Linking Health Terminologies: A Unified Approach to the WHO Family of International Classifications.

This paper presents an effort by the World Health Organization (WHO) to integrate the reference classifications of the Family of International Classifications (ICD, ICF, and ICHI) into a unified digital framework. The integration was accomplished via an expanded Content Model and a single Foundation that hosts all entities from these classifications, allowing the traditional use cases of individual classifications to be retained while enhancing their combined use. The harmonized WHO-FIC Content Model and the unified Foundation has streamlined the content management, enhanced the web-based tool functionalities, and provided opportunities for linkage with external terminologies and ontologies. This integration promises reduced maintenance cost, seamless joint application, complete representation of health-related concepts while enabling better interoperability with other informatics infrastructures.

An ICD for the Digital World: What Does the ICD-11 Research Show?

The 11th revision of the International Classification of Diseases (ICD) is now available for use. A literature search was conducted to review and summarize the research conducted to date. In addition to the ease of integration into electronic health records using standard digital tools such as uniform resource identifiers and application programming interfaces, ICD-11 and the World Health Organization provided linearization for mortality and morbidity, ICD-11-MMS, promise improved backward compatibility to ICD-10; increased availability in multiple languages; greater detail for clinical use, including traditional Chinese medicine; and enhanced maintenance for continued relevance. The studies reviewed here support the superior content and utility of ICD-11-MMS. Meaningful planning for implementation has begun, including the provision of a framework. It is time for the world to adopt a digitally prepared ICD.

Preliminary study of patient safety and quality use cases for ICD-11 MMS.

OBJECTIVE: This study investigated how well-suited the International Classification of Diseases, 11th Revision, for Mortality and Morbidity Statistics, (ICD-11 MMS) is for 2 morbidity use cases, patient safety and quality, examining the level of detail captured, and evaluating the necessity for the development of a US clinical modification (CM). MATERIALS AND METHODS: Utilizing the 5 NCVHS-specified perspectives plus the consumer perspective, a framework was created of International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) use cases. Analysis yielded candidate source criteria for use in case evaluation. Patient safety and quality were chosen because they are relevant across all perspectives.Granularity differences and content coverage of ICD-11 MMS entities were assessed pre- and post-coordination to determine suitability for the 2 use cases. Pressure ulcers, a common condition across 3 patient safety applications, became the focus for comparing ICD-10-CM codes to ICD-11 MMS codes. For 3 electronic clinical quality measures (eCQMs), the evaluation centered on specified value sets for ischemic stroke, hypertension, and diabetes. RESULTS: For pressure ulcers, the ICD-11 MMS was found to exceed ICD-10-CM capabilities via post-coordinated extension codes. For the 3 eCQM value sets explored, the ICD-11 MMS fully represented the disease concepts when post-coordinated code clusters were used. CONCLUSIONS: The examples from the patient safety and quality use cases evaluated in this study are appropriate for ICD-11 MMS. It captures greater detail than ICD-10-CM, and ICD-11 MMS specificity would benefit both use cases. The authors believe this preliminary study indicates the US should invest resources to explore adopting the WHO ICD-11 MMS and tooling and guidelines to implement post-coordination.

Semantic interoperation and electronic health records: context sensitive mapping from SNOMED CT to ICD-10.

An important case for successful deployment of a lifetime electronic health record is reuse of clinical data from the electronic health record (EHR) for epidemiology, reimbursement, and research. We report a collaboration between the IHTSDO and the WHO to develop knowledge-based tools supporting translation of data from SNOMED CT to the ICD-10 classification. These tools have been vetted by an international community and are available for system vendors to enhance the interoperability of their products. The maps we created are also informing the development of the next generation of classifications which will employ a common ontology base between SNOMED CT and ICD-11 to promote interoperability.

Mapping SNOMED CT to ICD-10.

A collaboration between the International Health Terminology Standards Development Organisation (IHTSDO®) and the World Health Organization (WHO) has resulted in a priority set of cross maps from SNOMED CT® to ICD-10® to support the epidemiological, statistical and administrative reporting needs of the IHTSDO member countries, WHO Collaborating Centres, and other interested parties. Overseen by the Joint Advisory Group (JAG), approximately 20,000 SNOMED CT concepts have been mapped to ICD-10 using a stand-alone mapping tool. The IHTSDO Map Special Interest Group (MapSIG) developed the mapping heuristics and established the validation process in conjunction with the JAG. Mapping team personnel were selected and then required to participate in a training session using the heuristics and tool. Quality metrics were used to assess the training program. An independent validation of cross map content was conducted under the supervision of the American Health Information Management Association. Lessons learned are being incorporated into the plans to complete the mapping of the remaining SNOMED CT concepts to ICD-10.

SNOMED CT survey: an assessment of implementation in EMR/EHR applications.

A descriptive study of health information technology (HIT) vendors was conducted to identify which EMR/EHR vendors currently work or anticipate working with SNOMED CT, determine the prevalence of SNOMED CT integration in electronic medical record (EMR) and electronic health record (EHR) products, identify the available and potential future applications for SNOMED CT in EMR/EHR systems, and learn what prompts vendors to include SNOMED CT in EMR/EHR systems. The Web-based survey consisting of 25 questions was fielded in November-December 2006. Seventy-two responses were received. The results from this survey on SNOMED CT show a mixed message from respondents with regard to the prevalence of SNOMED CT integration in EMR/EHR products. Those with plans for implementation cited strategic reasons most often. However, HIT vendors who have not yet obtained a SNOMED CT license are waiting for market forces to drive deployment in their systems. Finally, survey respondents currently working with SNOMED CT indicated an expected increase over the next three years in EMR/EHR applications where SNOMED CT will be implemented.

EHR's effect on the revenue cycle management Coding function.

Without administrative terminologies there is no revenue to manage. The use of healthcare IT to capture the codes for administrative and financial support functions will impact the revenue cycle and the management of it. This is presumed to occur because clinical data coded at the point of care becomes the source for claims data. Thus, as electronic health record system applications utilizing terminologies are implemented, healthcare providers need to systematically consider the effect on the coding function and management of the revenue cycle. A key factor is the sequence of events changes, i.e., instead of a health information management professional selecting billing codes at the conclusion of an encounter based on the review of the record, clinical data generates the claims data via mapping. Efficiencies and management challenges result.

Language barrier. Getting past the classifications and terminologies roadblock.

Health IT is bogged down in a quagmire of unaligned classification and terminology systems. New recommendations from AHIMA and AMIA help point to the way out.