By Robert J.G. Chalmers, MB, FRCP,
August 01, 2012Disease classification is something which may cause most physicians to groan, but is also something with which they have to be involved on a day-to-day basis in order to get paid. The International Classification of Diseases (ICD) is hosted by the World Health Organization (WHO) in Geneva and is the global standard for reporting mortality statistics. In many countries, including the U.S., modifications have been developed for use in health care management and electronic patient records. The U.S. is currently grappling with the complexities of a change from ICD-9 to ICD-10 and the impact that this may have, particularly on electronic record systems and reimbursement. Fortunately or unfortunately, the changes from ICD-9 to ICD-10 are quite minor so far as skin disease is concerned. Unfortunately, few of the proposals submitted to WHO by the AAD ICD-10 Workgroup for modification of the skin disease content of ICD-10 were accepted for the next update, scheduled for 2013.
Over the past two-and-a-half years, however, physicians around the world have been working to create a brand new and much expanded ICD as the 11th Revision (ICD-11). This is scheduled for presentation to the World Health Assembly for endorsement in May 2015. In 2008 WHO invited the International League of Dermatological Societies to form a Dermatology Topic Advisory Group (TAG), of which I was asked to be co-chair together with Professor Michael Weichenthal of Kiel University in Germany. Both of us have long had an interest in skin disease terminology and classification. The TAG has members from around the world, including two from the U.S. (Alanna Bree, MD, from Houston and Mark Pittelkow, MD from Rochester, Minn.).[pagebreak]
ICD-11 is being designed as a knowledge base for use on electronic platforms, although paper versions will still be produced. By introducing a polyhierarchical structure into ICD, WHO has enabled representation of disease entities in more than one location. It is thus now possible to display relevant neoplasms, infections, and complex developmental and inflammatory disorders within the skin disease chapter (see below).
Furthermore, each disorder must also have an explicit text definition together with a number of defined attributes (synonyms, body system and part involved, genes involved etc.) to create a so-called ontology (see below).
The skin disease chapter has been completely redesigned and now includes over five thousand entities arranged in what the TAG hopes will be seen as a logical hierarchical order (see below). A large number of these are from an updated and much expanded classification of genetic and developmental disorders. Indeed, over half of the entities are cross-references from other chapters.
From this foundation it will be possible to extract smaller subsets for use in different settings, such as primary care, internal medicine, etc. An important new feature is the inclusion of an anatomy chapter, which will allow any disorder to be associated with a code indicating location or distribution (e.g., right ala nasi or palmoplantar).
Many individuals have contributed to the development of the draft, which is certainly not yet complete, and there are areas with which I and the TAG are still dissatisfied. It is, however, now open for comment and criticism and I would urge you all to look at your areas of interest to see whether they are adequately and accurately represented. This is a once in a generation opportunity to shape the way skin disease is classified in the future.[pagebreak]
An online search for ICD-11 beta will take you to the ICD browser, or you can click on the image below.
Alternatively you can access it from www.who.int/classifications/icd/revision/.
The TAG is well aware that there is still much to be done. A large number of definitions have yet to be written. If any individual or group would like to take responsibility for providing definitions for a specific topic area please contact me at firstname.lastname@example.org. Comments and criticisms can be recorded online or sent to me at the same email address.
I look forward to hearing from you.