Volume 3, Number 2, 2005 Editorial Board Classification and terminology, what is in a name? Dr Marijke W. de Kleijn-de Vrankrijker Drs Huib Ten Napel The WHO-FIC Network meeting in October 2005 in Tokyo showed five Dr Willem M. Hirs projects on linking between WHO classifications and clinical terminologies: Realization and Design 1. R. Jakob, C. Çelik. Linkages between the ICD and terminologies A.C. Alta, Studio RIVM 2. K. Giannangelo & S. Fenton. Mapping: Creating the Terminology and Classification Published by Connection WHO-FIC Collaborating Centre in the 3. S. Zaiss, N. Hanser, N. Baerlecken. Comparison of ICHI and CCAM Basic Coding System Netherlands. 4. J.M. Rodrigues, A. Rector, P.E. Zanstra, R. Baud, J. Rogers, A.M. Rassinoux, S. Schultz, B. Responsibility for the information given Trombert, H. ten Napel, L. Clavel, E.J. vander Haring, C. Mateùs. Supporting WHO remains with the persons indicated. Classifications with GALEN tools Material from the Newsletter may be reproduced provided due 5. P.E. Zanstra, J..M. Rodrigues, A. Rector, M. Virtanen, G. Surjan, B. Üstün, P. Lewalle. acknowledgement is given. SemanticHealth. A semantic interoperability deployment and research roadmap; see p. 10 M. Virtanen chaired also a round table discussion with terminology experts, such Address WHO-FIC Collaborating Centre in the as C. Galinsky (Infoterm), J.M. Rodrigues (from the circle of Galen), K. Netherlands Spackman (from the circle of Snomed). Department for Public Health Forecasting In the summary report of the Network meeting it was stated that - "thanks to the National Institute of Public Health and the developments in informatics today - it is possible to link classifications and Environment (RIVM), P.O.Box 1, 3720 BA Bilthoven, The Netherlands. terminologies to formalize the representation of knowledge in classifications. The Telephone: 0031 30 274 2039/4276 linking of classifications and terminologies is essential to enable IT infrastructure Fax: 0031 30 274 4450 for electronic health records. The linking can be done in various ways including Website: www.rivm.nl/who-fic simple tables of correspondence or indexing, and further improved ways of E-mail secretariate: [email protected] ISSN: 1388-5138 knowledge representation such as in terms of essential features of diseases or decision making rules used in practice." This statement, however, is Contents questionable. Project reports give the impression that the linking is not an easy Classification and terminology 1 task, neither conceptually (1-3), nor ontologically (4) or organizationally (5). Editorial 2 For example, the first report conclude: International organisations - WHO-FIC Network meeting 2005 2 - The majority of the terms currently in use in the diagnostic definitions of the - ICECI 5 ICD-10 category F32 Depressive episode, can be linked to the terms in - Abbreviations and Acronyms 5 SNOMED-CT, however - Additional FAQ's on WHO website? 7 - Such linkages require considerable intellectual work; - The ICF-CY 9 - An automated linking or an automated verification of linkages between ICD- - ClaML 10 - Semantic Health project 10 10 and terminologies as SNOMED-CT is not feasible, at present; - Photo Contest 11 - This situation could be improved imposing a strict terminological control for FIC around the World the definitions in the classification and adding terms to SNOMED-CT. Australia Bedirhan Üstün of the WHO CAT team illustrated as the core of the linking - AIHW ICF reports 11 - FRHOM 12 problem F32.0 mild depressive disorder: two or three of a range of possible Belgium symptoms have to be present for coding F32.0. 17 Snomed codes are needed for - ICF -ICPC Workshop in Ghent 12 11 symptoms, and even than not all symptoms have got a code (see sheet page 2). Ireland Furthermore, 'mild depressive disorders' might be assessed by different sets of - Ethical Framework for ICF sufficient? 13 symptoms. And a psychiater can also avoid that overall title although a set of two Netherlands - ICF based Surveys and Statistics 15 symptoms are applicable. Most terminologists would dislike such a coding - Emancipation for people with disability 16 practice. Naming a client's health problem by a class is what classifications do; it differs in principle from describing a client's symptoms without an overall title. 1 Newsletter on the WHO-FIC, Volume 3, Number 2, 2005 the Netherlands we already started a Rewriting ICD Using SNOMED similar activity for our national level. We really believe that the two should example of Depressive Disorder F32.0 be seen together: distinguished but not separated. A. Low mood {41006004} An other remarkable issue is the XML Loss of interest {417523004 } Schema based on ClaML developed Low energy {248274002} by the Electronic Tools Committee, which should be adopted as the 1. Appetite (decrease, increase) {64379006, 72405004} B. standard for exchange of WHO-FIC 2. Body weight (decrease, increase) {89362005, 8943002} classifications. A contribution by Huib 3. Sleep (decrease, increase) {59050008, 77692006} Ten Napel is to be found on page 10. 4. Psychomotor (decrease, increase) {398991009, 47295007} Persons who are not involved in 5. Libido loss {8357008} classifications are confronted with a 6. Low self esteem {286647002, 162220005} lot of unknown acronyms and questions. In order to prevent this kind 7. Guilt, self blame {7571003} of confusion the Education Committee 8. Thoughts of death … prepared a document which is 9. Suicide Ideation {102911000, 6471006} included in this newsletter. We hope that this appears to be of help to find Sheet presented by Bedirhan Üstün. the way in the chaos. If certain It was noted (cf.. Executive summary) WHO Collaborating Centres will be relevant acronyms or specific in the round table that "the theory of asked to nominate experts to serve on a questions and their answers are terminology, confirmed by terminology reference group. The missing, please send them to the chair observations from pilot tests, indicates heads of the German and Nordic of the committee, Marjorie Greenberg that it is rather the encapsulated Centre will work with WHO CAT to (mailto:[email protected]). knowledge that could be captured for establish this group." As always there are several mapping purposes. Only then can it be For information: contributions relating to the ICF ascertained that the concepts are [email protected] included in this newsletter. A captured uniquely and specifically. surprising paper is contributed by This would also provide a stable, Catherine Sykes on behalf of the language-independent basis for Editorial Australian ICF team. The team implementation in other languages One of the major events last year was developed a kind of intermediate tool than English with increased the annual meeting of the WHO-FIC for exchange of information based on compatibility. The magnitude of the network in Tokyo last October. Our different assessment tools. We are task calls for a formal representation of Japanese host treated us with an interested to see the results of the such knowledge that would allow impressive and interesting meeting testing. See page 12. efficient and reliable machine environment which contributed to the Another interesting contribution processing." quality and results of the meeting. Of relates to the ethical framework of the It was concluded in the round table that course all classifications of the WHO- ICF prepared by Donal McAnaney "WHO could take lead role to FIC have been discussed and we refer from Ireland. This issue took a lot of disseminate and organize health the interested reader to the WHO attention at the time of the ICIDH information standards, take a proactive website in order to find details, papers, revision but lost attention during the stance for charting the universe of presentations and posters: last few years. We think it is time to health information standards and www.who.int/classifications/network/m consider this issue again and hope this establish mechanism of involving eeting2005. A short summary of the can be a topic for discussion during member states, multiple stakeholders highlights of the meeting is presented the next annual WHO-FIC meeting. and use mechanisms established by in this newsletter on page 3-5. During the Tokyo meeting an ISO, CEN and others.... Classifications A rather new phenomenon in the operational plan has been made for the and clinical terminologies are not annual meeting agenda was a round implementation of the ICF within the alternatives but complementary to each table discussion on the relation priority areas (surveys/censuses, other and should be used in between classifications and clinical and administrative conjunction with appropriate linkages terminology. Willem Hirs summarized applications, health outcome, policy). (also known as mappings) based on this interesting discussion, to be found Regarding the International existing scientific knowledge. on page 1-2 of this newsletter. At Classification of Technical Aids (new international level a terminology name: Assistive products for persons reference group will be established. In with disability) ISO9999 we can inform Newsletter on the WHO-FIC, Volume 3, Number 2, 2005 2 you that the new version will be and do not necessarily represent distributed by ISO and CEN in due WHO's or WHO-FIC Network's views. time for final voting by member states. The meeting served to review all A working group developed crosswalks elements of the WHO-FIC Network between ISO9999 and ICF. As soon as and its Committees. The Linkages possible a document containing these between Terminologies and crosswalks will be available for Classifications (see p. 1, 2); Case mix comments through the website of the Groupings, ICD revision process and Dutch WHO-FIC Collaborating ICF applications in multiple sectors Centre. received particular attention. In the area of ICPC and ICF action is The executive summary of the meeting taken in order to produce a mapping is used, giving you the highlights of between both classifications.