision/home/face-to-face-meetings/icamp2-2010

The iCamp2 meeting, scheduled for April but postponed due to volcanic ash cloud disruption of air traffic, was held between 27 September – 1 October, in Geneva.

iCamp2
27 September – 1 October 2010 Geneva, Switzerland WHO Headquarters   

RSG 2010 [Revision Steering Group]
30 September – 1 October 2010 Geneva, Switzerland WHO Headquarters  

The revised Agenda for the meeting can be read here in html on the ICD Revision site.

Download here as a Word document from the ICD Revision site or open here iCamp2 Agenda September 2010 on DSM-5 and ICD-11 Watch site.

I will post a link for the minutes, summary or note of this meeting when these are available on the ICD Revision site.

Click here for a list and bios of Meeting Participants

ICD-11 iCamp2 on YouTube 

ICD-11 ICAMP2 Day 5

WHOICD11’s Channel  | 21  October 2010  |  9.53 mins

iCAMP2 Day 2

WHOICD11’s Channel  | 29 September 2010  |  7:32 mins

 

Status and format of the ICD-11 Alpha Draft

Slipping timeline

In his iCamp2 Introductory presentation, Dr Bedirhan Üstün says there are just seven months to go before the start of the ICD-11 beta drafting phase and 43 months to the final version. Beta drafting remains scheduled to begin in May 2011, even though targets for the drafting of content are slipping and an Alpha Draft has yet to be published.

The Beta Requirements Document says, “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” and that the time until May 2011 “will be used to develop and test the Beta Draft software and procedures and make consultations with end users around key issues and basic questions.”

iCamp2 acknowledged that a considerable amount of work needs to be done in the interim if ICD Revision is going to meet its targets.

No detailed timeline for the development of ICD-11 is available on the WHO’s main website. But in March, an ICD Revision Project Plan document, published on the ICD Revision Google site, had projected an Alpha Draft release date of May 2010, with a Beta Draft ready by May 2012. [Source: Page 7, “Project milestones and budget, and organizational overview”.]

A press launch for the Alpha Draft had been tabled for discussion on the Agenda for the April iCamp2 meeting. In the event, the April meeting was postponed, but ICD Revision has issued no public explanation for why the anticipated Alpha Draft failed to be released in April/May, nor has the Steering Group issued a revised ETA.

From the ICD Revision Project Plan:

The Alpha draft will be produced in a traditional print and electronic format. The Alpha Draft will also include a Volume 2 containing the traditional sections and including a section about the new features of ICD-11 in line with the style guide. An index for print will be available in format of sample pages. A fully searchable electronic index using some of the ontological features will demonstrate the power of the new ICD.

According to sources, in July, a print version of the Alpha Draft was expected to be made available around the time that the rescheduled iCamp2 meeting took place in September. Requests for clarification of the status and accessibility of an alpha draft have been left on ICD Revision Facebook site by several members of the public. When a response was eventually forthcoming, in August, it was confirmed that a “draft print version will be available in September 2010”.

iCamp2 is over now, but it remains unclear whether a print version has been produced, whether it is intended for internal use only or is going to be made available for public scrutiny, and if so, when, and in what format(s). ICD Revision has been asked to clarify.

This slide from a DSPIM presentation says the Alpha Draft was scheduled for completion by 27 September:

Source: Slide 9, PDF presentation slides: ICD-11 Revision: where are we now? Ontology driven tools and web platform. JM Rodrigues et al, DSPIM, University of Saint Etienne, WHO Collaborating Centre for International Classifications in French Language, Paris.

 

The WHO is promoting the development of ICD-11 as a transparent, collaborative and inclusive process

The Revision Steering Group (RSG) has launched a number of public interfaces – the ICD-11 Revision site (meeting agendas, minutes, documents and presentations), a YouTube channel, a blog (not updated since October 2009), a Facebook site, Twitter and an iCAT users Google Group, open to any stakeholders who register for access.  The iCAT Web 2.0 drafting platform is also viewable by the public and the production server can be accessed here: http://icat.stanford.edu/.

But little consideration appears to have been given to who should take responsibility for responding to questions from stakeholders or fielding queries left on the ICD Revision Facebook site, which rarely receive a reasonably prompt response, or any response, at all.

WHO Secretariat do not always acknowledge or respond to enquiries. A request for clarifications from a Topic Advisory Group (TAG) Chair, whilst acknowledged, has received no response after three months. The 5th meeting of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders (currently ICD-10 Chapter V) was held on 28 – 29 September 2009. A year later, a Summary Report is still pending publication and no meeting summaries for TAG Mental Health have been published on the WHO website since the 4th Meeting 1 – 2 December 2008.

The WHO needs to decide whether, in launching public interfaces and using “social networking” for input and feedback from stakeholders it genuinely seeks to provide platforms for meaningful interaction with the public or whether these are tokenistic nods at “transparency”.

Content posted by ICD Revision admin on its Facebook Wall often lacks meaning and substance. What stakeholders really need to know is whether any form of alpha draft is going to be publicly released before the Beta phase – not photos of happy iCampers playing bassoons at musical soirées and iCamp bonding sessions.

I will update if and when any information is released on the status and public availability of an alpha draft, and what format(s) it will be available in.

Proposals

Since 2007, it has been possible for stakeholders in the development of ICD to submit proposals and comments, supported by citations, via the ICD Update and Revision Platform Intranet. It was understood, last September, that for some Topic Advisory Groups (notably Chapters 5 and 6) a proposal form for ICD-11 was being prepared for use by stakeholders.

Information about the availability of proposal forms for the various Topic Advisory Groups, up to what stage in the development process timeline these might be used and which stakeholders might be permitted to make use of any proposal forms already being issued or in preparation would also be welcomed from the Revision Steering Group or TAG managing editors.

Slipping targets

According to the iCamp2 PowerPoint presentation, Frequent Criticisms and this iCamp2 YouTube, targets for the population of content for the Alpha Draft have not been reached.

Less that 80% of Terminology Definitions have been uploaded to the iCAT and less than the 20% target for full Content Model completion for the many thousands of diseases and disorders classified within ICD has been met. [The Content Model identifies the basic properties needed to define any ICD concept (unit, entity or category) through the use of multiple parameters.] Not all parameters of the Content Model are implemented yet. Not all Topic Advisory Groups are at a similar developmental stage; Beta Plans are behind schedule.

The Revision Steering Group identifies barriers to keeping this technically very ambitious project on track:  lack of finances; the sheer amount of time required for the drafting of definitions and population of textual content according to the complex ICD-11 Content Model; recruiting external experts for reviewing proposals and generating content; familiarising TAG workgroup members with the functionality of the iCAT, the collaborative authoring platform through which ICD-11 is being drafted, and with informatics; entering data into the iCAT; the paucity of face-to-face meetings for TAG managing editors and workgroup members who are scattered across the globe and undertaking these roles in addition to professional commitments; difficulties facilitating interaction between the various Topic Advisory Groups where diseases overlap with other chapters.

A number of new workgroups have recently been created (Paediatrics, Dentistry, E.N.T, Traditional Medicine and Communicable/Tropical Diseases).

Under “Overall Directions” in the Beta Requirements Document, it says:

The knowledge representation space is too large to be curated by a small number of experts (e.g. 20,000 ICD Categories, 15 parameters of CM [Content Model], each may have 1-20 entries – on average a relational database matrix with 300,000 entries).

[…]

Scaling up the process from the alpha phase to beta should be carefully planned and modelled. It is estimated that the alpha phase participants will be at the magnitude of 500-1000 persons. In beta phase it is expected to have 10-100 fold increase.

If the Revision Steering Group is already struggling to maintain motivation and interaction between the various Topic Advisory Groups, then management of the project once the beta phase is reached and the process opened up to stakeholders is going to present the Steering Group and TAG workgroup managing editors with considerable challenges.

The original dissemination date for ICD-11 had been 2012, with the timelines for the revision of ICD-10 and DSM-IV running more or less in parallel. The dissemination date for ICD-11 was later extended to 2014 and the publication date of the next edition of the DSM, DSM-5, extended to May 2013.

(John Gever, Senior Editor, MedPage Today, reported on 5 October that Testing of new diagnostic criteria proposed for DSM-5, the revision of the psychiatric profession’s manual for patient assessment, is finally underway, more than two months behind schedule.)

The development of ICD-11 is a hugely complex and technically ambitious undertaking; all three volumes will be electronically published, integrable and intended to be integrable with some other health classification publications; the scope of ICD-11 is far greater than that of the previous edition.

It may be that come May 2011, we might anticipate some scaling back of plans and/or possibly a shift in the release of the Beta Draft from May 2012 to 2013+, in response to the recognition that the WHO may have significantly overestimated its capacity for securing the funding and resources to complete the technical work on this project by 2012, if implementation of the final version is to take place in 2014.

The iCamp YouTube commentaries have an air of brittle optimism about them.

Coming up

In a forthcoming post, in lieu of an Alpha Draft, I shall be reporting on what can currently be seen in the ICD-11 iCAT drafting platform and associated Revision documents in relation to the three ICD-10 categories: “Postviral fatigue syndrome”, “Chronic fatigue syndrome” and “(Benign) myalgic encephalomyelitis” and why I have asked the Chair of the Topic Advisory Group for Neurology for a clarification.

iCamp2 meeting documents  and presentations

A number of new and existing ICD revision related documents have been published on the ICD-11 Revision Google site in association with the iCamp2 and RSG September meetings. Not all the documents listed have been uploaded to the ICD Revision site and several links are returning “File not found”.

Face-to-Face Meetings‎ > ‎iCamp2: 27 September – 1 October 2010‎
http://sites.google.com/site/icd11revision/home/face-to-face-meetings/icamp2-2010/documents

iCamp2 Agenda  [27 September – 1 October 2010]

Workflow  [PDF]

iCAT Progress Table  [Not currently available]
Alpha Draft Print Sample  [Not currently available]
iCAT Tool Documents  [Not currently available]

• User Manual  [Content Model User Guide, 53 pp Word doc]  Key ICD-11 document
• Issues and Feature Lists  [Not currently available]

• Tasks Completed  [Not currently available]
• Tasks In Progress/Pending  [iCAT Release Notes on iCAT Google Group platform]

Narrative Workflow Diagram  [Not currently available]

Standard Operating Procedures  [Not currently available]

Beta Requirements Document   [3 pp Word doc]

Workplans:

• TAG HIM  [Not currently available]
• RSG  [Not currently available]
• TAGs  [Not currently available]

3 Component Content Model Description   [File not found]

• Linearization Component  [File not found]
• Foundation Component  [File not found]
• Ontology Component  [1 slide pptx + notes; PowerPoint slides require MS PP 2007 pptx reader]

Evaluation Strategy for Alpha Draft

• Questions for Reviewers  [Not currently available]
• Quality Assurance  [Not currently available]

Dagger-Asterisk Convention Abolition  [Not currently available]

DIFF File–Changes from ICD-10  [MS Excel doc. Retrieved 29.09.10; Not available on 01.10.10]

Field “A Type” specifies: new; unchanged; decision to be made; retired; real retired

[Note: ICD11 Alpha Codes may be temporary sorting codes; “FXC” against “G93.3” does not relate to the F Codes in ICD Chapter 5 (V); note also that Gj92 is an ICD-11 “Sorting label” not an ICD code.]

Extract Spreadsheet:

 

Frequent Criticisms   [11 slide pptx; PowerPoint slides require MS PP 2007 pptx reader]

Signs and Symptoms   [4 pp Word doc; Discussion document: Considerations for handling categories and concepts currently found in chapter 18 of ICD-10, “SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND
LABORATORY FINDINGS NOT ELSEWHERE CLASSIFIED”, (R-codes), authors: Aymé, Chalmers, Chute, Jakob.] Or open here: Discussion: Signs and Symptoms (Chapter 18)

PDF: https://dxrevisionwatch.com/wp-content/uploads/2018/08/icd-revision-signs-and-symptoms-discussion-document.pdf

Multisystem Chapter   [12 pp Word doc; Discussion document: Multisystem Chapter, authors: Aymé, Chalmers, Chute, Jakob.] Or open here: Discussion: Multisystem Chapter

PDF: https://dxrevisionwatch.com/wp-content/uploads/2018/08/icd-revision-multisystem-diseases-discussion-document.pdf

“ICD has traditionally grouped diseases by aetiology and by affected organ system.  For ICD­11 the creation of a new chapter for multisystem disorders has been proposed.  The following text sets out the rationale for and the possible scope of a multisystem disorders chapter.”

Contains Literature search reference at 119 to the Maes and Twisk paper, Treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a multisystem disease, should target the pathophysiological aberrations (inflammatory and oxidative and nitrosative stress pathways), not the psychosocial “barriers” for a new equilibrium. 2010: Ireland. p. 148-9.

Contains Literature search reference at 118 to published response to Maes and Twisk paper by Luyten, P. and B. Van Houdenhove, Treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a multisystem disease, should target the pathophysiological aberrations (inflammatory and oxidative and nitrosative stress pathways), not the psychosocial “barriers” for a new equilibrium – Response to Maes and Twisk. 2010, ELSEVIER IRELAND LTD, ELSEVIER HOUSE, BROOKVALE PLAZA, EAST PARK SHANNON, CO, CLARE, 00000, IRELAND. p. 147-147.

Presentations  [PowerPoint slides require the MS PP 2007 pptx reader unless identified as ppt]

Introduction (USTUN)  [14 slides]

Volume 1 (JAKOB)  [26 slides]

Volume 2 (JAKOB)  [11 slides]

Volume 3 (CELIK)  [6 slides + notes]

iCAT (TUDORACHE)  [26 slides PDF; iCAT Progress Update, Stanford Center for Biomedical Informatics Research]

iCAT & TAG Statistics (COTTLER)  [10 slides; New, Retired and Unchanged ICD Concepts (statistics)]

Rare Diseases (RATH)  [19 slides; Rare Diseases TAG feedback on ICD revision]

Dermatology (CHALMERS/WEICHENTHAL)  [ppt; 15 slides]

Ophthalmology (COLENBRANDER/KASHII)  [ppt; 3 slides]

Internal Medicine (SUGANO)  [10 slides]

Paediatrics (LINZER)  [ppt; 4 slides; Newly created TAG]

Musculoskeletal (SUNDBERG)  [ppt; 7 slides]

External Causes and Injuries  (HARRISON)  [ppt; 11 slides]

Maternal, Neonatal and Urogenital  (CHOU)  [ppt; File will not open at 01.10.10]

Socio-Technical Systems (STOREY)  [pptx; 31 slides]

 

TAG Neoplasms  [ppt; 105 slides]

Functioning TAG  [ppt; 21 slides]

TAG Morbidity  [ppt; 5 slides]

Additional documents  [All PDFs]

Ophthalmology TAG DRAFT
Pre001.2 Dermatology TAG
Rare Diseases Chapter 3 Haematological diseases DRAFT 2
Rare Diseases Chapter 3 Immunological Diseases DRAFT
Rare Diseases Chapter 4 Endocrine Diseases DRAFT
Rare Diseases Chapter 4 Metabolic Diseases DRAFT
Rare Diseases Chapter 4 Nutritional Diseases DRAFT
Rare Diseases Chapter 6 Neurological Diseases DRAFT

 

References:

PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring Platform, 7 June 2010, Post # 46: http://wp.me/pKrrB-KK

[1] ICD-11 Revision Project Plan – Draft 2.0 (v March 10):
Describes the ICD revision process as an overall project plan in terms of goals, key streams of work, activities, products, and key participants: ICD Revision Project Plan
http://www.who.int/classifications/icd/ICDRevisionProjectPlan_March2010.pdf

[2] User Manual [Content Model User Guide, 53 pp Word doc]  Key ICD-11 document
Identifies the basic properties needed to define any ICD concept (unit, entity or category) through the use of multiple parameters. Open here on DSM-5 and ICD-11 Watch: User Manual 20.09.10

[3] iCAT production server:
http://sites.google.com/site/icd11revision/home/icat
iCAT production server: http://icat.stanford.edu/

[4] iCAT Glossary
http://apps.who.int/classifications/apps/icd/icatfiles/iCAT_Glossary.html

Filed under DSM revision process, DSM-5, DSM-5 in the media, iCAT, ICD on YouTube, ICD revision process, ICD-10, ICD-10-CM, ICD-11, ICD-11 Alpha Draft, ICD-11 in the media, ICD-11 revision docs, WHO (World Health Organization)

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