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ICD-11 Alpha Draft scheduled to launch in May

Discussion in 'General ME/CFS News' started by Dx Revision Watch, May 6, 2010.

  1. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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    ETA: Please see Posts # 5, 6, 7 and 8 for most most recent information @ 10 June 2010


    A version of this report will also be published on Co-Cure mailing list and Dx Revision Watch site.

    6 May 2010

    Note that information in this report applies to the revision of ICD-10 towards ICD-11. Countries using a "Clinical Modification" of ICD, for example, Canada (ICD-10-CA), the USA (implementing ICD-10-CM, in October 2013), Australia (ICD-10 AM) and Germany (ICD-10-GM) should refer to their own national modifications of ICD.


    Information on the launch of ICD-11 Alpha Draft

    The revision of ICD-10 is overseen by a Revision Steering Group (RSG) and is being undertaken by a number of Topic Advisory Groups (TAGs) via a collaborative authoring platform called the iCAT (Initial ICD-11 Collaborative Authoring Tool) using wiki like software.

    Topic Advisory Groups have responsibility for revision of the various chapters, formulating definitions and diagnostic criteria for the relevant categories and suggesting changes to the classification structure.

    Since 2007, anyone has been able to submit proposals to the various Topic Advisory Groups for changes or additions to ICD-10 via the ICD Update and Revision Platform. This is not the iCAT, but an extranet where any registered user has been able to submit proposals backed up with citations.

    You can register for access, here:
    https://extranet.who.int/icdrevision/nr/login.aspx?ReturnUrl=/icdrevision/default.aspx

    The WHO has scheduled a press launch of the ICD-11 Alpha Draft and the iCAT electronic authoring platform between 10 - 17 May.

    You can see how the iCAT operates in this series of ICD Revision YouTubes: http://wp.me/PKrrB-eV

    Once launched, the iCAT will be viewable to anyone who registers for access. But there will be varying levels of editing authority which will initially be restricted to WHO Classification Experts, WHO Secretariat, ICD-11 Revision Steering Group, the Managing Editors and members of Topic Advisory Groups and working groups and the reviewers and expert advisers recruited by the TAG Managing Editors to assist with the reviewing of content.

    There is also an iCAT User Group for which anyone can register for membership.

    It is anticipated that the public will not be able to interact with the iCAT, for example to add comment on proposals, until after the Beta Draft has been released for public review and consultation. But following the launch, it should be possible to monitor the progress and population of content.

    I have requested clarification of whether the names of external reviewers recruited by TAG Managers will be identified within the iCAT and whether the public will be able to track reviewers' input and comments as content proposals progress through the Alpha Drafting Workflow.

    ICD Revision maintains a Google website here: https://sites.google.com/site/icd11revision/home

    This site publishes agendas and minutes for ICD Revision meetings and also PowerPoint presentations and revision documents. Some of these documents are works in progress and revised versions are uploaded from time to time on this page and on the Face-to Face Meetings pages:
    https://sites.google.com/site/icd11revision/home/face-to-face-meetings/icamp/documents
    https://sites.google.com/site/icd11revision/home/face-to-face-meetings

    There are links for several key documents in Footnotes [1].


    The WHO publishes only ICD-10 Volume 1: The Tabular List and ICD-10 Volume 2: The Instruction Manual, online. Summaries of WHO meetings in 2007 and presentations in 2008 proposed that all three volumes of ICD-11 should be freely accessible via the internet. When ICD-11 is disseminated (2014+), all volumes, including Volume 3: The Alphabetical Index, will be electronically published and accessible online.

    In ICD-10 Volume 1: The Tabular List, "Postviral fatigue syndrome" is classified in Chapter VI (6) Diseases of the nervous system under G93 Other disorders of brain, coded G93.3.

    "Benign myalgic encephalomyeltis" is also coded G93.3.
    http://apps.who.int/classifications/apps/icd/icd10online/?gg90.htm g933
    http://dxrevisionwatch.wordpress.com/icd-11-me-cfs/

    In ICD-10, "Chronic fatigue syndrome" is listed in Volume 3: The Alphabetical Index, only, where it is indexed to G93.3.

    To date, ICD Revision has been silent around the inclusion (or not) of "Chronic fatigue syndrome" in Volume 1: The Tabular List, in ICD-11.

    Nor has ICD Revision published any intention that it proposes to revise the existing Index code for "Chronic fatigue syndrome" for ICD-11 or that "Chronic fatigue syndrome" should be placed in a chapter other than Chapter VI (6), to which it is currently indexed, if it were the case that ICD Revision is considering the inclusion of "Chronic fatigue syndrome" in Volume 1: The Tabular List.

    My websites and reports make no assumptions about what proposals might be made by any of the Topic Advisory Groups for the potential inclusion of "Chronic fatigue syndrome" in Volume 1, in ICD-11. But since all three volumes of ICD-11 will be integrable, it is reasonable to anticipate that "Chronic fatigue syndrome" might be included in Volume 1 in this forthcoming edition. (See Footnote [2])

    ICD-11 will drop the use of Roman numerals for chapter numbering, so we shall be monitoring, for example, the development of Chapter 5: Mental and behavioural disorders (TAGMH) and Chapter 6: Diseases of the nervous system (TAG Neurology).


    The "Start-up List"

    The starting point for the Alpha Draft is the "Start-Up List" of categories that has been drafted by WHO to initiate the editing process. This list includes current ICD-10 content, input from ICD national modifications, primary care versions and speciality adaptations, textual definitions imported from affiliate classification publications, proposals received to revise the existing ICD via the Update and Revision Platform and other channels.

    During alpha drafting, detailed structured definitions will be added to these ICD categories according to a common template - the "Content Model".


    The Content Model

    According to ICD Revision, the most important difference between ICD-10 and ICD-11 will be the "Content Model".

    The Content Model is designed to support detailed descriptions of the clinical characteristics of each category and clear relationships to other terminologies and classifications. It identifies the basic characteristics needed to define any ICD category through use of multiple parameters (eg Body Systems, Body Parts, Signs and Symptoms, Diagnostic Findings, Causal Agents, Mechanisms, Temporal Patterns, Severity, Functional Impact, Treatment interventions, Diagnostic Rules).

    So there is the potential for considerably more content to be included for diseases, disorders and syndromes for any given entity in ICD-11 than currently appears in ICD-10.

    There are examples of several disease entities populated in accordance with the Content Model on the ICD Revision website. The most recent version of the Content Model can be downloaded from this page:
    https://sites.google.com/site/icd11revision/home/face-to-face-meetings/icamp2-2010/documents

    or open the file here:

    Word Document: Doc2b
    Content Model Specifications and User Guide
    http://tinyurl.com/ICD11ContentModelApril10

    See also this paper:

    "A Content Model for the ICD-11 Revision"
    http://bmir.stanford.edu/file_asset/index.php/1522/BMIR-2010-1405.pdf


    How advanced will the Alpha Draft be when it is launched?

    According to this late 2009 document: http://tinyurl.com/SummaryiCAMPSept09

    It was projected that

    "Volume I of ICD-11 Alpha Draft will be published with full Morbidity Linearization ( like ICD-10 fourth edition ) including definitions for at least 80% of the categories. 20% of the entries should have content model parameters completed.

    "Volume II of ICD-11 Alpha Draft will be published as a prototype with guidelines and rules to the use of the classification for mortality and morbidity use cases.

    "Volume III Index: will be presented both a Digital Search Tool and possible paper version"


    The most recent iCamp2 (2010) and Revision Steering Group Meetings took place on 19-23 April, in Geneva. The agenda is available here: http://tinyurl.com/AgendaiCAMP2April10

    Revising ICD via the iCAT platform towards a publication comprising three integrable volumes capable of continuous revision in response to new scientific evidence is an ambitious and technically complex operation. ICD-11 is being authored collaboratively by Topic Advisory Group Managers, members and reviewers who are scattered all over the world and who are undertaking these roles in addition to their professional commitments. At present, 136 scientists from 36 countries and all WHO regions are contributing to the work. The Minutes of the April RSG meeting are not yet available and it's not clear how on target the Alpha Draft remains or whether the goals for May 2010 have had to be revised.


    To view the iCAT Demo and training platform:

    Go to the ICD-11 Revision site:

    https://sites.google.com/site/icd11revision/home/

    then to this page:

    iCAT - Initial ICD-11 Collaborative Authoring Tool
    https://sites.google.com/site/icd11revision/home/icat

    and click on this link:

    The demo and training iCAT platform: http://icatdemo.stanford.edu/

    this will link to the server hosting the iCAT Demo and Training Platform where you can see how the iCAT will function. (Give it a little time to load.)

    Once you are into the iCAT demo, you can poke about:

    Click on the "ICD Content" Tab (second Tab on left)

    Open the + next to "ICD Categories" if the drop down list is not already displaying

    Open the + next to 06 VI Diseases of the nervous system

    Open the + next to G90-G99 Other disorders of the nervous system

    Open the + next to G93 Other disorders of brain

    Click on G93.3 Postviral fatigue syndrome


    On the Right of your screen:

    Click on the "Definition" Tab if it is not already selected

    You should see the following:

    ICD Code* G93.3

    ICD Title Postviral fatigue syndrome

    Definition (Text currently unpopulated)


    *For a Glossary of Terms click on the ? next to the Field Titles which link to a general page setting out the terms and template for content population within ICD-11.

    (URL for this Glossary page is: http://apps.who.int/classifications/apps/icd/icatfiles/iCAT_Glossary.html#definition )


    There are no Definitions populated in this demo for the entry for "Postviral fatigue syndrome".

    Note that until the actual ICD-11 Alpha Draft is released, it cannot be determined how far the various Topic Advisory Groups have progressed with populating content according to the ICD Content Model for the categories of interest to us.

    Some "External definitions" have been entered into the demo.

    Note these have been imported from other classification systems, either as part of the initial "Start-up List", used to kick start the revision process, or are being used as examples of a populated field.

    Again, we need to wait until the draft comes out to see how many fields have been populated so far, their textual content, and the editing status of their content.

    External definitions:

    Three definitions are currently displaying. (These three definitions are collated on this site along with their sources):
    http://www.fpnotebook.com/Rheum/Sx/ChrncFtgSyndrm.htm


    iCAT field: External definitions:

    A syndrome of unknown etiology. Chronic fatigue syndrome
    (CFS) is a clinical diagnosis characterized by an unexplained
    persistent or relapsing chronic fatigue that is of at least six
    months duration, is not the result of ongoing exertion, is not
    substantially alleviated by rest, and results in substantial reduction
    of previous levels of occupational, educational, social
    or personal activities. Common concurrent symptoms of at least
    six months duration include impairment of memory or concentration,
    diffuse pain, sore throat, tender lymph nodes,headaches of a new
    type, pattern, or severity, and nonrestorative sleep.
    The etiology of CFS may be viral or immunologic. Neurasthenia
    and fibromyalgia may represent related disorders. Also known as
    myalgic encephalomyeltis.

    Ontology ID UMLS/NC12007_05
    E


    distinctive syndrome characterized by chronic fatigue, mild fever,
    lymphadenopathy, headache, myalgia, arthralgia, depression, and
    memory loss: candidate eitiological agents include Epstein-Barr and
    other herpesviruses.

    Ontology ID UMLS/CSP2006


    A syndrome characterized by persistent or recurrent fatigue,
    diffuse musculoskeletal pain, sleep disturbances, and subjective
    cognitive impairment of 6 months duration or longer. Symptoms
    are not caused by ongoing exertion; are not relieved by rest; and
    result in a substantial reduction of previous levels of occupational,
    educational, social or personal activities. Minor alterations of
    immune, neuroendocrine, and automatic function may be
    associated with this syndrome. There is also considerable
    overlap between this condition and FIBROMYALGIA. (From Semin
    Neurol 1998;18(2):237-42: Ann Intern Med 1994 Dec 15;121(12):
    953-9)

    Ontology ID UMLS/MSH2008_2
    008_02_04​

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

    Very few Tabs have been populated in this demo version of the iCAT

    Terms

    Synomyms: Not yet populated

    Inclusions: Benign myalgic encephalomyeltis

    Exclusions: Not yet populated

    Clinical Description; Body System; Body Part not yet populated

    Entire brain (body structure) Term ID 258335003
    Brain structure (body structure) Term ID 12738006

    Diagnostic Criteria; Causal Mechanism and Risk Factors not yet populated

    Causal Mechanism Virus (organism) Term ID 49872002

    Risk Factors; Genomic Linkages; Etiology Type; Causal Mechanism; Functional Impact; SNOMED References not yet populated etc.

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

    Go back to the ICD Content Tab list and open the page for Chapter 5 (V) Mental and behavioural disorders.

    Then open the + for F40-F48 Neurotic, stress-related and somatoform disorders

    Then open "F45 Somatoform disorders"

    where the existing categories in ICD-10 Chapter V: Somatoform disorders are listed.

    Note they are listed as they currently appear in ICD-10, as set out in this Comparison Table:
    http://dxrevisionwatch.files.wordpress.com/2010/01/dsm-icd-equiv3.png

    and are not congruent with any current proposals by the DSM-5 Work Group for Somatic Symptoms Disorders for the proposed major restructuring of the "Somatoform Disorders" categories, as published in the DSM-5 draft proposals for diagostic criteria, on 10 February:
    http://www.dsm5.org/ProposedRevisions/Pages/SomatoformDisorders.aspx


    "Harmonization" and integration of ICD-11 with DSM-5

    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."


    It should be evident from the iCAT demo that there is the potential for considerably more content to be included in ICD-11 than there is in ICD-10 and that the progress of the population of content for the categories of interest to us is going to need continuous monitoring as the Topic Advisory Groups and their reviewers work towards the Beta Draft.

    I shall update when further information on the launch of the alpha and iCAT becomes available over the next couple of weeks.

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

    Footnotes:

    [1] Key documents:

    Content Model Specifications and User Guide (v April 10)
    Identifies the basic properties needed to define any ICD concept (unit, entity or category) through the use of multiple parameters.
    http://tinyurl.com/ICD11ContentModelApril10

    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.
    http://www.who.int/classifications/icd/ICDRevisionProjectPlan_March2010.pdf

    Alpha Drafting Workflow (v 06.10.09)
    Sets out lines of responsibility between the various contributors for the alpha drafting phase.
    http://dxrevisionwatch.files.wordpress.com/2010/01/alpha-drafting-workflow-27-01-10.doc

    Further documents eg Style Guide, ICD-11 Conventions:
    https://sites.google.com/site/icd11revision/home/face-to-face-meetings/icamp/documents


    [2] The Introduction to ICD-10 Volume 3: The Alphabetical Index lists several possible relationships between a term included in the Alphabetical Index and a term included in the Tabular List to which it is indexed:

    "The terms included in the category of the Tabular List are not exhaustive; they serve as examples of the content of the category or as indicators of its extent and limits. The Index, on the other hand, is intended to include most of the diagnostic terms currently in use. Nevertheless, reference should always be made back to the Tabular List and its notes, as well as the guidelines provided in Volume 2, to ensure that the code given by the Index fits with the information provided by a particular record.

    "Because of its exhaustive nature, the Index inevitably includes many imprecise and undesirable terms. Since these terms are still occasionally encountered on medical records, coders need an indication of their assignment in the classification, even if this is to a rubric for residual or ill-defined conditions. The presence of a term in this volume, therefore, should not be taken as implying approval of its usage."​


    and, according to a February 2009 response from WHO HQ Classifications, Terminology and Standards Team, terms that are listed in the Index may be:

    a synonym to the label (title) of a category of ICD;
    a sub-entity to the disease in the title of a category;
    or a "best coding guess".​


    In indexing "Chronic fatigue syndrome" to G93.3, ICD-10 does not specify how it views the term in relation to "Postviral fatigue syndrome" or in relation to "Benign myalgic encephalomyelitis". Nor does ICD-10 specify how it views the relationship between "Postviral fatigue syndrome" and "Benign myalgic encephalomyelitis".


    Suzy Chapman for Dx Revision Watch | 06.05.10
     
  2. dean

    dean

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    you are doing great work and I appreciate it.....any word on the alpha draft, and if not where can I find the latest progress on its release, and the next steps

    thanks again

    dean
     
  3. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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    Hi Dean,

    Thank you for your kind words.

    According to Page 7 of this key ICD Revision document:

    http://www.who.int/classifications/icd/ICDRevisionProjectPlan_March2010.pdf

    An Alpha Draft for ICD-11 was expected to be released by May 2010.

    The Agenda of the April meeting of the ICD Revision Steering Group (RSG) also projected an ETA between 10 and 17 May.


    The Revision Steering Group (RSG) that is overseeing the revision of ICD-10 towards ICD-11 has yet to publish an update on the delay on the release of this early draft but I think we can assume that the timeline has slipped.

    The Alpha Draft is anticipated to be a partial draft. Diseases and disorders in ICD-11 are having considerably more content included, populated according to a common Content Model. For example, Definitions, Synonyms, Inclusions, Exclusions, Clinical Description, Diagnostic Criteria, Causal Mechanism and Risk Factors etc.

    The authoring of content by the various Topic Advisory Groups for all these fields for the thousands of diseases and disorders classified in ICD-11 is a considerable undertaking and ICD Revision has a great deal of work to plough through if the beta version is going to be ready by this time next year.

    The beta draft is scheduled for May 2011 and at that point, it is expected that the public will be able to comment on the beta version via the iCAT and possibly via other means.

    Until the WHO or the RSG issues a notice, I cannot provide you with any information on when we might now expect to see this early draft and as I say, when it is available, not all fields for all categories may be complete.

    As soon as I have some information, I will update here and on my websites.

    It isn't expected that there will be a public review process like the APA held between February and April for its own alpha draft for proposals for revised criteria for DSM-5.

    In September, last year, I was given to understand that a proposal form for use jointly in relation to ICD-11 Chapters 5 and 6 was in the process of being refined and would be available in the fall of 09 for the use of all stakeholders in the revision process. Evidently there was a change of plan and the Topic Advisory Groups (TAGs) have not published any public notice about the availabililty of a form.

    I have recently established, however, that some organisations, for example, the American Psychological Association (not to be confused with the American Psychiatric Association) appears to have submitted proposals via a joint form in relation to Chapter 5 F coded categories, unrelated to the focus of this site.

    So something else I need to establish is which stakeholders this form is being made available to, and when the Alpha Draft is released, whether there will be any process through which any stakeholder may submit comment on the alpha draft.

    The revision of ICD-10 towards ICD-11 will be of interest to the US, especially what textual content is included, but as you are probably aware, the US does not use ICD-10 and will not be moving on to ICD-11 post 2014+.

    The US uses what is called a "Clinical Modification" of ICD and will be moving onto a revised version of its current version, called ICD-10-CM, in October 2013.

    The current proposals for the classification and codings of Postviral fatigue syndrome, (Benign) mylagic encephalomyelitis and Chronic fatigue syndrome for the forthcoming ICD-10-CM differ from those in ICD-10 and are likely to differ from proposals for ICD-11.

    Proposals for the forthcoming ICD-10-CM are discussed in this thread:

    See Post #196 where the proposed codes are set out:

    http://www.forums.aboutmecfs.org/sh...perate-illnesses&p=79932&viewfull=1#post79932

    See Post #212 for PDF files for the ICD-10-CM Tabular List and other documents:

    http://www.forums.aboutmecfs.org/sh...perate-illnesses&p=83272&viewfull=1#post83272

    Earlier proposals for the forthcoming ICD-10-CM had all three terms classified in Chapter 6 at G93.3 (as is the case in the Canadian Clinical Modification, ICD-10-CA).

    As soon as I have any further information I will update this thread.

    Best,

    Suzy

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

    Some key ICD-11 revision documents here:

    Content Model Specifications and User Guide (v April 10)
    Identifies the basic properties needed to define any ICD concept (unit,
    entity or category) through the use of multiple parameters.
    http://tinyurl.com/ICD11ContentModelApril10

    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.
    http://www.who.int/classifications/icd/ICDRevisionProjectPlan_March2010.pdf

    Alpha Drafting Workflow (v 06.10.09)
    Sets out lines of responsibility between the various contributors for the
    alpha drafting phase.
    http://dxrevisionwatch.files.wordpress.com/2010/01/alpha-drafting-workflow-27-01-10.doc
     
  4. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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    US Clinical Modification ICD-10-CM

    New post on Dx Revision Watch site

    US Clinical Modification ICD-10-CM
    June 6, 2010

    by Suzy Chapman

    Shortlink Post #45: http://wp.me/pKrrB-Ka

    This post is intended to clarify any confusion between ICD-10, ICD-11 and the forthcoming US Clinical Modification, ICD-10-CM.

    Read full post here
     
  5. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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    PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring Platform Part1

    Part 1

    PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring Platform

    Shortlink Post #46: http://wp.me/pKrrB-KK


    The information in this report relates to proposals for ICD-11. It does not apply to ICD-10-CM, the forthcoming US "Clinical Modification" of ICD-10.


    Whither the ICD-11 Alpha Draft?

    According to documents published by the ICD Revision Steering Group (RSG) and the Agenda for the iCAMP2 and Revision Steering Group meeting on 19-23 April 2010, it was projected that an alpha draft for ICD-11 would be ready by 10 May 2010 [Key document 1a].

    The RSG meeting Agenda proposed that the alpha draft should be presented to the World Health Assembly (WHA) between 17-25 May. A proposal for a press launch was also tabled for discussion.

    It is understood that the ICD-11 alpha draft is being created for internal users, was not expected to be complete by May 2010, but released as a "work in progress" towards the beta stage. The beta draft for ICD-11 is scheduled for 2011, which will be subjected to systematic field trials and then made available for public comment.

    10 May has come and gone, and there has been no public launch of an alpha draft or the iCAT - the wiki-like collaborative authoring platform through which ICD-11 is being drafted.

    As the Minutes of the April RSG meeting are not yet available, it remains unclear how on target the alpha draft is or whether the goals for 2010 have had to be revised. (See Page 7, ICD-11 Revision Project Plan - Draft 2.0 for Project milestones and budget, and organizational overview.)

    When the RSG does release information on the status of the alpha draft and the operational status of the iCAT, I will post an update.

    In the meantime, I have raised a number of queries around the status of the alpha draft, whether the RSG intends to make a draft available for public viewing, at what point, and in what format(s). I have also asked for information about the availability of Topic Advisory Group proposal forms for stakeholder input, up to what stage in the development process timeline these might be used, and which stakeholders are going to be permitted to make use of proposal forms.


    iCAT production server

    In the posting ICD-11 Alpha Draft scheduled to launch between 10 and 17 May, 6 May, I reported that it is already possible to view a "Demo and Training iCAT Platform" and also access the iCAT production server.

    I cautioned that until an official ICD-11 Alpha Draft is released, it cannot be determined how far the various Topic Advisory Groups have progressed with revising classifications and populating textual content according to a common "Content Model" for the ICD Chapters and categories of interest to us [Key document 1b].

    I noted that the Demo and Training iCAT Platform, at that point, was sparsely populated for content and that the classifications and codings listed within the various chapters appeared to have been imported from ICD-10, with little discernable change - presumably as the starting point for the drafting process.

    A revised Demo and Training iCAT Platform is now accessible, the content of which is also viewable on the iCAT production server and it is to these proposed revisions that I want to draw your attention.

    Note that anyone can view the Demo and Training iCAT Platform and iCAT production server but only WHO, ICD Revision and IT personnel and the Managers and members of the various Topic Advisory Groups (TAGS)will have editorial access. External reviewers recruited by TAG Managers will also use the iCAT to upload reviews and comment on proposals and content.

    I have compiled a series of screenshots and very brief notes on what is viewable at the moment for the chapters and categories of interest to us.

    Note: Screenshots are taken from the Demo and Training iCAT Platform and iCAT production server as they stood at 24 May 2010. Alpha drafting is an ongoing process and what currently appears may be subject to revision, refinement and additions before an official Alpha Draft is released. Not all the classification and content work currently undertaken may have been entered into the iCAT.

    Note also that when viewing the iCAT in your browser, the left hand side of the screen displays the ICD Categories listings with the category Definition, Term, Clinical Description, Diagnostic Criteria etc displaying on the right of the screen. Because this view is too wide to display on my website template, the screenshots have had to be split in two. On your screen the iCAT will look like this:

    [​IMG]

    When you have read this report and familiarised yourself with the way the iCAT functions, I suggest you poke around you cant break anything as members of the public have no editing access.

    All screenshots as they stood at 24 May 2010


    A wiki-like Collaborative Authoring Tool (known as the iCAT)) is being used for the initial authoring of the alpha draft.

    The iCAT production server and Demo and Training iCAT Platform can be accessed here:


    https://sites.google.com/site/icd11revision/home/icat

    iCAT production server at: http://icat.stanford.edu/

    Demo and Training iCAT Platform at: http://icatdemo.stanford.edu/

    Load either (they may take a minute or more to load and appear less inclined to hang in Firefox).

    One loaded, you will be presented with an Entry Page this is the My ICD Tab

    Welcome to iCAT the Initial ICD 11 Collaborative Authoring Tool!


    Select the ICD Content Tab and ICD Categories by chapter will populate down the left side of the screen.

    Scroll down and open up the + next to 06 VI Diseases of the nervous system

    [Continued in Part 2]
     
  6. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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    PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring Platform Part2

    PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring Platform Part 2

    Part 2

    ICD Categories:

    [​IMG]


    Scroll down and note that ICD-10 codings between G83.9 and G99.8 are being reorganised and have been assigned the labels GA thru GN (some of which, like GN, are parent categories with child and grandchildren categories).

    Open up the + next to GN Other disorders of the nervous system

    which is a parent to category Gj92 Chronic fatigue syndrome

    (Note: Gj92 is known as a “Sorting label”. A Sorting label is a string that can be used to sort the children of a category. This is not the ICD code.)

    Note that Postviral fatigue syndrome and Benign myalgic encephalomyelitis are not currently accounted for in the ICD Categories List as children of the parent category GN Other disorders of the nervous system. Only Chronic fatigue syndrome is listed and assigned the Sorting Label “Gj92″ . [See Glossary: Inclusions]

    [​IMG]


    Click on the double speech bubble icon next to Gj92 Chronic fatigue syndrome which will display 1 Category Discussion Note (Click Expand to display the full note. Discussion Notes can also be accessed via the Category Notes and Discussions Tab, from which the screenshot below, orginates).

    Discussion Note for Gj92 Chronic fatigue syndrome:

    [​IMG]

    This Discussion Note records a Change in hierarchy for class: G93.3 Postviral fatigue syndrome because its parent category (G93 Other disorders of brain) is removed.

    Note that the removal of the parent G93 Other disorders of brain will affect other categories also classified under G93 in ICD-10, not just G93.3. Open up the double speech bubble icons next to other category listings and you can view the Discussion Notes on proposed restructuring for other G8x and G9x categories.


    Next, with the ICD Content Tab selected, click on Gj92 Chronic fatigue syndrome and the Details for Gj92 Chronic fatigue syndrome will display on the right side of the screen. Allow a few moments for the text in the boxes to load.

    With the Title & Definition Tab selected (the Tab may read Definition only, depending on whether you are viewing the iCAT production server or the Demo iCAT), you can view the

    Details for Gj92 Chronic fatigue syndrome

    To view a Glossary of Terms page, which defines the terms in the Tabs click on the blue question mark icons which will load the iCAT Glossary.

    Content for Gj92 Chronic fatigue syndrome:

    [See Glossary: Definition] The full text of External Definitions (imported from affiliate classification publications) which is partly hidden in the screenshot, is appended at end of this post. According to discussion on the iCAT Users Google Group, it is proposed that External Definitions might be given less prominence when displaying in the iCAT.

    [​IMG]

    [Continued in Part 3]
     
  7. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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    PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring Platform Part3

    PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring Platform Part 3

    Part 3

    Now click on the Terms Tab.

    Terms for Gj92 Chronic fatigue syndrome:

    Benign myalagic encephalomyelitis currently appears listed as an Inclusion to Gj92 Chronic fatigue syndrome.

    Note that Postviral fatigue syndrome is not listed as an Inclusion and that Synonyms and Exclusions for Gj92 Chronic fatigue syndrome have yet to be populated. [See Glossary: Synonyms, Inclusions, Exclusions]

    Very few of the other Content Tabs have been populated but it is envisaged that they will be in due course.


    [​IMG]


    I provide no screenshots for Benign myalagic encephalomyelitis or Postviral fatigue syndrome because these are not listed in the ICD Categories List. [See Glossary: ICD Title, Synonyms, Inclusions, Exclusions]


    Extract from the iCAT Glossary

    6. Inclusions

    Short definition: Inclusion terms are either synonyms of the category titles or subclasses which are not represented in the classification hierarchy.

    Details: Inclusion terms appear in the tabular list of the traditional print version and show users that entities are included in the relevant concept. All of the ICD-10 inclusion terms have been imported and accessible in the iCat. These are either synonyms of the category titles or subclasses which are not represented in the classification hierarchy. Since we have synonyms as a separate entity in our ICD-11 content model, the new synonyms suggested by the users should go into the synonyms section. In the future, iCat will provide a mechanism to identify whether an inclusion is a synonym or a subclass.

    7. Exclusions

    Short definition: Exclusion terms help users eliminate entities that should be assigned to a different ICD category because of differences in meaning or terminology.

    Details: Exclusion terms help users eliminate entities that should be assigned to a different ICD category because of differences in meaning or terminology.


    I am including some screenshots of other Chapters which will be of interest.

    Chapter 5 (V) Somatoform Disorders at F45 (currently same as or near ICD-10):

    [​IMG]


    Neurasthenia remains in Chapter 5 (V) at F48.0:

    [​IMG]


    Inclusions and Exclusions for Neurasthenia:

    [​IMG]

    [Continued in Part 4]
     
  8. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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    PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring Platform Part4

    PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring Platform Part 4

    Part 4

    Chapter 18 (XVIII) displaying R53 Malaise and fatigue (this is the Chapter under which the US Clinical Modification, ICD-10-CM, proposes classifying Chronic fatigue syndrome, at R53.82):

    [​IMG]

    Inclusions and Exclusions for R53 Malaise and fatigue:

    [​IMG]



    Here are the two Category discussion Notes that appear directly beneath 06 VI Diseases of the nervous system ((no ICD10 concepts from Chapter 06 VI are currently moved into either of these "holding pens").I]

    1 Discussion Note for: Needing a decision to be made

    [​IMG]

    1 Discussion Note for: To be retired

    [​IMG]


    External Definitions: (Imported from affiliate classification publications, these remain the same as my 6 May posting.)

    External Definitions for Gj92 Chronic fatigue syndrome

    A syndrome of unknown etiology. Chronic fatigue syndrome (CFS) is a clinical diagnosis characterized by an unexplained persistent or relapsing chronic fatigue that is of at least six months duration, is not the result of ongoing exertion, is not substantially alleviated by rest, and results in substantial reduction of previous levels of occupational, educational, social or personal activities. Common concurrent symptoms of at least six months duration include impairment of memory or concentration, diffuse pain, sore throat, tender lymph nodes,headaches of a new type, pattern, or severity, and nonrestorative sleep. The etiology of CFS may be viral or immunologic. Neurasthenia and fibromyalgia may represent related disorders. Also known as myalgic encephalomyeltis.

    Ontology ID UMLS/NC12007_05
    E

    distinctive syndrome characterized by chronic fatigue, mild fever, lymphadenopathy, headache, myalgia, arthralgia, depression, and memory loss: candidate eitiological agents include Epstein-Barr and other herpesviruses.

    Ontology ID UMLS/CSP2006

    A syndrome characterized by persistent or recurrent fatigue, diffuse musculoskeletal pain, sleep disturbances, and subjective cognitive impairment of 6 months duration or longer. Symptoms are not caused by ongoing exertion; are not relieved by rest; and result in a substantial reduction of previous levels of occupational, educational, social or personal activities. Minor alterations of immune, neuroendocrine, and automatic function may be associated with this syndrome. There is also considerable overlap between this condition and FIBROMYALGIA.
    (From Semin Neurol 1998;18(2):237-42: Ann Intern Med 1994 Dec 15;121(12):953-9)

    Ontology ID UMLS/MSH2008_2
    008_02_04



    Based only on the information visible in the iCAT as it stood at 24 May 2010, it appears that instead of:

    ICD-10 (version for 2007) Tabular List

    http://apps.who.int/classifications/apps/icd/icd10online/?gg90.htm g933

    Chapter VI (6)

    Diseases of the nervous system
    (G00-G99)

    [...]

    Other disorders of the nervous system
    (G90-99)

    [...]

    G93 Other disorders of brain

    [...]

    G93.3 Postviral fatigue syndrome
    Benign myalgic encephalomyelitis

    (with Chronic fatigue syndrome indexed to G93.3 in Volume 3: The Alphabetical Index)​


    it appears that what may be being proposed at this point is:

    that G83.9-G99.8 codes in ICD-10 Chapter VI: Diseases of the nervous system are being restuctured;

    that G93 Other disorders of brain is removed as a parent category for G93.x codings;

    that GN Other disorders of the nervous system

    is now the parent to a large number of categories previously classified between G83.9 and G99.8


    that GN Other disorders of the nervous system is the parent to

    Gj92 (Sorting label) Chronic fatigue syndrome


    that Gj92 Chronic fatigue syndrome is included in ICD-11 Chapter 06 VI Diseases of the nervous system (Neurology chapter) in the ICD Categories list as an ICD Title term;

    that there is currently displaying no Gj9x Sorting label (or any other Sorting label) listing for Postviral fatigue syndrome or Benign myalgic encephalomyelitis in ICD Categories list or any Category Details for either term;

    (Whether this is because Inclusion terms appear in the tabular list of the traditional print version but not in the iCAT version, or because of proposed hierarchy changes to the relationship between these three terms or because text remains to be entered into the iCAT for these two terms, cannot be determined from the information available at 10 June - please refer to Glossary of Terms which sets out the relationships between an ICD Title and its inclusion in the iCAT Categories list and between an ICD Title and its Synonyms, Inclusions and Exclusions.)


    that Gj92 Chronic fatigue syndrome is an ICD Title term with a Details page, a Definition and an Inclusion term (but with no Synonyms or Exclusions or other fields yet populated);

    that Benign myalgic encephalomyelitis is listed under Inclusions to Gj92 Chronic fatigue syndrome


    that Chapter 5 V Details for F48.0 Neurasthenia specifies
    “postviral fatigue syndrome” underExclusions with References

    G93.3 -> Gj92 Chronic fatigue syndrome

    that Chapter 18 XVIII Details for R53 Malaise and Fatigue specifies
    “fatigue syndrome postviral” [sic] under Exclusions with References

    F48.0 -> F48.0 Neurasthenia,
    G93.3 -> Gj92 Chronic fatigue syndrome


    but that in the absence of further information, it is currently unclear what the proposed hierarchical status of Postviral fatigue syndrome and Benign myalgic encephalomyelitis will be in relation to Chronic fatigue syndrome, and in relation to each other.

    I shall continue to monitor the iCAT production server closely and report on any changes to proposals for Category listings and on the progress of the population of content.



    [1] Key documents:

    a) ICD-11 Revision Project Plan – Draft 2.0 (v March 10) [PDF format]
    Describes the ICD revision process as an overall project plan in terms of goals, key streams of work, activities, products, and key participants.

    b) Content Model Specifications and User Guide (v April 10)
    Identifies the basic properties needed to define any ICD concept (unit, entity or category) through the use of multiple parameters.

    c) Alpha Drafting Workflow (v 06.10.09)
    Sets out lines of responsibility between the various contributors for the alpha drafting phase.

    d) Further documents eg Style Guide, ICD-11 Conventions:
    ICD Revision Google site

    [This concludes the report]
     
  9. V99

    V99 *****

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    ME agenda
    I will need to read this again at some point, so could you tell me what your overall impression of this is, or is it to early to say anything?
     
  10. Esther12

    Esther12 Senior Member

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    Thanks for all this suzy.

    To me, this is looking okay so far. I've only had a glance, and like V99 would be interested to hear what you think.
     
  11. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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    The long answer:

    Firstly, it's essential that the brief ICD Glossary of Terms page is read, especially the Glossary entries for ICD Title, Synonyms, Inclusions and Exclusions.

    Secondly, it needs to be understood that the alpha draft is a "work in progress" and that not all content will have been compiled yet, or if compiled, not yet entered into the iCAT.

    It was not anticipated that by May 2010, all proposed content for all categories for all Chapters would have been populated in the iCAT; previous versions of ICD have not contained this amount of textual content, before, and much of it will need generating.

    I have been waiting for information on whether a draft is going to be released, at this stage, in addition to what can be seen in the iCAT. I received confirmation this morning, from a secondary source, that a print copy of the draft was presented by the WHO at the World Health Assembly meeting between 17 and 25 May.

    It's unconfirmed, but it does not look as though there is going to be any press launch at this stage. It's also unconfirmed whether any form of alpha draft other than the iCAT will be made publicly available further on in the production timeline but before the beta drafting stage is reached.

    This is an important extract from the Glossary:

    Extract from the iCAT Glossary

    6. Inclusions

    Short definition: Inclusion terms are either synonyms of the category titles or subclasses which are not represented in the classification hierarchy.

    Details: Inclusion terms appear in the tabular list of the traditional print version and show users that entities are included in the relevant concept. All of the ICD-10 inclusion terms have been imported and accessible in the iCat. These are either synonyms of the category titles or subclasses which are not represented in the classification hierarchy. Since we have synonyms as a separate entity in our ICD-11 content model, the new synonyms suggested by the users should go into the synonyms section. In the future, iCat will provide a mechanism to identify whether an inclusion is a synonym or a subclass.​


    I don't consider there is sufficient information at the moment, to gain a clear picture of current proposals.

    As I've noted in my report, the removal of the G93 category parent "Other disorders of brain" affects a number of old ICD-10 classifications. And as you see, the section of ICD-10 G83.9 to G99.8 is being restructured.

    When you click on the double speech bubble icons for some of the categories, the Discussion Notes are often more explict, for example, the Discussion Note against:

    GN Other disorders of the nervous system

    > Gj90 Disorders of CSF pressure and flow​

    > Gj90.0 Increased intracranial pressure disorders​

    Reads: [Reason for change]: Create class with name: Increased intracranial pressure disorders, parents: Disorders of CSF Pressure and Flow

    replaces G93.5, G93.6, and G93.7


    ---------

    But the Discussion Note against Gj92 Chronic fatigue syndrome is not that clear. It notes a hierarchy change because the parent class G93 Other disorders of brain is being removed so the G93 parent loses child G93.3 Postviral fatigue syndrome but it doesn't set out what then happens with the ICD-10 legacy term "Postviral fatigue syndrome".

    "Postviral fatigue syndrome" had been the Category Term in ICD-10 under which Benign ME had sat (though the relationship was not specified) and to which Chronic fatigue syndrome had been indexed.

    But rather that allocate a Gjxx "Sorting label" to Postviral fatigue syndrome and specify in the Details that Benign ME and Chronic fatigue syndrome are proposed as Inclusions to Gjxx Postviral fatigue syndrome or Synonyms or Subclasses, or make Benign ME the ICD Title term, then specify the relationship of the other two terms to it, what we see in the iCAT is apparently:

    Gj92 Chronic fatigue syndrome as an ICD Title, with Benign ME specified as an Inclusion, but no accounting for Postviral fatigue syndrome, other than being specified as an Exclusion to F48.0 Neurasthenia and R53 Malaise and fatigue where is lists Postviral fatigue syndrome in the References, in one instance as:

    G93.3 -> Gj92 Chronic fatigue syndrome

    Now the following is purely speculative:

    Possibly the legacy ICD-10 Title term Postviral fatigue syndrome is proposed to be subsumed under Chronic fatigue syndrome; that Chronic fatigue syndrome will be the new ICD Title term, with Benign ME an Inclusion (though the relationship is not currently specified, ie as a Synonym or as a Subclass) or

    that Postviral fatigue syndrome and Benign ME are accounted for in a print version (but not the iCAT) but that the Details (Definition and all other Terms) will default to the Details for Gj92 Chronic fatigue syndrome. (Note there are references to ME in the imported External Definitions).

    Which is why I stress that the projected relationship between the three isn't possible to determine from the information we currently have. Until this is clear and until we have more fields populated then I defer commenting on the Definition as it currently stands, in case there is also to be a "stand alone" Details page for Benign ME.

    It's not known what eventual codes either of the three terms will be allocated at this stage. After all these years, and given the literature and all the material on websites, it would seem odd to have one or more of these familiar terms allocated a new code. But if the parent class G93 is being removed, then there is the potential for many categories to have a new code allocated.

    ICD-11 isn't scheduled for completion until 2014/5.

    From Page 7 of ICD-11 Revision Project Plan – Draft 2.0

    Project milestones and budget, and organizational overview

    [...]

    Alpha draft phase I begins 2 Oct 2009
    Alpha-draft Released May 2010
    Beta- draft released May 2012
    Field trials completed July 2012
    Pre-final draft released Mar 2013
    ICD-11 endorsed by WHA May 2014
    ICD-11 implementation package ready July 2014
    ICD-11 published in six official languages Mar 2014
    Pilot countries implemented ICD-11 Mar 2014

    The Chair of the Topic Advisory Group is based at Imperial College London. I may approach the Chair for a clarification of proposals as they currently stand.

    The short answer: If you were thinking of getting a G93.3 tattoo done - might be best to hang on for a bit...

    Suzy
     
  12. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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    Extract: ICD-11 Revision Project Plan Draft 2.0

    http://www.who.int/classifications/icd/ICDRevisionProjectPlan_March2010.pdf

    ICD-11 Revision Project Plan Draft 2.0 (v March 10) [PDF format]

    [Extract]

    Page 38

    Endorsement of Alpha-draft ICD-11 by WHO.

    WHO will consider endorsement of the alpha draft, after all concerns of RSG and the Classification TAGs have been duly taken into account. The alpha draft is a frozen state of development of the ICD-11 that will include a large part of the structural changes, and the majority of the definitions. 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.


    ---------

    See Page 7, ICD-11 Revision Project Plan Draft 2.0 for Project milestones and budget, and organizational overview.)
     
  13. V99

    V99 *****

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    The tattoo thing was bothering me, good job I only got the WHO ICD bit.

    Thanks ME agenda, your hard work is very much appreciated. You completely blow me away with you knowledge and fight.
     
  14. Esther12

    Esther12 Senior Member

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    lol.

    Thanks for the summary Suzy.
     
  15. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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    LOL.

    Well, thank you, V99.

    Suzy
     
  16. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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    Update on the ICD-11 Alpha Draft at 06.09.10

    September 6, 2010

    Update on the ICD-11 Alpha Draft at 06.09.10

    Shortlink Post #47: http://wp.me/pKrrB-MD

    ***********************************************

    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

    ***********************************************

    On 7 June, in Post #46, I published a report that includes 13 screenshots from the iCAT, the wiki-like Web 2.0 collaborative authoring platform through which ICD-11 is being drafted.

    Screenshot: ICD-11 iCAT Chapter 6 (VI) Disorders of the nervous system


    [​IMG]


    Screenshot: Discussion Note to "Gj92 Chronic fatigue syndrome

    [​IMG]

    To view proposals as they currently appear in the iCAT, see the 13 screenshots and my brief notes here:

    PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring Platform

    Note that what currently appears in the iCAT and in my June report may be subject to revision by the ICD Revision Steering Group and Topic Advisory Groups prior to an alpha draft being publicly released or presented at the forthcoming September iCamp2 meeting.


    Update on the ICD-11 Alpha Draft

    ICD Revision maintains a website at: http://sites.google.com/site/icd11revision/

    where the public can access minutes of iCamp and Topic Advisory Group (TAG) meetings, meeting agendas, key documents and presentations.

    Text on this website had read:

    ICD-11 alpha draft will be ready by 10 May 2010
    ICD-11 beta draft will be ready by 10 May 2011
    ICD final draft will be submitted to WHA by 2014″


    This text has recently been changed to read:

    ICD-11 alpha draft process began September 2009
    ICD-11 beta draft process will begin in 2011
    ICD final draft will be submitted to WHA by 2014″


    No detailed timeline has been published but there is a Project milestones and budget, and organizational overview on page 7 of this document:

    ICD-11 Revision Project Plan Draft 2.0 (v March 10) PDF: ICD Revision Project Plan

    or: http://www.who.int/classifications/icd/ICDRevisionProjectPlan_March2010.pdf

    which projects a Beta Draft release for May 2012.


    Release of ICD-11 Alpha Draft

    No ICD-11 Alpha Draft was publicly released in May. But a hard copy snapshot of the alpha, as it stood at that point, was presented by the WHO at the 63rd World Health Assembly meeting, between 17 and 25 May.


    September iCamp2 meeting

    An ICD Revision iCamp2 meeting had been scheduled for April but was postponed. The meeting has been rescheduled for later this month.

    iCamp2 is now scheduled for 27 September 1 October 2010, in Geneva.

    The revised Agenda for this meeting is here:

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

    http://sites.google.com/site/icd11revision/home/face-to-face-meetings/icamp2-2010/icamp-2-agenda

    Following iCamp meetings, PowerPoint presentations are sometimes made publicly available on the website.

    According to sources, the print version of the alpha draft is now expected to be made available around the time that the iCamp2 meeting takes place, later this month.

    ICD Revision maintains a blog, here: http://whoicd11.blogspot.com/

    which hasnt been updated since last October and a Facebook presence here: http://www.facebook.com/ICD11

    In response to some questions raised several months ago, ICD Revision confirmed, on 6 August, that:

    A draft print version will be available in September 2010.


    On 7 August, I raised the following:

    ICD Revision has clarified that a draft print version will be available in September 2010.

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

    According to the Revision document ICD Revision Project Plan [1], published on the ICD Revision Google site, in March:

    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 [2]. 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.

    Since 2007, it has been possible for stakeholders in the development of ICD-11 to submit proposals and comments, supported by citations, via the ICD Update and Revision Platform Intranet. It was understood last year, that for some Topic Advisory Groups 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 would be permitted to make use of proposal forms would be welcomed.

    It remains unclear what will be ready by September, whether it will be available for public scrutiny, and in what format(s), and by what various means stakeholders might submit proposals prior to and following the release of an Alpha Draft.


    This request for clarification has yet to receive a response.



    Current proposals for the classification and coding of PVFS, ME and CFS for the ICD-11 Alpha Draft

    On my Dx Revision Watch website, at Post #46, is a report I published on 7 June that includes screenshots from the iCAT, the wiki-like collaborative authoring platform through which ICD-11 is being drafted.

    To view what is currently visible in the iCAT, see the screenshots and my brief notes here:

    PVFS, ME, CFS: the ICD-11 Alpha Draft and iCAT Collaborative Authoring Platform, 7 June 2010


    Caveat


    For better understanding, it is important that the brief iCAT Glossary page is read in conjunction with the iCAT screenshots, especially the Glossary entries for ICD-10 Code; ICD Title; Definition; Terms: Synonyms, Inclusions and Exclusions [4].

    Read the iCAT Glossary here: http://apps.who.int/classifications/apps/icd/icatfiles/iCAT_Glossary.html

    Secondly, it needs to be understood that the alpha draft is a work in progress. Not all content will have been compiled yet and entered into the iCAT and there are many blank fields awaiting population for all chapters and for all categories. It also needs to be understood that some text already entered into the various Details fields may still be in the process of internal review and subject to revision.

    Because Topic Advisory Groups are still in the process of entering content into the iCAT not all listings and content that is intended to be included in the print version of the alpha draft may be visible to us, at this point, in the iCAT drafting platform.


    ICD-10 > ICD-11

    One of the biggest changes between ICD-10 and ICD-11 is that in ICD-11, Categories will be defined through the use of multiple parameters.

    In ICD-10, there is no textual content for the three terms Postviral fatigue syndrome, Benign myalgic encephalomyelitis and Chronic fatigue syndrome. There are no definitions and the relationship between the three terms is not specified.

    But in ICD-11, categories will be defined through the use of multiple parameters: Title & Definition, Terms: Synonyms, Inclusions, Exclusions, Clinical Description, Signs and Symptoms, Diagnostic Criteria and so on, according to a common Content Model [2] and as evidenced by the screenshots.

    So have a look at Post #46 if you have not already done so. Or have a poke around in the iCAT wiki production server. The public has no editing rights so you cant break anything [3].



    On 28 June, I contacted Dr Raad Shakir who chairs the ICD Revision Topic Advisory Group for Neurology, for clarifications in respect of current proposals for ICD-11 Chapter 6 (VI).

    Dr Shakir has been asked if he would disambiguate current proposals for ICD-11 for the classification of, and relationships between the three terms, Postviral fatigue syndrome, Chronic fatigue syndrome and Benign myalgic encephalomyelitis, since this is not explicit from the information as it currently displays in the iCAT, nor from the Discussion Note for Gj92 Chronic fatigue syndrome, which has been listed in Chapter 6 (VI) under

    Chapter 6 (VI) Disorders of the nervous system

    > GN Other disorders of the nervous system



    To: Dr Raad Shakir, West London Neurosciences Centre, Charing Cross
    Hospital, Fulham Palace Road, London W6 8RF
    raad.shakir@imperial.nhs.uk

    Re: Query in relation to Topic Advisory Group for Neurology proposals for ICD-11 Chapter 6 (VI)

    28 June 2010

    Dear Dr Shakir,

    I am writing to you in your capacity as Chair, ICD Revision TAG Neurology, with a request for clarification of current proposals for the restructuring of categories classified in ICD-10 under G93 Others disorders of brain, specifically those at G93.3. That is:

    Diseases of the nervous system (G00-G99)

    > Other disorders of the nervous system (G90-99)

    > G93 Other disorders of brain


    [...]

    G93.3 Postviral fatigue syndrome
    Benign myalgic encephalomyelitis

    (with Chronic fatigue syndrome indexed to G93.3 in ICD-10: Volume 3: The Alphabetical Index)

    In the absence of the release of an ICD-11 Alpha Draft, I rely on information as it currently displays in the ICD Categories listed in the iCAT production server at: http://icat.stanford.edu/

    My understanding is that what is being proposed at this point for ICD-11 is that ICD categories coded between G83.9 thru G99.8 in ICD-10 Chapter VI: Diseases of the nervous system, are being reorganised.

    That in ICD-11, Chapter 6 (VI) codings beyond G83.9 are represented by new parent classes numbered GA thru to GN thus:

    Chapter 6 (VI) Disorders of the nervous system

    [...]
    G80-G83 Cerebral palsy and other paralytic syndromes
    GA Infections of the nervous system
    GB Movement disorders and degenerative disorders
    GC Dementias
    [...]
    GN Other disorders of the nervous system

    That GN Other disorders of the nervous system is parent to five child classes that are assigned the Sorting labels Gj90-Gj94.

    (It is understood that a Sorting label is a string that can be used to sort the children of a category and is not the ICD code.)

    At Gj92, sits Chronic fatigue syndrome

    That Gj92 Chronic fatigue syndrome displays no child classes of its own.

    The Category Note associated with Gj92 Chronic fatigue syndrome records a Change in hierarchy for class: G93.3 Postviral fatigue syndrome because its parent category (G93 Other disorders of brain) is removed.*

    [*Ed: Note that the removal of the parent "G93 Other disorders of brain" affects many other categories also classified under G93 in ICD-10, not just G93.3, which have also been assigned "Sorting labels".]

    According to the iCAT ICD Categories Details for Gj92 Chronic fatigue syndrome

    Gj92 Chronic fatigue syndrome displays as a ICD Title term.

    Gj92 Chronic fatigue syndrome has a Definition field populated.**

    [**Ed: Which may be subject to revision and in response to proposals.]

    It has an External Definitions field populated which includes definitions imported from other classification systems, the text of which includes Also known as myalgic encephalomyelitis.

    It has Benign myalgic encephalomyelitis specified under Inclusions.

    It has no Synonyms, Exclusions or other descriptor fields populated yet.

    That at this point and as far as the iCAT version displays, there is no explicit accounting for Postviral fatigue syndrome, as an entity, other than that Postviral fatigue syndrome is specified under Exclusions to Chapter 5 (V) F48.0 Neurasthenia and to Chapter 18 (XVIII) R53 Malaise and fatigue and is referenced in these chapters as

    postviral fatigue syndrome G93.3 -> Gj92 Chronic fatigue syndrome

    It is further understood, from the iCAT Glossary at
    http://apps.who.int/classifications/apps/icd/icatfiles/iCAT_Glossary.html

    that:

    Inclusion terms appear in the tabular list of the traditional print version and show users that entities are included in the relevant concept. All of the ICD-10 inclusion terms have been imported and accessible in the iCat. These are either synonyms of the category titles or subclasses which are not represented in the classification hierarchy. Since we have synonyms as a separate entity in our ICD-11 content model, the new synonyms suggested by the users should go into the synonyms section. In the future, iCat will provide a mechanism to identify whether an inclusion is a synonym or a subclass.

    I should be most grateful if you could clarify the following for me:

    1] In ICD-10 Volume 3: The Alphabetical Index, Chronic fatigue syndrome is indexed to G93.3 but does not appear in the Tabular List.

    In ICD-11, is it being proposed that Chronic fatigue syndrome will be included in the Tabular List in Chapter 6 (VI) Diseases of the nervous system under (GN) Other disorders of the nervous system?

    2] In ICD-11, is it being proposed that rather than Postviral fatigue syndrome being the ICD Category Title term (previously coded at G93.3, but which has now lost its parent class, G93) that Gj92 Chronic fatigue syndrome is proposed as a new ICD Category Title term?

    If this is the case, what is the current proposed relationship between the terms Postviral fatigue syndrome and Gj92 Chronic fatigue syndrome ?

    That is, is it proposed that in the tabular list, Postviral fatigue syndrome would still appear as a discrete Category Title term or is it intended that it should be subsumed under Gj92 Chronic fatigue syndrome or become a Subclass of, or Synonym to Chronic fatigue syndrome, or to have some other relationship?

    3] In the iCAT, the term Benign myalgic encephalomyelitis (previously coded at G93.3, but which has now lost its parent class G93) is listed as an Inclusion under Details for Gj92 Chronic fatigue syndrome but does not appear listed under GN Other disorders of the nervous system in the ICD Category List with a Sorting label of its own, nor as a child to Gj92 Chronic fatigue syndrome.

    What is currently being proposed for ICD-11 for the classification and coding of Benign myalgic encephalomyelitis, as an entity, and its relationship to Chronic fatigue syndrome?

    Since this is not explicit from the information as it currently displays in the iCAT, nor from the Discussion Note to Gj92, I should be pleased if you could disambiguate current proposals for the classification of, and relationships between these three terms for ICD-11.

    Sincerely,

    etc

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

    I will update when a response has been received and when further information about a print version of the alpha draft becomes available.

    Other than making general enquiries around the development of ICD-11 and the operation of the iCAT and this request for clarification of current proposals, I have made no representations to any ICD Topic Advisory Group, nor submitted any proposals through any means nor have I had any discussions with WHO personnel or Topic Advisory Group members in relation to current or future proposals for the three terms of interest to us.

    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:
    http://www.who.int/classifications/icd/ICDRevisionProjectPlan_March2010.pdf

    [2] Content Model Specifications and User Guide (v April 10):
    Identifies the basic properties needed to define any ICD concept (unit, entity or category) through the use of multiple parameters: http://tinyurl.com/ICD11ContentModelApril10

    [3] iCAT production server and Demo and Training iCAT Platform:
    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
     
  17. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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    Update on the ICD-11 Alpha Draft at 06.09.10

    Benign myalagic encephalomyelitis currently appears listed under Inclusions to Gj92 Chronic fatigue syndrome.

    Note that Postviral fatigue syndrome is not listed under Inclusions and that Synonyms and Exclusions for Gj92 Chronic fatigue syndrome have yet to be populated. [See Glossary: Synonyms, Inclusions, Exclusions]. Very few of the other Content Tabs have been populated but it is envisaged that they will be in due course.


    [​IMG]



    What may be being proposed at this point is:


    that G83.9-G99.8 codes in ICD-10 Chapter VI: Diseases of the nervous system are being restuctured;

    that G93 Other disorders of brain is proposed to be removed as a parent category for G93.x codings;


    that GN Other disorders of the nervous system

    is currently displaying as the parent to a large number of categories previously classified between G83.9 and G99.8


    that GN Other disorders of the nervous system is the parent to

    Gj92 Chronic fatigue syndrome (Gj92 is a Sorting label and not an ICD code)


    that Gj92 Chronic fatigue syndrome is included in ICD-11 Chapter 06 VI Diseases of the nervous system (Neurology chapter) in the ICD Categories list as an ICD Title term;

    that there is currently displaying no Gj9x Sorting label (or any other Sorting label) listing for Postviral fatigue syndrome or Benign myalgic encephalomyelitis in ICD Categories list or any Category Details for either term;

    (Whether this is because Inclusion terms appear in the tabular list of the traditional print version but not in the iCAT version, or because of proposed hierarchy changes to the relationship between these three terms or because text remains to be entered into the iCAT for these two terms, cannot be determined from the information available at 10 June please refer to Glossary of Terms which sets out the relationships between an ICD Title and its inclusion in the iCAT Categories list and between an ICD Title and its Synonyms, Inclusions and Exclusions.)


    that Gj92 Chronic fatigue syndrome is an ICD Title term with a Details page, a Definition and an Inclusion term (but with no Synonyms or Exclusions or other fields yet populated);

    that Benign myalgic encephalomyelitis is listed as an Inclusion to Gj92 Chronic fatigue syndrome

    that Chapter 5 V Details for F48.0 Neurasthenia specifies postviral fatigue syndrome as an Exclusion with References

    G93.3 -> Gj92 Chronic fatigue syndrome

    that Chapter 18 XVIII Details for R53 Malaise and Fatigue specifies
    fatigue syndrome postviral [sic] as an Exclusion with References

    F48.0 -> F48.0 Neurasthenia,
    G93.3 -> Gj92 Chronic fatigue syndrome


    but that in the absence of a clarification from the TAG Neurology Chair and sight of the Alpha Draft it is currently unclear what the proposed hierarchical status of Postviral fatigue syndrome and Benign myalgic encephalomyelitis will be in relation to Chronic fatigue syndrome, and in relation to each other.

    I shall continue to monitor the iCAT production server closely and report on any changes to proposals for Category listings and on the progress of the population of content.
     
  18. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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    7 October 2010


    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 Rodrigues1,2
    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 1990and 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 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

    References:

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

    [2] 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:
    http://www.who.int/classifications/icd/ICDRevisionProjectPlan_March2010.pdf

    [3] User Manual [Content Model User Guide, 53 pp Word doc]
    Key ICD-11document: Identifies the basic properties needed to define any ICD concept (unit, entity or category) through the use of multiple parameters:
    http://dxrevisionwatch.files.wordpress.com/2010/10/icd1120alpha20user20guide202620september1.doc
     
  19. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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

    November 19, 2010

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

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

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

    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.

    Before the iCAT was taken out of the public domain, I had taken a series of screenshots of what could be seen in the iCAT for Chapter 5 and Chapter 6 which I shall be posting on DSM-5 and ICD-11 site shortly.
     
  20. Dx Revision Watch

    Dx Revision Watch dxrevisionwatch.com

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    Content removed.
     

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