The development of the 11th Revision of the International Classification of Diseases, has been widely based on computerized tools, marking a strong departure from previous paper-based procedures. The rationale behind this move is a strategic attempt to prompt and facilitate the integration of classifications into healthcare information systems. The overall ICD-11 platform includes components aimed at end-users and developers, as well as tools for classification authoring and maintenance. The present paper focuses on the former components only. The designed ICD-11 platform includes software modules at different levels of abstraction, all sharing some basic principles: multilingualism, support of multiple versions of the classification, and support of postcoordination. All the modules, their usage, and the distribution methods are described. For the first time, the release of an ICD classification revision is not made through printed books, but through a series of computer-based tools with their digital documentation. First examples of tools and API adoption in third-party systems have already surfaced, suggesting that the overall approach could be appropriate for the deployment strategy, further facilitated by the open access policy for ICD-11.

WHO maintains classifications that are crucial for the functioning of the healthcare systems worldwide, namely ICD (International Classification of Diseases), ICF (International Classification of Functioning, Disability and Health) and the upcoming ICHI (International Classification of Health Interventions). The traditional way of making classifications available to their audience was based on printed books, which in turn shaped their usage in health information systems. However, in the recent years and specifically with the development of ICD 11th Revision (ICD-11), a shift towards full integration with computerized systems has been designed and implemented. So, nowadays the official distribution of ICD-11 is no more based on a 3 books set, but on a computerized platform that includes an API, a Javascript toolkit for embedding classifications in health information systems, a browser for navigating the classification and other tools, all oriented towards multilinguality and openness. Furthermore, the architecture of ICD-11 itself is more modern and includes a foundation layer on which the proper Mortality and Morbidity Statistics Classification is built upon. Since the last year, the same technological approach has been extended to the other two classifications, which now share the same platform and approach. This talk will explore the approach and novelties that characterize the digital path undertaken by WHO for its classifications, and its impact on future digital systems.

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.

BACKGROUND:The International Classification of Diseases (ICD) has progressed from a short list of causes of death to become the predominant classification of human diseases, syndromes, and conditions around the world. The World Health Organization has now explored how the ICD could be revised to leverage the advances in computer science, ontology, and knowledge representation that had accelerated in the twentieth and early twenty-first centuries. METHODS:Many teams of clinical specialists and domain leaders worked to fundamentally revise the science and knowledge base of ICD-11. Development of the ICD-11 architecturally was a fundamental revision. The architecture for ICD-11 proposed in 2007 included three layers: a semantic network of biomedical concepts (Foundation), a traditional tabulation of hierarchical codes that would derive from that network (Linearization), and a formal ontology that would anchor the meaning of terms in the semantic network. Additionally, each entry in the semantic network would have an associated information model of required and optional content (Content Model). RESULTS:This paper describes the innovative architecture developed for ICD-11. CONCLUSION:ICD11 is a revolutionary transformation of a century long medical classification that retains is historical rendering and interface while expanding the opportunity for multiple linearization and underpinning its content with a formally constructed semantic network. The new artifact can enable modern data science and analyses with content encoded with ICD11.

A crucial process for world-level mortality statistics is the capability to identify the underlying cause of death from death certificates. Currently such certificates are coded using ICD-10. The selection of the underlying cause is done by means of semi-automated rule-based systems. However, starting from 2022, countries should begin to adopt ICD-11, for which no system is already available. The present paper describes the architecture of a novel system for automated UC selection, with classification-independent rules, and its preliminary validation on two sets of death certificates coded with ICD-10 and ICD-11.

World Health Organisation (WHO) has updated the International Classification of Diseases to version 11 (ICD-11) which was recently adopted for use by countries in 2019. ICD-11 can be used in Electronic Medical Records (EMR) systems with support of extended technologies like Application Program Interface (API). Integration of ICD-11 in Rwandan EMR (OpenMRS) in two health facilities was conducted in July-October 2019. Findings indicated that adapting ICD11-API in EMR is feasible. More than 50% of diagnoses were recorded using ICD-11. Healthcare providers perceived ICD-11 API as easy to learn and useful for harmonization of diagnosis, data reporting and insurance reimbursement. Integration of ICD-11 API in EMR can be scaled up to all hospitals for use in Rwanda and other countries using similar system.

Background: The 11th revision of the International Classification of Diseases (ICD-11), for the first time in ICD history, deployed web-based collaboration of experts and ICT tools. To ensure that ICD-11 is working well, it needs to be systematically field tested in different settings, across the world. This will be done by means of a number of experiments. In order to support its implementation, a web-based system (ICDfit) has been designed and developed. The present paper illustrates the current prototype of the system and its technical testing. Methods: the system has been designed according to WHO requirements, and implemented using PHP and MySQL. Then, a preliminary technical test has been designed and run in January 2016, involving 8 users. They had to carry out double coding, that is, coding case summaries with both ICD-10 and ICD-11, and answering quick questions on the coding difficulty. Results: the 8 users coded 632 cases each, spending an average of 163 seconds per case. While we found an issue in the mechanism used to record coding times, no further issues were found. Conclusion: the proposed system seems to be technically adequate for supporting future ICD-11 testing.

In the beta phase of the 11 revision of International Classification of Diseases (ICD-11), the World Health Organization (WHO) exposes ICD-11 content through a collection of web services. The emerging Common Terminology Services 2 (CTS2) standard provides a common model and semantics for representation, interchange, and federation of terminological resources. We hypothesize that the CTS2 standard can provide service layer of standardization that could potentially aid in the interoperability among authoring applications for the ICD-11 revision. This paper examines the existing WHO ICD-11 content services from the perspective of the CTS2 standard. The content in the WHO ICD-11 content services was mapped to the Code System Catalog, Code System Version Catalog, Entity Description and Association models in the CTS2 specification. It proposes mappings for existing ICD-11 properties and suggests additional CTS2 properties may be important for ICD-11. The mapping effort was used to develop a prototype of the CTS2 Services Wrapper for the ICD-11. In conclusion, the CTS2 standard is useful in exposing ICD-11 content representation through predictable and familiar services. Keywords—ICD-11; CTS2; Medical Classification; Data Standards; Biomedical Ontologies

Classification revision and update can be defined as a social experience, with the participating community of experts behaving like a social network. ICD11 is being revised using an innovative web based process, for which we envisioned also tools for social platforms integration. The present poster preliminarily describes the Facebook tools developed for soliciting expert and participation in the ICD11 revision process.

Samson W. Tu, Olivier Bodenreider, Can Çelik, Christopher G. Chute, Sam Heard, Robert Jakob, Guoquian Jiang, Sukil Kim, Eric Miller, Mark M. Musen, Jun Nakaya, Jon Patrick, Alan Rector, Guillermo Reynoso, Jean Marie Rodrigues, Harold Solbrig, Kent A Spackman, Tania Tudorache, Stefanie Weber, Tevfik Bedirhan Üstün Stanford Univ., Stanford, CA, USA; National Library of Medicine, Bethesda, MD, USA; World Health Organization, Geneva, Switzerland; Mayo Clinic College of Medicine, Rochester, MN, USA; Ocean Informatics, Chatswood, NSW, Australia; Catholic Univ. of Korea, Korea; Zepheira, Fredricksburg, VA, USA; Tokyo Medical and Dental Univ., Tokyo, Japan; Univ. of Sydney, Sydney, NSW, Australia; Univ. of Manchester, Manchester, UK; Buenos Aires, Argentina;Université de Saint Etienne, Saint Priest en Jarez, France; IHTSDO, USA; DIMDI German Institute of Medical Documentation and Information, Köln, Germany Abstract

As part of the International Classification of Disease (ICD) revision platform development tasks, the representation of the ICD10 in a formal terminology model is required. The ICD10 is originally rendered by the World Health Organization (WHO) in the Classification Markup Language (CLaML) format which is a European Standard for representing the content of medical classification systems. In this study, we explored representing the CLaML-based ICD10 in the LexGrid terminology model, a community based proposal for standard storage of controlled vocabularies and ontologies. The decision we made for mapping between two models and the merits for utilizing the LexGrid terminology model and service are discussed.

Since the last WHO-FIC meeting, where the functional specifications of the planned maintenance and publication tool were discussed, the technical specification of the tool was finalized and the programming has begun. As described in the functional specifications the toolset will be a standalone tool which will hopefully run under the most common operating systems. The database containing the classification will be an XML database (Berkeley DB XML) which will be accessed by the maintenance tool and the publication tool via an interface. As a basis for the tools the Eclipse Rich Client Project will be used with the features realized as plug-ins, e.g. the WYSIWYG editor or the history functionalities. Documentation and programming will be in English. For the discussion of sharing resources and assuring WHO needs towards this software a meeting was held in Cologne, Germany and WHO agreed on programming certain parts of the system. This cooperation will guarantee the adjustment of the toolset to WHO requirements and therefore enables possible worldwide use of the software. Document C503 Maintenance and Publication Tool for WHOFIC Classifications – Proceedings in development WHOFIC2006