Transcript Source Term 3 axes ICD-9-CM

WHO ICHI와 의료행위분류
2012.11.07
가톨릭의대 김석일
Acknowledgement
• Jean Marie Rodrigues, Emeritus president
of PCS international, University of Saint
Etienne
• Richard Madden, University of Sydney
co-chair of WHO FIC FDC
WHO Family of Classifications
• International
Classification of
Diseases – ICD-10
• International
Classification of
Functioning, Disability
and Health – ICF
• International
Classification of
Interventions – ICHI
(under development)
ICHI history
• WHO International Classification of
Procedures in Medicine: 1978 (ICPM)
• Out of date within 10 years
• Decision not to update in late 1980s
• Renewed interest from 2000, work begins
2006
• Structure, Content Model and Coding
Scheme now in place
• Alpha version is published
The situation now
• Proliferation of national classifications (US,
Australia, France, Germany...)
• Limited scope of national classifications
• Many countries without a classification
• Drawback for international comparisons
• Drawback for an international casemix
system
• and now End of ICD-9-CM Volume 3 (2013)
International Classification of
Health Interventions
•
National systems
ICD-9-CM
ACHI
CCI
CCAM
NCSP
OPS
OPCS4
ICPM extensions (The
Netherlands, Hungary
et.)
– ICD10 PCS
–
–
–
–
–
–
–
–
•
International systems
– UMLS metathesaurus
– SNOMED CT
– LOINC
Main existing coding systems of
surgical procedures(1)
• ICHI: International Classification of Health
Intervention: ICHI project plan version 2.2 .R
Madden .In Proc WHO-FIC Annual meeting Toronto
16-22 Octobre 2010
• CCAM, Classification Commune des Actes Medicaux :
http://www.ameli.fr/fileadmin/user_upload/document
s/CCAMV23.pdf
• ICD-9-CM International classification of Disease 9
Clinical Modification: http://icd9cm.chrisendres.com/
• ACHI Australian Classification of Health Intervention:
http://www3.fhs.usyd.edu.au
• CCHI Canadian Classification of Health Intervention :
http://secure.cihi.ca/cihiweb/dispPage.jsp
Main existing coding systems of
surgical procedures (2)
• NCSP NOMESCO Classification of Surgical
Procedures:
http://www.helsedirektoratet.no/vp/multimedia/archiv
e/00269/Ncsp_1_14_269099a.pdf
• OPS Operationen und ProedurenSchlüssel:
http://www.dimdi.de/static/en/klassi/index.htm
• OPCS4 Office of Population, Censuses and Surveys
Classification of Surgical Operations and Procedures:
http://www.connectingforhealth.nhs.uk/systemsandse
rvices/data/clinicalcoding/codingstandards/opcs4
• ICD 10 PCS Procedure Coding System:
www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/08_I
CD10.asp
Why develop a new ICHI
• To describe and compare with a common framework the
provision and effectiveness of health interventions at the
local, national or international level and across different
populations or subpopulations
• To provide a classification of appropriate scope detail to
which countries may align their more finely grained national
classifications
• To make available a classification that can be used without
adaptation in countries which do not wish to develop their
own classification or use another country's coding system
• To support efficiency based health policies (eg, activity
based funding)
• To avoid duplication of efforts at national level
ICHI definition
• An activity performed for, with or on behalf
of a client(s)
– This definition includes interventions that apply
to more than one client or to a population
group
• Whose purpose is
– to improve individual or population health,
– to alter or diagnose the course of a health
condition, or
– to improve functioning.
ICHI Framework/Structure
• Starting point:
– Pr EN ISO 1828: Categorial Structure for
terminological systems of surgical
procedures
– Pr EN ISO 18104: Categorial Structure for
terminological systems of nursing
– Used in several national classifications:
France (CCAM), Canada (CCI)
ICHI Framework: Categorial
Structure
• Categorial structure for healthcare
terminological systems:
– Minimal set of domain constraints to represent
a healthcare terminology in a precise domain
with a precise goal
a.
b.
c.
d.
list of semantic categories
goal of the categorial structure
list of semantic links authorised with their
associated semantic categories,
set of minimal constraints necessary to comply with
the standard (DL/like)
CEN EN 1828 Categorial structure
for terminological systems of
surgical procedures
• A list of semantic categories
– surgical deed, human anatomy, lesion, device
• The goal of the terminological system
represented by the categorial structure
• The list of semantic links between semantic
categories authorised with their associated
semantic categories
– (ex hasObject,hasSite,hasMeans,
hasSubsurgicaldeedj
• The minimal constraints
UML diagram for EN/ISO1828 for Terminological
systems of surgical procedures
Minimal constraints
• Each surgical procedure terminological phrase
shall, as a minimum, consist of a surgical deed
and have the semantic link ‘hasObject’.
• Each surgical procedure terminological phrase
shall contain the category human anatomy in
relation with the semantic link ‘hasObject’ or
‘hasSite’. It can also have both.
• The surgical procedure terminological phrase
shall include the category lesion when the
surgical deed is applied to a modified human
anatomy structure without mention of the
disease cause of the lesion
• Each surgical procedure terminological phrase
may need more than one surgical deed. One
surgical deed shall be chosen as a main deed
and the others as subprocess deeds related to
the main deed by the semantic link
hasSubsurgicaldeed' .
• Each surgical procedure sub-process
terminological phrase shall as a minimum,
consists of a surgical deed ,the semantic link
'hasObject' (4.4.1) and of the category human
anatomy in relation with the semantic links
'hasObject' (4.4.1) or 'hasSite' (4.4.2)
Categrorial structure and classification
of health interventions
ICHI Structure
•
•
•
Target
–
–
–
–
Anatomy
Function
Activities & Participation
...
–
–
–
–
–
–
Investigation
Treating
Managing
Assisting
Preventing
...
–
–
–
–
Approach
Technique
Method
...
Actions
Means
3 characters
2 characters
2 characters
PREVIOUS EXPERIENCE IN
KCHI
Method: Hierarchy
ICD-9-CM
3 AXES
Covered item
by insurance
TARGET
MEANS
Uncovered item
by insurance
ACTION
IS-A Hierarchy
New Classification
No Code for axes terms
• Strong probability of code change
• Possible introduction of notations for rich
content expression
• Flat hierarchy
– needs to be extended to multilevel hierarchy
• Human readable understanding of each
axes by human being
– Items can be substituted to code easily by
computing
Discrepancy among the coders
• Limited number of terms with definition
– Different level of understanding about the
terms in axes
• Inborn error of the axes structure
Hierarchical rearrangement
Exact Match
Source
Term
ICD-9-CM Code
English
Korean
66.01
Salpingootomy
자궁관 절개
3 axes
Target
Means
Action
Fallopian tube
Open
Incision
자궁관
개방
절개
Broad Match : Lower level
terms after “:”
Source
Term
ICD-9-CM Code
English
73.6
episiotomy
Korean 외음절개
3 axes
Target
Means
Action
Vulva:Perineum
Open
Incision
외음부
개방
절개
Broad Match : & for two or more
terms in a axis
Source
Term
ICD-9-CM Code
English
Korean
65.62
3 axes
Target
Other removal of
Fallopian tube
remaining ovary
and tube
& Ovary
기타 잔존 난소 및 자궁관 및 난소
자궁관 제거
Means
Action
Open
Removal
개방
제거
Broad Match : “or” |
Source
Term
ICD-9-CM Code
English
66.93
Implantation or
replacement of
prosthesis of
fallopian tube
3 axes
Target
Means
Action
Device:Prosthes Open
Implantation
is>Fallopian
device|Change
tube
Korean
자궁관 인공삽입물 인공삽입물 >자 개방
삽입 또는 교체
궁관
삽입 또는 교체
of
Broad Match : “with” &+
Source
ICD-9-CM
Term
Code
English
3 axes
66.62
Target
Means
Salpingectomy with
Fallopian tube&+
Open
removal of tubal
pregnancy
Fetal
or
embryonic
Action
Excision&+Removal
structure
Korean
자궁관 임신 제거가 자궁관 및 난소
동반된 자궁관 절제
개방
제거
Broad Match : “without” &Source
Term
ICD-9-CM Code
English
73.21
Internal and
combined version
without
extraction
3 axes
Target
Fetal or
Means
Per Orifice/Transorifice Reposition:Internal
embryonic
만출술이 동반되
지 않은 내태아회
전 및 복합태아회
전
태아
version
combined version &-
structure
Korean
Action
Extraction: Delivery
구멍을 통해
만출술이 동반되지 않은
내 태아 회전 및 복합태아 회전
and
Broad Match : condition ]
Source
Term
ICD-9-CM Code
English
Korean
75.92
3 axes
Target
Means
Evacuation of
other hematoma Vulva|Vagina]Hematoma Open
of vulva or
vagina
외음 또는 질의 기 외음 또는 질 ] 혈종
타 혈종의 배출
개방
Action
Drainage:Evacuation
배출
Broad Match : ”D.O>I.O”
Source
Term
ICD-9-CM Code
English
Korean
66.93
Implantation or
replacement of
prosthesis of
fallopian tube
3 axes
Target
Device:Prosthesis
Open
>Fallopian tube
자궁관 인공삽입물 인공삽입물(D.O)
삽입 또는 교체
Means
>자궁관 (I.O)
Action
Implantationof
device|Change
개방
삽입 또는 교체
2개 이상의 행위
•
실제 행위가 특정 목적을 위한 것이고, 목적이 행위로 정의되는 경우
•
연속적인 행위
•
최종 행위를 위해 동시에 일어나는 행위
– 보험급여에서는 하나의 행위
– Ligation (of fallopian tube) = occlusion
– insertion of pessary (in prolaps uteri)= restoration
– 보험급여의 경우 ()안의 것은 급여 대상이 아님
– (Craniotomy + )clipping of aneurysm = clipping of aneurysm
– (Skin incision+)appendectomy = appendectomy
– sonoguided endoscopic biopsy
•
•
•
본래 endoscopy가 main. Endoscopy를 하는 과정에서 biopsy가 필요한 경우
의도적으로 biopsy를 하기 위해 sonoguided, endoscopy를 하는 경우
독립된 두 개의 행위
– 보험급여에서 부가적인 행위를 50%인정
– Ceaserian section + appendectomy
Ambiguity in actions
• Action as the purpose of intervention vs action by itself
– Ligation (of fallopian tube) = occlusion
– insertion of pessary (in prolaps uteri)= restoration ( of prolaps
uteri)
• Series of actions vs final action
– (Craniotomy + )clipping of aneurysm = clipping of aneurysm
– (Skin incision+)appendectomy = appendectomy
• Selection of final action in a series of actions
– sonoguided endoscopic biopsy
• Endoscopy is the main action and sonoguided biopsy is done when
needed
• Sonoguided endoscopy is done to do biopsy
• Two separate actions in one time
– Ceaserian section + appendectomy
실 행위 기술 vs 행위의 목적 기술
•
전립선내 주사
– Injection of drug into prostate gland
• Action = injection, IO = prostate, DO = drug
– Destruction or reduction of size of prostate using injection of
drug
• Action = destruction|reduction of size, target = prostate, means =
injection of drug
– Pharmacotherapy확인
• 경피적내신우절개술[경피적신(우)루설치술,방사선료포함]
– Dilatation of renal pelvis by incision
• Action = dilatation, target = renal pelvis, means =
endoscopic&transparietal &incision
• Action = incision, target = renal pelvis, means =
endoscopic&transparietal
Different models for the same
concept
• Urology
– Injection of silicon to ureteral submucosa
• Action = injection, IO = ureteral submucosa, DO
= silicon
– Reduction of size of ureteral caliber with
silicon
• Action = reduction of size(temporary), target =
ureteral caliber, means = silicon
Additional intervention on the
main procedure
• Endoscopic biopsy
– Action = biopsy, means = endoscopy
– 요관경검사[요관점막하주입포함]-경성요관경
• Action = injection, IO = ureter, DO = silicon등,
means = endoscope:ureteroscope
Future plan
• Application of extended model with 3
axes values to the real classification for
KCHI
• Consensus on the building guideline
• Hard work!!!
• ICHI meeting: 17 – 21 June 2013 in
Uddevalle, Sweden