Classifications without Borders

AHIMA representatives to the World Health Organization participate in the development and maintenance of classifications that create consistent data worldwide. In the July print edition, Sue Bowman and Rita Scichilone describe three work groups on which they serve. This online version of the story includes additional information on each group’s specific charges.

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The World Health Organization maintains the Family of International Classifications, a suite of classification products that may be used in an integrated fashion to compare health information internationally and nationally. The International Classification of Diseases is published and maintained by WHO-FIC. ICD-10 is the current edition, and ICD-11 is in development.

Internationally endorsed classifications such as those in WHO-FIC facilitate the storage, retrieval, analysis, and interpretation of data; they enable the comparison of data within populations over time and between populations at the same point in time. Their use results in the compilation of internationally consistent data.

Accordingly, WHO-FIC seeks to

  • improve health through provision of sound health information to support decision making at all levels;
  • provide a conceptual framework of information domains for which classifications are, or are likely to be, required for purposes related to health and health management;
  • provide a suite of endorsed classifications for particular purposes defined within the framework;
  • promote the appropriate selection of classifications in a wide range of settings in the health field across the world;
  • establish a common language to improve communication;
  • permit comparisons of data within and between member states, health care disciplines, services and time; and
  • stimulate research on health and the health system.

WHO has designated a number of collaborating centers to work with it in the development, dissemination, maintenance, and use of WHO-FIC. The WHO Collaborating Center for the Classification of Diseases for North America was established in 1976 to represent the US and Canada in international activities related to study and revision of ICD.

Now known as the WHO Collaborating Center for the Family of International Classifications for North America (abbreviated as NACC), it is located at the National Center for Health Statistics, a part of the US Centers for Disease Control and Prevention.

NACC works in close collaboration with two Canadian agencies: the Canadian Institute for Health Information and Statistics Canada. It maintains liaison with WHO on use, implementation, and maintenance of the FIC by the US and Canadian governments.

Nine WHO committees and reference groups contribute to maintaining the FIC:

  • Update and Revision Committee
  • Education Committee
  • Implementation Committee
  • Family Development Committee
  • Electronic Tools Committee
  • Mortality Reference Group
  • Morbidity Reference Group
  • Functioning and Disability Reference Group
  • Terminology Reference Group

In addition to representatives from the collaborating centers who are members of the WHO-FIC network, other classification, health information, and clinical experts can be appointed by respective collaborating centers to represent their respective countries.

Representatives from AHIMA currently serve on three committees and reference groups: the Morbidity Reference Group, the Terminology Reference Group, and the Education Committee.

Morbidity Reference Group

The Morbidity Reference Group seeks to improve international comparability of morbidity data and the application of ICD in morbidity by analyzing and integrating needs deriving from statistics (e.g., hospital data), case mix (e.g., DRG systems), and clinical documentation (e.g., clinical terminology and electronic health records).

AHIMA’s participation helps provide the US health information management perspective to the process of developing and maintaining current and future versions of ICD and developing associated international usage rules.

While differences in national regulatory requirements and reimbursement systems inevitably lead to differences in clinical modifications of ICD and reporting rules, the goal is to minimize these differences and achieve international data consistency and comparability, to the extent possible, through international collaboration.

Sue Bowman, RHIA, CCS, AHIMA director of coding policy and compliance, currently serves on the Morbidity Reference Group and shares a US vote with Donna Pickett, MPH, RHIA, medical systems administrator at the National Center for Health Statistics.

The group:

  • Identifies, discusses, and solves problems related to the interpretation and application of ICD to coding and classification of morbidity, including the establishment of standardised interpretation of the categories and the development of agreed definitions, coding rules and guidelines
  • Develops recommendations for ICD-10 updates for forwarding to the Update and Revision Committee annually, through a democratic process that attempts to achieve consensus
  • Supports the revision process for ICD by providing advice on morbidity-related issues and possible terminology linkage for morbidity coding
  • Reviews possible morbidity applications of WHO-derived and related classifications, to inform recommendations for change to ICD
  • Considers and supports statistical, epidemiological, reimbursement (including casemix), and clinical applications of ICD for morbidity purposes
  • Constructs a database summarizing national applications of ICD for morbidity purposes
  • Provides documentation of discussions and decisions in a database that can be used online and offline

The Morbidity Reference Group participates in the development of ICD-11, as do all of the committees and reference groups.

Terminology Reference Group

The Terminology Reference Group follows terminology and terminology systems developments and promotes awareness of the need to ensure and verify congruence between concepts underlying clinical terminologies and the WHO classifications.

The group first convened at the 2006 WHO-FIC meeting in Tunisia. Its establishment reflects the importance placed on the relationship between the classifications of WHO-FIC and the emerging clinical terminology initiatives around the world. Subsequent meetings were held in 2007 and 2008.

AHIMA director of practice leadership Rita Scichilone, MSHA, RHIA, CCS, CCS-P, F-CHC, serves as a US representative to the group. The group:

  • Promotes awareness of the need to ensure and verify congruence between concepts in clinical terminologies and the categories available within the WHO-FIC products such as ICD and ICF
  • Collaborates with the research community, healthcare providers, software developers, and health authorities
  • Monitors and provides guidance for mapping between classification and clinical terminologies
  • Guides the evolution of WHO-FIC products (e.g., ICD-11) so new work takes account of the content and formalisms used to construct and maintain clinical terminologies

Discussions between the International Healthcare Terminology Standards Development Organisation (IHTSDO) and WHO-FIC began in 2007 for harmonization of classification systems with the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT).

Education Committee

The Education Committee assists and advises WHO and the WHO-FIC Network in improving the level and quality of use of WHO-FIC in member states by developing an education, training, and certification strategy; identifying best training practices; and providing a network for sharing training expertise and experience. Its current work plans prioritize ICD and the International Classification of Disability, Functioning, and Health.

The Education Committee entered into a joint collaboration with the International Federation of Health Records Organizations (IFHRO) in 2001. IFHRO is a nongovernmental organization in official relations with WHO; AHIMA is its US representative. Together the Education Committee and IFHRO have developed an international training and certification program for ICD-10 coders and trainers. In cooperation with the WHO, they have been developing Web-based training tools for ICD-10 and the International Classification of Disability, Functioning, and Health.

AHIMA director of practice leadership Rita Scichilone serves as a US representative to the Education Committee. Its functions include:

  • Assessment of the needs of users of the classifications, including those who provide source information, apply codes, conduct research or use the resulting data
  • Identification of the learning objectives for educational approaches
  • Inventory of existing educational materials and capacity
  • Recommendations for learning content including development of core curricula
  • Recommendations for best practices for promotion and delivery of educational material
  • Harmonization, review, development, and maintenance of self learning tools.

Berg, Lars, and James R. Campbell. “Mapping SNOMED CT to ICD-10—A Joint Task of IHTSDO and WHO-FIC.” 2008.

National Center for Health Statistics. “WHO Collaborating Center for the Family of International Classifications for North America.”

World Health Organization. “Terms of Reference of the WHO-FIC Committees.”

World Health Organization. “The WHO Family of International Classifications.”

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