Classifications in health care Health Problem Health interventios • Reason and main features Functioning and • What has been done with of the contact disability the patient • Routine collection • Effects of disaese and • Collected everywhere but – Causes of death therapy non-standard – Hospital data • Scientific developmental projects WHO-FIC Laboratory Equipment investigations • Equipment to deliver care • Necessary for exchange ”Terminological of information • Technical aids Systems” • Routinely used but non-standard Pharmacological substances • Key element in treatment Casemix • Records on sales exist, but not on usage Diagnostic Classifications ICD ICPC - International Classification of – Developed and maintained by primary care WHO – WONCA • ICD-10 / ICD-9 • WHO-FIC related classification • National versions – ICD-9-CM, ICD-10-CM • USA, many other countries – ICD-10-AM • Australia – ICD-10-CA • Not too many standards • Canada • Mappings are available or – German version fairly easy to establish – Nordic versions Goal of diagnosis information collection • Reason of the healt problem • Disease spectrum of the • Main features of resulting population condition – Statistical analysis of causes of – Disease / Disorder death – Trauma – Hospital statistics – Intoxication • Correct diagnosis => Correct • External causes therapy – Evidence based medicine – ICD-10 / ICECI / NCECI guidelines • International comparisons – short lists necessary • Existing common structure Functioning and disability • ICF - International • Other classifications Classification of – Bartel, GAF, Functioning Disability RUG/RAI, FIM ..... and Health – WHO Classification – Very complex, needs – No agreement on any further development standard for the user interface – No standard mapping Diagnoses do not indicate severity of illnes – more information is needed • Effects of disease • Need of care • Effects of therapeutic interventions • Black hole of • Economical information systems compensation • International standard – Currently evaluation is not based on facts badly needed Laboratory investigations • Different systems in different countries – IUPAC • INTERNATIONAL UNION OF PURE AND APPLIED CHEMISTRY – LOINC (Logical Observation Identifiers Names and Codes) • Produced for US Federal Government by Regestrief Institute • Public, may be used unchanged both in commercial and non- commercial applications – Snomed • College of American Pathologists (CAP) • Early versions – not Snomed-CT – ICD-O version 3 • WHO – loose connection with WHO-FIC work • Close relation to early versions of Snomed – CEN-TC251? – Local and national systems Exchange of information between clinical units and laboratories • Ordering information • Measurements – All measurements should be • Results covered – No modern health care • length, weight, blood pressure system can work without • Investigations with written basic laboratory data- reports system – borders with diagnostic radiology • No international standard available • No standard mapping • National standards? Procedures performed to the patient • CPM • ICHI – International Classification – Classification of Procedures in Medicine of Health Intervention – WHO Classification – Never updated – WHO-FIC related classification – Holland and Germany – Developed from the Australian • ACHI ACHI – Australian Classification of Health Interventions – Not in use yet • CCAM – Classification commune des actes médicaux – Based on CEN-TC251 standard • NCSP – Nomesco: Classification of Surgical procedures • ICD-9-CM CSP • No standard • ICD-10-PCS – USA – Base of 3M DRG systems • No mapping • CCI – Canadian Classification of Health Interventions What is done to the patients • Procedures performed to • Performed by patients – medical doctors • Surgical procedures – nurses – What is surgery? – physioterapists – Endoscopy? – Etc • Therapeutic and/or diagnostic procedures • provider is registered separately – Laparotomy – diagnostic or therapeutic • Obvious need • Radiological procedures • Coverage of the differents – Intravascular cathetrisation systems varies with injection of contrast? • Definite need for international standardisation Pharmacological substances • No de facto standard • ATC (Anatomical-Therapeutic Classification) – Used in Nordic countries, some other European countries, but not for example in the USA – Does not code each preparation and package • Commercial coding systems – For prising and storage Equipment to deliver care • Hospital equipment – Patient specific use is currently not registered • Problems in use are not systematically available • Tools for clinical laboratory and diagnostic radiology are registered throuhg the procedures • No need for further registration? • There is no standard registration for materials used during surgery • Complications related to materials cannot be systematically analysed Technical aids • ISO-9999 Technical aids for persons with disabilities – WHO-FIC related classification – Classification and terminology – ISO-standard sold by standardisation bodies in each country WHO-FIC Classifications • Reference classifications – Health problems – ICD-10 • International Classification of diseases ... – Functioning and Health – ICF • International Classification of Functioning, Disability and Health – Health interventions – ICHI • International Classifiction of Health Interventions • Derived Classifications – Derived from reference classifications • Psychiatric ICD • ICD-10 NA (Neurological application) • ICD-10 DA (Dental application) • ICPC – Primary care • ICECI – External causes classification • Related classification – Related areas classified with independent classifications • Medical substances – ATC – Anatomical Therapeutic Classification • ICD-O-3 – Oncological histology • ISO-9999 – Techinal aid for persons with disability • Missing area • Laboratory investigations – LOINC?? ICPC within WHO-FIC Casemix • Secondary patient • Based on primary classification classifications • DRG – Diagnoses (ICD-10) – Clinically relevant, – Procedures (NCSP) resource homogenic – Functioning (ICF?) groups – Based on existing information Semantic structure • Classifications are (or should be) • ”Terminological systems” based on semantic structure – Terminology consisting of terms is • Aggregation of information for language specific collection and exchange – Terms cannot be translated • They should create natural links to – Detailed classification of concepts Knowledge systems • Term(s) defines the concept • User-interphases for classification systems should be based on • Translation of concepts is intellectual semantic vocabulary possible systems • Increase in details increases – Easy search and selection of problems in translation correct term resulting in correct • Semantic links creating a network classification • Possible systems – Read – past – Snomed – CT – commercial? – MESH / UMLS?? – GALEN based systems?? Terminological systems in relation to classifications Classification use Classification development • Search for correct code • Classifications may • Multiaxiality greated remain in their original through mapping to purpose terminological system and – Statistical reporting semantic links in it – Casemix tool component • Increased possibilities to • Less complex reporting classifications that are easier to implement – Developing countries Nordic Centre for Classifications in Health Care Uppsala University Martti Virtanen Head of Center.