GAFFI and colleagues worldwide have contributed to the International Classification of Disease 11. This work is ongoing and a major consultation process will commence in early May 2014. ICD9 and ICD10 classify many fungal infections poorly, especially aspergillosis. Revisions are in progress.
THE CURRENT STATE OF ICD-11 From the outset of the Project, it has been envisaged that there would be multiple versions of ICD. The base repository of data is the Foundation in which all diagnostic concepts are kept. In the Foundation any single entity may be linked to several different hierarchical parents, so
that, for instance, Malignant neoplasms of skin (link) can be viewed from the Skin chapter as well as the Neoplasms chapter. You can move readily from one location to the other by clicking on the relevant Parent concept in the browser.
From this Foundation an essentially limitless number of so-called linearizations can be extracted. A linearization contains a restricted and mutually exclusive list of entities. It has recently been agreed that the replacement for ICD-10 should be termed the Joint Linearization for Mortality and Morbidity Statistics. There will, however, be linearizations for primary care and for specialty classifications including neurology,
ophthalmology, paediatrics, mental health, occupational health and dermatology amongst others. These will also be extractions from the Foundation but will provide greater detail for each
To give an example the Joint linearization includes granuloma annulare but its subtypes are given as “Index terms” which would be found on a search but classified to the parent
concept, granuloma annulare. The dermatology linearization will enable the subtypes to be coded individually.
With respect to cutaneous disease, WHO has agreed with the International League of Dermatological Societies (ILDS) that there would be joint ownership of the Dermatology Specialty Classification and that this could be published in print format as well as available on-line.
A further innovation into ICD-11 is the facility to “post-coordinate”. This enables much greater detail to be captured where required without an explosion of specific “pre-coordinated” titles. Thus the current US modification of ICD-10, which is only just being introduced in that country has Acute lymphangitis of left toe, Acute lymphangitis of right toe and Acute lymphangitis of unspecified toe. ICD-11 will enable a stem (or base)
concept to be further qualified by the addition of information on anatomical site, laterality, severity etc. as extension codes. The permissible extensions to any given stem concept will be
explicitly determined by sanctioning rules in order to avoid the creation of nonsense combinations. In many cases it may be appropriate for the combined term (e.g. localized granuloma annulare)
to be displayed explicitly in the specialty linearization but to be rendered for coding as STEM granuloma annulare | EXTENSION localized. This provides a very powerful means to generate
sophisticated descriptions of disease states in a systematic fashion where this is needed, but to make it simple to code basic information where this is all that is required.
PEER REVIEW AND FIELD TESTING
WHO is now very keen to get as many content experts and specialist departments as possible involved in peer review and field-testing. It is at present possible to submit comments on the Beta Browser website though you will need to register in order to do so. In May or June a proper proposal mechanism will be available online in which additions or changes can be requested. GAFFI will announce this.