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Digital Health and Electronic Medical Records: Aligning the EU and UK Agendas 15th July 2010, RCP London, UK. WHO Agenda: Classifications – Terminologies - Standards. Nenad Kostanjsek World Health Organization. KRs Mappings. e-Health Record Systems. Terminologies. Population Health

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who agenda classifications terminologies standards

Digital Health and Electronic Medical Records:

Aligning the EU and UK Agendas

15th July 2010, RCP London, UK

WHO Agenda: Classifications – Terminologies - Standards

Nenad Kostanjsek World Health Organization




e-Health Record



  • Population Health
  • Births
  • Deaths
  • Diseases
  • Disability
  • Risk factors
  • Clinical
  • Decision Support
  • Integration of care
  • Outcome
  • Administration
  • Scheduling
  • Resources
  • Billing
  • Reporting
  • Cost
  • Needs
  • Outcome

Placing WHO Classifications in HIS & IT of the 21st Century







the desiderata for a who fic in 21st century
The desiderata for a WHO FIC in 21st Century
  • Evolve a multi-purpose and coherent WHO classification which are
    • consistent yet adaptable and interoperable across
      • different uses (public health, service management, research)
      • the spectrum of health care (Primary, Secondary, Tertiary)
      • in developing and developed countries
    • compatible with other WHO classifications
  • Serve as an international and multilingual reference standard for scientific comparability and communication purposes
  • Ensure that WHO classification will function in an electronic health records environment.
    • Link WHO FIC logically to underpinning terminologies and ontologies (e.g. SNOMED, GO, …)
    • WHO FIC categories “defined” by "logical operational rules" on their associations and details
key workstreams elements for developing who fic
Key workstreams & elements for developing WHO FIC
  • Use cases
  • Content model (parameter & value set)
  • Population & peer review of content model
  • Web based collaborative authoring tool (iCAT)
  • Ontology development
the content model any category in icd is represented by
THE CONTENT MODELAny Category in ICD is represented by:

ICD Concept Title: Name of disease, disorder, or syndrome

Classification Properties: Parents, Type, Use

Textual Definition(s):Fully Specified Name

Terms: synonyms, Index, inclusion, exclusion

Clinical Description:Body System(s), Body Part(s), [Anatomical Site(s), Histopathology

Manifestation Properties:Signs & Symptoms, Findings

Causal Properties:etiology type, agents, mechanisms, genomic characteristics; risk factors

Temporal Properties: age of occurrence & occurrence Frequency, development course

Severity Properties

Functioning Properties

Specific Condition Properties

Treatment Properties

Diagnostic Criteria

External Causes

  • Maintenance attributes
  • Unique identifier
  • Mapping relationships
    • Linkages to other systems like SNOMED etc.
  • Other rules
icd 11 foundation component and linearizations
ICD 11 Foundation Component and Linearizations



ICD-11 content model parameters

- Definitions, synonyms

- Clinical descriptions

- Manifestation properties

- Causal properties

- Functional properties

Primary Care




Value Set

SNOMED-CT, International Classification of Functioning, Disability and Health (ICF), International Classification of External Causes of Injury (ICECI)…

web based collaborative authoring tool icat
Web based collaborative authoring tool (iCAT)

display & browse taxonomy with its content model rubrics

allow user to comment on the content

allow users editing the content and facilitate the use of value sets derived from other classifications and terminologies

allow user restructuring the classification

Incorporates multiple level of user access

supports multilingual representation

ontology tooling interface with description logic technology

making who fic ontology based example icps ontology development
Making WHO FIC ontology based Example: ICPS ontology development




Patient outcome

Preven. action

Incident type


Managing action


Adverse Reaction



has cause

has circumstances

has type

Contextual Factors

has impact

has consequence

is a

is a

Org. outcome

is a

who classification development in the 20 th century construction of icd 10 icf
WHO classification development in the 20th CenturyConstruction of ICD-10 & ICF:

ICD: 8 Annual Revision Conferences (1982 - 89) ICF: 7 int. & 38 nat. Revision Conferences (1994 - 2001)

ICD: 17 – 58 Countries participated

1- 5 person delegations

mainly Health Statisticians

ICF: 61 Countries participated

1- 5 person delegations


Manual curation

List exchange

Index was done later

"Decibel" ? Method of discussion

ICF: Concept driven

Output: Paper Copy

Work in English only

ICD: Limited testing in the field ICF: draftstranslated into/ tested in 27 languages

post-coordinated development of linkages to related classification, terminologies and assessment instruments

who classification development in the 21 th century
WHO classification development in the 21th Century

Internet-based permanent platform

All year round

Open to all people in a structured way

Linkagesto related classification, terminologies and assessment instruments

Content experts & users are empowered

Digital curation

Wiki enabled collaboration


Enhanced discussion & peer review

Electronic copy print version

Work in multiple languages

field tests

based on Use Cases

what is the answer what is the question
What is the answer? ... what is the question?

Computers are useless. They can only give you answers.

Pablo Picasso (1881-1973)