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Updates on status of ICD-11 and changes to other classification and terminology systems

Discussion in 'General ME/CFS News' started by Dx Revision Watch, May 4, 2018.

  1. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    Thank you Ravn, that's made my day.
     
  2. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    The Seventy-second World Health Assembly (WHA72) opened this morning, Monday, 20 May 2019.


    This year's Assembly runs from Monday 20 to Tuesday 28 May.

    WHA72 website and Documents page: http://apps.who.int/gb/e/e_wha72.html

    Daily webcasts: https://www.who.int/about/governance/world-health-assembly/seventy-second-world-health-assembly

    Official Twitter hashtag: #WHA72



    A Daily Journal is posted each morning (links for the Journals on the left of the WHA72 website and Documents page).

    N° 1 20 May 2019 | Programme of meetings for Monday, 20 May 2019: http://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_JOUR1-en.pdf


    According to Daily Journal No 1 20 May, the Eleventh revision of the International Classification of Diseases is Item 12.7 under
    Item 12 Other technical matters and is the purview of Committee A.


    Item 12.7 Eleventh revision of the International Classification of Diseases
    is currently expected to be reached on Saturday, 25 May:

    Extract Page 7, Daily Journal N° 1:

    [​IMG]



    Edited to insert revised Agenda:

    Extract Page 5, Daily Journal N° 5:

    [​IMG]


    The two key documents for Item 12.7 Eleventh revision of the International Classification of Diseases are:

    A72/29
    Eleventh revision of the International Classification of Diseases
    Report by the Director-General

    and

    A72/29 Add.1
    Eleventh revision of the International Classification of Diseases
    Draft Resolution

    [I have also attached PDFs for these two key documents to this post.]



    Draft resolution for consideration by Committee A:

    Page 1:


    [​IMG]

    Page 2:

    [​IMG]
    Continued in Part 2
     

    Attached Files:

    Last edited: May 24, 2019
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  3. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    Part 2:

    It should be possible to stream the Tenth Meeting of Committee A via the webcast page on Saturday 25 May from 9:00 Geneva time (CEST) (8:00 GMT). I will be watching the segment for Item 12.7 when that is reached and will report on any significant discussions/decisions.

    Edited to add: The daily webcasts of Plenary, Committee A and Committee B meetings will be available for 3 months.

    The 72nd Assembly closes on Tuesday, 28 May. Finalization of Committee A resolutions and reports is scheduled for the final day:

    [​IMG]



    There are in the region of 55,000 codes in the Eleventh Edition of ICD compared with around 14,400 in ICD-10.

    It is anticipated that some Member States may continue to raise concerns over specific controversial additions, for example, the inclusion of Gaming disorder, which may potentially be further discussed at the meeting. There have also been statements of concern lodged by some Member States regarding the timelines for adoption and transitional arrangements, as currently proposed.

    I will update this thread with any significant discussions or amendments to the draft resolution as it currently stands and will post the finalized reports and ICD-11 resolution, when these become available.


    The Blue ICD-11 MMS platform:

    The ICD-11 for Mortality and Morbidity Statistics (ICD-11 MMS) 2018 version
    was released by WHO, in June 2018, as a pre-implementation version for Member States to begin the process of evaluation, consultations, training, translations and preparing for eventual transition to the new edition.

    This initial release was replaced with an updated release in December 2018. The December 2018 version was replaced by a further release, in April 2019.

    The current release is dated Version : 04 / 2019:

    https://icd.who.int/browse11/l-m/en

    It is unclear whether Version : 04 / 2019 is the version that is being presented for endorsement on Saturday, or whether the MMS will be updated this week to reflect the most recent content changes in the Orange Maintenance Platform, then frozen for presentation next Saturday. I will keep an eye on the Blue Platform for any new release in the run up to Saturday's meeting.

    I will also post the Daily Journal (and any associated background documents) for the Item 12.7 meeting of Committee A, currently scheduled for Saturday, 25 May.


    The listing for the Blue Platform for PVFS, CFS and BME is:


    https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/569175314

    [​IMG]
     
    Last edited: May 23, 2019
  4. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    World Psychiatry: Letter to the Editor: Free access, 6 May 2019

    Public stakeholders’ comments on ICD‐11 chapters related to mental and sexual health

    Johannes Fuss, Kyle Lemay, Dan J. Stein, Peer Briken, Robert Jakob, Geoffrey M. Reed, Cary S. Kogan

    Html: https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20635
    PDF: https://onlinelibrary.wiley.com/doi/epdf/10.1002/wps.20635


    ...Between January 1, 2012 and December 31, 2017, 402 comments and 162 proposals were submitted on mental, behavioural and neurodevelopmental disorders, sleep‐wake disorders, and conditions related to sexual health. The largest number of submissions related to mental, behavioural and neurodevelopmental disorders focused on compulsive sexual behaviour disorder (N=47), complex post‐traumatic stress disorder (N=26), bodily distress disorder (N=23), autism spectrum disorder (N=17), and gaming disorder (N=11).

    (...)

    ...A majority of submissions regarding bodily distress disorder were critical, but were often made by the same individuals (N=8). Criticism mainly focused on conceptualization (48%; κ=0.64) and the disorder name (43%; κ=0.91). Use of a diagnostic term that is closely associated with the differently conceptualized bodily distress syndrome5 was seen as problematic.* One criticism was that the definition relies too heavily on the subjective clinical decision that patients’ attention directed towards bodily symptoms is “excessive”. A number of comments (17%; κ=0.62) expressed concern that this would lead to patients being classified as mentally disordered and preclude them from receiving appropriate biologically‐oriented care. Some contributors submitted proposals for changes to the definition (30%; κ=0.89). Others opposed inclusion of the disorder altogether (26%; κ=0.88), while no submission (κ=1) expressed support for inclusion. The WHO decided to retain bodily distress disorder as a diagnostic category6 and addressed concerns by requiring in the CDDG the presence of additional features, such as significant functional impairment.

    ----------------------------

    *Although WHO's Dr Geoffrey Reed (a co-author of this Letter to the Editor) had twice agreed with me that there was potential for confusion between the ICD-11 disorder term, "BDD" and Fink et al (2010) "BDS" and that he would be discussing the issue of BDD terminology with the S3DWG working group (in 2015), ICD Revision did not at any point respond to the specific issue of nomenclature or provide a rationale for not considering an alternative term, which had been raised with them, several times, via Proposal Mechanism Comments and in Submissions.

    ICD-11's Bodily distress disorder (BDD) has strong conceptual and characterization alignment with DSM-5's Somatic symptom disorder (SSD). Somatic symptom disorder is listed under Synonyms under ICD-11's Bodily distress disorder.

    Creed, Henningsen and Fink acknowledge that the Fink et al (2010) BDS construct is differently conceptualized to DSM-5’s SSD; that BDS and SSD have very different criteria and that they capture, or potentially capture, different patient populations [1].

    Budtz-Lilly, Fink et al outline some of the conceptual differences between SSD and BDS:

    "The newly introduced DSM-5 diagnosis, somatic symptom disorder (SSD), has replaced most of the DSM-IV somatoform disorder subcategories [10]. The diagnosis requires the presence of one or more bothering somatic symptoms of any aetiology and is not based on exclusion of any medical condition (…) BDS and SSD represent two very conceptually different diagnoses. BDS is based on symptom pattern recognition only, and symptoms are thought to be caused by hyperactivity in the central nervous system, whereas SSD criteria are based on prominent positive psycho-behavioural symptoms or characteristics, but no hypothesis of aetiology. BDS is assessed without asking patients about psychological symptoms." [2].


    1 Medically Unexplained Symptoms, Somatisation and Bodily Distress: Developing Better Clinical Services, Francis Creed, Peter Henningsen, Per Fink (Eds), Cambridge University Press, 2011.

    2 Anna Budtz-Lilly, Per Fink, Eva Ornbol, Mogens Vestergaard, Grete Moth, Kaj Sparle Christensen, Marianne Rosendal. A new questionnaire to identify bodily distress in primary care: The ‘BDS checklist’. J Psychosom Res. June 2015 Volume 78, Issue 6, Pages 536–545.
     
    Last edited: May 24, 2019
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  5. Esther12

    Esther12 Senior Member (Voting Rights)

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    Thanks for all your work on this. It sounds as if it possibly would have been useful to have more people raising concerns (their N=8 point)? Maybe something for next time.
     
  6. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    Concerns around the BDD construct and terminology were also included in the joint submission with Mary Dimmock of March 26, 2017 for the G93.3 legacy terms, in our proposal sections: 4.3 Exclusions under Bodily distress disorder and 4.4 Potential for conflation of bodily distress disorder and bodily distress syndrome.

    That submission had received over 320 comments from stakeholders, including comments of support from around 50 international patient organizations and advocacy groups.
     
    Last edited: May 23, 2019
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  7. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    UK patient organizations and local ME groups had been provided with updates on developments with BDD and with the G93.3 legacy terms, since 2010. You can lead a horse to water...

    What may have been useful is for clinicians, academics, and professional and scientific organizations to have raised concerns. But beyond the field of psychosomatics, there has been very little interest in the development of, and implications for the replacement for the ICD-10 Somatoform disorders.

    Which is disturbing, given that patients with any disease or condition, for example, cancer, cardiovascular disease or diabetes, can potentially be assigned an additional diagnosis of BDD (or SSD).
     
    Last edited: May 23, 2019
  8. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    By contrast, DSM-5's SSD was one of the DSM-5 disorders that received the largest number of comments during its public review and comment exercises and attracted media coverage, journal papers and commentaries.
     
  9. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    As well as submitting comments and suggestions for changes via the ICD-11 Beta Proposal and Comment mechanism, practitioners were invited to register to review and comment on the drafts for the expanded description and guideline texts for the ICD-11 companion publication:

    The Clinical Descriptions and Diagnostic Guidelines (CDDG) for ICD‐11 Mental, Behavioural and Neurodevelopmental Disorders


    (the ICD-11 equivalent of ICD-10's "Blue Book") via the Global Clinical Practice Network (GCPN).

    But this is not a public platform and the draft texts (and clinicians'/practitioners' comments on the draft texts) are not available to the public. And unless clinicians have been motivated to join the GCPN, they will not have had access to the expanded description and guideline text for BDD - only to the brief description texts in the Beta draft.

    It would have been better (and potentially generated greater interest and participation), if WHO/ICD Revision had released the texts of the CDDG last year, for a well publicized, professional and lay stakeholder review and comment exercise.

    The CDDG texts aren't being released until after the core ICD-11 has been approved.
     
    Last edited: May 24, 2019
  10. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    Note: Item 12.7 Eleventh revision of the International Classification of Diseases

    is now 3rd item on the Agenda for the meeting of Committee A on the morning of Saturday, 25 May.

    There are no meetings scheduled for Sunday 26. If there is insufficient time on Saturday to complete Item 12.7, this may be carried over to Monday 27.


    Extract Page 5, Daily Journal N° 5:


    [​IMG]
     
    Last edited: May 24, 2019
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  11. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    Consideration of draft resolution for adoption of ICD-11:


    After more than 11 years in development and several extensions to the timeline, the World Health Assembly is today considering a draft resolution recommending adoption of ICD-11. If the resolution is approved (as it stands or with agreed amendments), WHA's endorsement would not take effect until 1 January 2022.

    Due to time constraints, Item 12.7 Eleventh revision of the International Classification of Diseases has been transferred from WHA Committee A to the purview of WHA Committee B.

    The two key resolution documents are:

    A72/29
    Eleventh revision of the International Classification of Diseases
    Report by the Director-General

    and

    A72/29 Add.1
    Eleventh revision of the International Classification of Diseases
    Draft Resolution



    This is the schedule according to today's Daily Journal N° 6 Programme of meetings for Saturday, 25 May:
    http://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_JOUR6-en.pdf

    Item 12.7 is second on this morning's Agenda:

    9:00 Geneva time: Sixth meeting of Committee B

    Item: Draft fourth report of Committee A

    Item 12 (continued) Other technical matters [Item transferred from Committee A]

    Item 12.7 – Eleventh revision of the International Classification of Diseases Documents A72/29 and A72/29 Add.1

    Item 12.9 – Emergency and trauma care Documents A72/31, A72/A/CONF./1 and A72/A/CONF./1 Add.1

    Item 12.8 – Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) Document A72/30

    If time permits:

    Item 21
    (continued) Matters for information

    Item 21.3 – Progress reports

    Item 12 (continued) Other technical matters [Item transferred from Committee A]

    Item 12.6 – Smallpox eradication: destruction of variola virus stocks Document A72/28​




    Today's meeting of Committee B is being live streamed here: https://www.who.int/about/governance/world-health-assembly/seventy-second-world-health-assembly

    Webcasts will be available for 3 months.


    If this draft resolution for adoption is passed as it stands or passed with amendments, WHA's endorsement would not take effect until 1 January 2022.

    After that date, member states can begin reporting data using the ICD-11 code sets when their countries have prepared their health systems for transition and have implemented the new edition.
    Whilst the WHO will be encouraging all member states to start preparations for implementation, there is no mandatory date by which member states must migrate to the new edition and no sanctions for late adopters. For a period of time, data will be collected and aggregated using both ICD-10 and ICD-11. It’s anticipated that even the earliest implementers will take several years to prepare their countries for transition.

    ----------------------------------------

    Live stream: https://www.who.int/about/governance/world-health-assembly/seventy-second-world-health-assembly

    This meeting opens at 09:00 CEST (Geneva time) (08:00 GMT).

    Select tab for Live, select Committee B Live.

    I will return to this post later today to add brief notes on decisions or to note any requests delivered by member state reps for consideration of amendments to this draft resolution.

    A Report on this meeting should be posted on the WHA72 website document page in the next few days and I will post a copy here, once available.


    Update: Draft resolution A72/29 Add.1 (ICD-11) has been passed without amendments

    Sixth meeting of Committee B, Saturday 25 May:


    10:20 Geneva time: Following statements from around 31 Member State reps and 1 non-State actor (IOGT International), and a response from the Secretariat, Draft resolution A72/29 Add.1 has been approved with no amendments and agenda Item 12.7 is now closed.



    A WHA72 Draft report of the Sixth meeting of Commitee B will be available in the next day or two and I shall post a copy when this has been posted.
     
    Last edited: May 25, 2019
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  12. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    Last edited: May 25, 2019
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  13. It's M.E. Linda

    It's M.E. Linda Senior Member (Voting Rights)

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    Can I please second this view?

    I couldn’t even remember the basic “ICD11” term or @Dx Revision Watch‘s name when I was trying to recall something this morning.

    Thank goodness a ‘international medical descriptions’ search brought me back here to see that important work was continuing last weekend in Switzerland.

    @Dx Revision Watch has managed to stay alert and work tirelessly on these very important issues - thank you :emoji_bouquet::emoji_bouquet::emoji_bouquet: - whilst I can’t even remember your name - sorry! o_O:(
     
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  14. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    Well thank you, It's M.E. Linda, for your very kind words and bunches of flowers. I have had the advantage of not being an ME patient, myself, but a carer.

    I have a couple more posts to draft for my Dx Revision Watch site, next week, then I shall finally retire.

    WHO has said that it plans to release the text of the ICD-11 specialty publication: Clinical Descriptions and Diagnostic Guidelines (CDDG) for ICD‐11 Mental, Behavioural and Neurodevelopmental Disorders "as soon as possible" after WHA's approval of the Recommendation to adopt the Core ICD-11 MMS (the Recommendation which was passed, without amendments, last Saturday).

    I don't know whether the "CDDG" will be released by mid June, though I suspect not. But if it is, I will update this thread and post extracts from the descriptions and diagnostic guideline's texts for Bodily distress disorder.

    If it isn't released by then, I'll post a brief reminder before I "sign off" of which ICD-11 speciality publications have yet to be released.
     
  15. Roy S

    Roy S Senior Member (Voting Rights)

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    from the head of the DSM-IV 'task force' months ago-



    and now-



     
  16. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    As well as reaching out to APA Board members specifically around his concerns for the draft SSD criteria, in late 2012 Allen also met informally with Joel E Dimsdale (Chair, DSM-5 Somatic Symptom Disorders Working Group), to put before him suggestions for a redrafted criteria that if implemented, would have resulted in a significantly stricter criteria set [1][2].

    Despite these efforts and the fact that SSD was one of the categories that received the largest number of comments in the three stakeholder review periods, the SSD Working Group and DSM-5 Task Force signed off on the criteria, making no concessions towards tightening them up.

    In fact, when DSM-5 was published in May 2013, the finalized SSD criteria were even looser than those presented for comment during the third draft review; the requirement for meeting two from the "B type" criteria in order to meet the diagnosis had been lowered to require only one from the "B type".

    In the APA's 2012 field trials, 15% of the diagnosed with cancer or severe coronary disease study group met the SSD criteria when one from the "B type" criteria was required; if the threshold was increased to two "B type" criteria" about 10% met criteria for dual-diagnosis of diagnosed illness + Somatic Symptom Disorder. For the "functional somatic" study group, comprising 94 people with irritable bowel and chronic widespread pain (a term often used synonymously with fibromyalgia) about 26% met the criteria for an additional SSD diagnosis, when one cognition was required; 13% were coded if two cognitions were required [3].

    Whilst ICD-11's BDD is conceptually close to DSM-5's SSD, ICD-11 does not use criteria sets, as such. The ICD-11 disorder descriptions and severity characterizations texts are more flexible and allow for greater clinical judgement.

    As a result, BDD is potentially more inclusive than SSD.


    1 Bad News: DSM 5 Refuses to Correct Somatic Symptom Disorder, Allen Frances' DSM5 in Distress blog, Psychology Today, January 2013:
    https://www.psychologytoday.com/gb/...sm-5-refuses-correct-somatic-symptom-disorder
    (Also republished on Psychiatric Times blog.)

    2 Why Did DSM 5 Botch Somatic Symptom Disorder? Allen Frances' DSM5 in Distress blog, Psychology Today, February 2013:
    https://www.psychologytoday.com/gb/.../why-did-dsm-5-botch-somatic-symptom-disorder

    3 Allen Frances¹, Suzy Chapman². DSM-5 somatic symptom disorder mislabels medical illness as mental disorder. 1 Department of Psychiatry, Duke University 2 DxRevisionWatch.com Aust N Z J Psychiatry. 2013 May;47(5):483-4. doi: 10.1177/0004867413484525 http://www.ncbi.nlm.nih.gov/pubmed/23653063

    4 Frances A. DSM-5 Somatic Symptom Disorder. J Nerv Ment Dis. 2013 Jun;201(6):530-1. doi: 10.1097/NMD.0b013e318294827c http://www.ncbi.nlm.nih.gov/pubmed/23719325

    5 Frances A. The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill. BMJ. 2013 Mar 18;346:f1580. doi: 10.1136/bmj.f1580 http://www.ncbi.nlm.nih.gov/pubmed/23511949

    Somatic Symptom Disorder is discussed in Saving Normal: An Insider’s Revolt Against Out-Of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life (pp. 193-6): Allen Frances, William Morrow & Company (20 May 2013).

    Also discussed in Essentials of Psychiatric Diagnosis: Responding to the Challenge of DSM-5 (Chapter 16): Allen Frances, Guilford Press (14 June 2013).
     
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  17. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    Four additional terms have very recently been added under Synonyms under ICD-11's Bodily distress disorder:

    https://icd.who.int/dev11/f/en#/http://id.who.int/icd/entity/767044268

    The existing Synonyms terms are:
    • somatoform disorders
    • Somatization disorder
    • Somatic symptom disorder

    The four additional Synonyms terms are:
    • Briquet’s disorder
    • polysomatising disorder
    • polysomatizing disorder
    • multiple psychosomatic disorder

    The existing Synonyms terms and these four additional terms are not specified as inclusion terms to BDD and are not coded to the 6C20 code.

    They are coded in the Index and the Coding Tool to 6C20.Z Bodily distress disorder, unspecified. (In ICD-11, codes that end XXXX.Z are known as 'unspecified residual categories'.)

    I have left a couple of comments on the Orange Maintenance Platform and a request for clarification, as this addition of new content to the Maintenance Platform (and in the case of the ICD-10 legacy entity, "Briquet’s disorder", also added in the Blue ICD-11 MMS implementation browser) appears to have bypassed the public review and comment system:


    https://icd.who.int/dev11/f/en#/http://id.who.int/icd/entity/767044268

    6C20 Bodily distress disorder

    (...)


    [​IMG]
     
    Last edited: Jun 7, 2019
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  18. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    New post on Dx Revision Watch site:


    ICD-11 implementation package

    JUNE 6, 2019

    Post #353 Shortlink: https://wp.me/pKrrB-4R7

    On Saturday, May 25, 2019, member states meeting at the 72nd World Health Assembly voted unanimously to approve the draft resolution to adopt the Eleventh revision of the International Classification of Diseases. The resolution passed with no amendments.

    Adoption comes into effect on January 1, 2022, subject to transitional arrangements. After this date, member states can start using or transitioning to the ICD-11 codes when they have prepared their health systems for migration from earlier editions.


    [​IMG]

    Source: Presentation slides: Dr Robert Jakob, November 2018 Information session on ICD-11


    The two key documents for Agenda Item 12.7 Eleventh revision of the International Classification of Diseases are:

    A72/29 Add.1
    Eleventh revision of the International Classification of Diseases
    Draft Resolution

    A72/29
    Eleventh revision of the International Classification of Diseases
    Report by the Director-General



    Implementation package


    The World Health Organization (WHO) has prepared an implementation package. These tools can be accessed at ICD-11.


    1) ICD-11 Implementation or Transition Guide (version 1.05, May 2019)

    This document is a part of the ICD11 implementation package¹ developed by the World Health Organization. This document also provides some background related to the development of the ICD11 and its components. The document outlines essential issues that countries need to consider in the lead up to and during the transition from an existing ICD environment to the eventual implementation of ICD11.

    1 The ICD-11 implementation package comprises the Classification System, the Coding Tool, Browser and all supporting documents including the Reference Guide and Implementation Guide, and a set of tools. Source: ICD-11 Implementation or Transition Guide, Geneva: World Health Organization; 2019; License: CC BY-NC-SA 3.0 IGO.


    2) Coding tool (multilingual)

    Index based search tool.

    [​IMG]

    See Additional resources [1] for NHS overview of ICD-11 Coding Tool.



    3) ICD-11 browser for Mortality and Morbidity Statistics (MMS)

    Blue ICD-11 MMS platform (current release: 04 / 2019)

    English: https://icd.who.int/browse11/l-m/en

    Spanish: CIE-11 para estadísticas de mortalidad y morbilidad (Versión : 04 / 2019): https://icd.who.int/browse11/l-m/es


    [​IMG]

    See Additional resources [2] for NHS overview of ICD-11 MMS Browser and [3] for general overview of ICD-11.



    4) ICD-11 Reference Guide (version 11-04-2019)

    Detailed guide to ICD-11 and how to use it; update and maintenance workflow; updating cycles; requirements for proposal submission.



    5) ICD-10 / ICD-11 mapping Tables

    Map ICD-11 codes to and from ICD-10 (links to Zip file; crosswalks in Text and MS Excel formats)



    6) Orange ICD-11 Maintenance Platform

    English: https://icd.who.int/dev11/l-m/en

    The audience for this site is the maintainers, contributors and translators of the classification. The content of the Orange browser is not the released version of the classification. The content is updated on a daily basis to incorporate changes approved since the most recent release of the Blue ICD-11 browser for Mortality and Morbidity Statistics (MMS).

    The Orange Maintenance Platform incorporates the ICD-11 Proposal Mechanism (a proposal and commenting tool for which registration is required). Once an account is registered, new proposals, comments and suggestions for changes and enhancements to existing content can be submitted and notifications set up. For help with submissions see: Maintenance Platform User Guide.

    [​IMG]



    Specialty versions and derived classifications

    Specialty versions provide more detail for particular user groups, such as Mental Health, Neurology, Dermatology and less detail for primary care or low diagnostic resource settings.

    For ICD-11, the WHO Department of Mental Health and Substance Abuse has developed a companion publication to ICD-11 Chapter 06 for mental health professionals, general clinical, educational and service use.

    The Clinical Descriptions and Diagnostic Guidelines for ICD‐11 Mental, Behavioural and Neurodevelopmental Disorders (CDDG) provides expanded disorder descriptions and includes: essential (required) features, severities, boundaries with other disorders and normality, differential diagnoses, additional features and culture-related features.

    WHO has given no firm release date but says the CDDG will be published “as soon as possible” following approval of the overall system by the WHA¹.

    Also under development is the ICD-11 PHC – a clinical guideline written in simpler language to assist non-mental health specialists, especially primary care practitioners and non medically trained health workers, and for use in low resource settings and low- to middle-income countries with the diagnosis and management of 27 mental disorders. No finalization and publication date is available. Like the ICD-10 PHC (1996), this revised edition will not be a mandatory classification for member states.

    1 Reed GM, First MB, Kogan CS, et al. Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry. 2019;18(1):3-19.


    Linkages with other classifications and terminologies

    ICD11 incorporates or links with the following classifications and terminologies through the ICD11 Foundation:

    • International Classification of Disease for Oncology – ICD-O
    • International Classification of External Causes of Injury – ICECI
    • International Classification of Functioning, Disability and Health – ICF
    • International Classification of Primary Care – ICPC [Ed: developed/maintained by WONCA]
    • Other terminologies such as OrphaNet and SNOMED-CT

    Source: ICD-11 Implementation or Transition Guide, Geneva: World Health Organization; 2019; License: CC BY-NC-SA 3.0 IGO.


    Additional resources:

    1 NHS Digital: ICD-11 Coding Tool Overview, September 2018

    2 NHS Digital: ICD-11 Browser Overview, September 2018

    3 NHS Digital: ICD-11 Overview

    4 Presentation: Information session on ICD-11 Dr Robert Jakob, Team Leader, WHO, Geneva, Classifications, Terminologies and Standards, November 2018

    5 Presentation: NHS Digital: Clinical Coding for non coders – Brief overview of clinical coding and the role of the Clinical Classifications Service

    6 ICD-11: The 11th Revision of the International Classification of Diseases – Site maintained by eHealth DSI Semantic Community providing resources for ICD-10, ICD-11, ICD derivative classifications and other classification and terminology systems
     
    Last edited: Jun 7, 2019
  19. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    A note regarding:

    2) Coding tool (multilingual) (in Post above)

    Index based search tool.

    [​IMG]

    See Additional resources [1] for NHS overview of ICD-11 Coding Tool.

    1 NHS Digital: ICD-11 Coding Tool Overview, September 2018
    ----------------------------------------------------------------------------------------------


    The coding tool is the ICD-11 Index and the starting point for coders.

    Although WHO has not approved proposals for deprecation of the "Benign" prefix, and the specified Inclusion terms remain as per my screenshot below, any of the terms listed under code 8E49's Synonyms and Narrower Terms point to the 8E49 Title Concept when entered into the coding tool.

    So for example, if "myalgic encephalomyelitis" is entered, that will return the Title Concept code: 8E49, as in my screenshot above.

    From the browser:

    [​IMG]



    The two specified inclusion terms are: Benign myalgic encephalomyelitis and chronic fatigue syndrome.

    The additional terms are legacy Index terms imported from ICD-10, apart from "myalgic encephalomyelitis syndrome" which is a SNOMED CT term. (ICD-11 will link to SNOMED CT and the crosswalks between the two systems are in production.)

    These are the terms listed under Synonyms in SNOMED CT International Edition and SNOMED CT UK Edition. Note that SNOMED CT UK Edition has two additional terms which are unique to the UK Edition, and three optional severity specifiers which are also unique to the UK Edition, and are designated as such by the flag symbol:



    [​IMG]


    Edit: Note the term "chronic fatigue, unspecified" had also been included under Synonyms in the ICD-11 Beta draft. This term does not exist in ICD-10 and appeared to have been imported from the US's ICD-10-CM (R53.82). I proposed that this term should be removed; WHO accepted the supporting rationale for its removal, which was implemented in January 2018.
     
    Last edited: Jun 7, 2019
  20. Dx Revision Watch

    Dx Revision Watch Senior Member (Voting Rights)

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    SNOMED CT national editions

    Two new SNOMED CT national edition browsers have been added, this year, to the SNOMED CT International browser platform:

    Norwegian Edition release v 20190415 https://browser.ihtsdotools.org/

    Irish Edition release v 20190421 https://browser.ihtsdotools.org/


    Note re ICD-10 usage:

    Ireland does not use ICD-10, it uses ICD-10-AM (the Australian clinical modification of ICD-10). In 2018, Ireland was reported as having no plans for implementing ICD-11 [1].

    Belgium uses ICD-10-CM (the U.S. clinical modification of ICD-10). In 2018, Belgium was reported as having no plans for implementing ICD-11 and plans to use SNOMED CT in electronic patient files [1].

    The Netherlands uses ICD-10 but not for patient record keeping or primary care [1].

    See also Spain, France, Germany, Austria and a number of other countries' current usage of ICD-10, clinical modifications of ICD-10, ICPC-2 (primary care) and SNOMED CT and their plans regarding ICD-11 [1].


    1 This webpage (from a project maintained by eHealth DSI Semantic Community) collates information (from 2018) from around 18 member states on their country's plans regarding potential future implementation of ICD-11:

    Current status of the use of ICD by eHDSI deploying countries (2018):
    https://ec.europa.eu/cefdigital/wiki/pages/viewpage.action?pageId=62884034
     
    It's M.E. Linda, mango and Sly Saint like this.

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