Updated on: November 21, 2016

As ICD-10 Looms, Work on ICD-11 Quietly Continues

Original story posted on: March 30, 2015

EDITOR’S NOTE: This is the first in a occasional series on ICD-11 expected to be completed by 2017.

The prospects of the U.S. healthcare system jumping straight from ICD-9 to ICD-11 could be considered analogous to the prospects of a precocious child jumping straight from fourth grade to sixth, Talk-Ten-Tuesday host and ICD-10monitor.com Publisher Chuck Buck suggested during the most recent edition of the popular Internet radio broadcast.


World Health Organization (WHO) official T.B. Ustun loved the comparison.

“Indeed, U.S. healthcare is one of the most advanced (systems) in the world,” Ustun said. “Hence, you’re right in calling it a smart kid.”

Yet that kid would be wise, he added, to look before she leaps.

“What happened to the smart kid? Why was she left behind? Looking at her capacity and capabilities, she surely does not deserve this,” Ustun, the team coordinator for Classifications, Terminologies, and Standards for the WHO’s Health Statistics and Informatics Department, quipped. “So, should your smart kid jump the grade? I would never let her. I’d say no – a clear and unambiguous no.”

“If you’re the parent, custodian, or whatever, of the smart kid, I would encourage you to go to ICD-10, because you have prepared for quite a long time,” Ustun added. “Get out of 9 as soon as possible. But in the future, please – do not get stuck in 10 for as long. You’re doing yourself a disservice; the longer you wait, the worse it is for the smart kid.”

Ustun’s comments were part of a broader Talk-Ten-Tuesday discussion not only on the prospects of the U.S. leaping from ICD-9 to ICD-11, but also on the progress quietly being made on ICD-11 while the Oct. 1, 2015 ICD-10 implementation date draws nearer.

“The puzzle is … why the U.S. has gotten stuck with ICD-9 for so long,” Ustun added. “Some people may say that surely it has worked until now, so why change it. It’s an American saying: If it ain’t broke, don’t fix it.”

The good news for the U.S., Ustun noted, is that whereas previous switches from one ICD iteration to the next were tantamount to wholesale changes to the coding sets used around the globe to collect data on procedures, conditions, and diagnoses, the leap from ICD-10 to ICD-11 is expected to be a more gentle ride – even if the introduction of the newest version is still years away.

“In a sense, (for) the ICD-11 digitalization, with a few tweaks, we can make it a retrofit to ICD-10-CM. So my recommendation would be to go to (ICD-10) as soon as you can, but start ‘elevenizing’ it now,” Ustun said. “Sorry for the new verb; what I mean is, think of the benefits of ICD-11 and build them into your system, day by day.”

Among the anticipated advantages of ICD-11, Ustun listed enhanced granularity and easily managed linkages to other methodologies.

Two people becoming intimately familiar with those advantages and others include Dr. Mark Musen, director of the Stanford University Center for Biomedical Informatics Research, and Tania Tudorache, a senior research scientist at the Center. It is here that technology is being developed for use by WHO to create ICD-11 content, and both Musen and Tudorache gave Talk-Ten-Tuesday listeners an insider’s perspective on that process.

“As you may know, the ICD-11 revision process is now an open, social process that involves a large international community of experts. And this is very different from how things used to work with previous revisions – when most things happened, when most (changes) happened, it (then) would take place in meetings behind closed doors,” Tudorache said. “The current process is similar to how Wikipedia works, where a large number of people contribute to the content – except, in (this) case … we have a large number of medical experts contributing to the content of ICD-11.”

Musen explained that the Center has been engaged in the process of developing its aforementioned technology for the better part of three decades, with the application of the technology by no means limited to the realm of healthcare.

“People use the buzzword ‘ontology’ to describe ways in which we can encode information about some particular area of interest – in the case of ICD-11, that would be clinical medicine – and to frame it in a way so that people can look at it and understand what (a) computer might be ‘thinking’ (about it),” Musen explained.  “When we think about iCD-9 or ICD-10, we’re really thinking in terms of lexicons. Lexicons are lists of terms obviously having codes that are very important for the kinds of activities that we use ICD-9 and ICD-10 for. In the case of ontology, those codes can still exist, but what’s most important is that we have very explicit relationships among the terms.”

This way, Musen noted, computers can “reason and understand that, say, a pneumonectomy is a kind of surgery, or know that pneumonia is a kind of infection.” Then the computers can actually infer information about a patient’s condition from the ICD-11 data entered into the system.

Artificial intelligence? Not quite. But pretty close.

“We started building all this technology at Stanford not because we had ICD-11 in mind, but because we were generally interested in being able to have computers reason about things that are important in clinical medicine,” Musen explained. “We were particularly interested in clinical decision support, and to drive the modern generation of clinical decision support systems, we had to have these representations of medical knowledge.”

About 10 years ago, Musen added, Stanford officials started having conversations with WHO, which clearly realized the potential for the technology to be integrated into ICD-11.

“And so we’ve been working on the technology that makes it possible to not only have the computer reason about the relationships among all the terms in ICD-11, but also to include properties of those terms that provide a lot of information that allows us to understand (details) about the diseases themselves,” Musen said. “That (is) simply not possible with something like iCD-9 or 10, where we just list the diseases without much more information.”



Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Mark Spivey

Mark Spivey is a national correspondent for ICDmonitor.com who has been writing on numerous topics facing the nation’s healthcare system (and federal oversight of it) for five years.

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