The Elephant in the Room Series Three: Who’s watching the WHO?


Image | belgianchocolate | Creative Commons


APA    DSM    DSM-IV    DSM-V    WHO    ICD    ICD-10    ICD-11    American Psychiatric Association    Diagnostic and Statistical Manual of Mental Disorders    World Health Organization    Classifications    DSM Revision Process    DSM-V Task Force    DSM-V Somatic Distress Disorders Work Group    Somatic Symptom Disorders Work Group    DSM-ICD Harmonization Coordination Group    International Advisory Group    Revision of ICD Mental and Behavioural Disorders    Global Scientific Partnership Coordination Group    ICD Update and Revision Platform    WHO Collaborating Centre    CISSD Project    MUPSS Project    Somatoform    Somatisation    Somatization    Functional Somatic Syndromes    FSS    MUS    Myalgic encephalomyelitis    ME    Chronic fatigue syndrome    CFS    Fibromyalgia    FM    IBS    CS    CI    GWS

The Elephant in the Room Series Three:

Who’s watching the WHO?

WordPress Shortlink for this posting:

30 September 2009

It’s now Week Two of the Geneva iCAMP Meeting to test iCAT – the multi-layered, wiki-like collaborative authoring platform that the WHO will be using to revise ICD-10. Are you watching the video reports?

The most important difference between ICD-10 and ICD-11 will be the Content Model:

“Population of the Content Model and the subsequent review process will serve as the foundation for the creation of the ICD-11. The Content Model identifies the basic characteristics needed to define any ICD category through use of multiple parameters (e.g. Body Systems, Body Parts, Signs and Symptoms, Diagnostic Findings, Causal Agents, Mechanisms, Temporal Patterns, Severity, Functional Impact, Treatment interventions, Diagnostic Rules).”

For the next edition of ICD, we’re unlikely to be looking at just a couple of lines in Chapter VI*, or whatever…

Daily iCAMP YouTubes are being posted on the WHOICD11 Channel. They’re all less than five minutes long and you can watch Days 1 to 6 here: or on ME agenda here and here

For those with connections too slow for YouTube, transcripts of the narrations that intersperse the footage are being posted on the ICD11 blog, here:

There are three more YouTube reports to come before iCAMP disperses.

The videos will give a feel for the potential extent of the Content Model and how the iCAT platform is intended to function as a multi-user, web-based authoring and review tool, through which alpha and beta drafts will be developed.

But for better understanding of the proposed structure of ICD-11 and the potential implications for the population of content, you really need to go here:

Here you will find:

Minutes of the 3 – 7 August 2009 iCAMP Meeting, Geneva [MS Word]

Provisional List of Participants for 22 September – 2 October 2009 iCAMP Meeting [MS Word]

Participants’ CVs [MS Word]

Agenda for the 22 September – 2 October iCAMP Alpha Draft Training Meeting [MS Word]

Content Model Style Guide document [MS Word]

Morbidity Reference Group Discussion papers:
ICD-11 rules, conventions and structure [MS Word]
Revision topics for topic advisory groups [MS Word]

ICD11 Model Representation Comparison document [MHTML]

Content Model Blank document [Excel]

Content Model Myocardial infarction example document [Excel]

Content Model Urticaria example document [Excel]

Content Model Hypertension Category example document [Excel]

ICD 11 Alpha Draft presentation by Dr B. Ustun [MS pptx slides]

Start-Up List presentation by Dr R. Jakob [MS pptx slides]

iCAT Tool presentation by T. Tudorache [MS ppt slides]

Myocardial infarction Content Model presentation [MS ppt slides]

Workflow document [pdf]

and ancillary material.

[Note that some of these documents are “works in progress” and subject to ongoing review and revision, so you will need to monitor the site from time to time for revised and updated versions, which is why I’ve not given the file paths.]

[Note also, that those with Office 2003 installed may not be able to open the slides of two presentations produced using the more recent PowerPoint file format “pptx” and will need to download the free MS Office 2007 PowerPoint Viewer (pptx viewer) or in my case, in order to view the Robert Jakob Start-Up List presentation, the MS Office Compatibility Pack for Word, Excel, and PowerPoint 2007 File Formats.]

The ICD-11 alpha draft is planned for May 2010, the beta draft for May 2011 and the final draft expected to be submitted to WHA by 2014, for implementation in 2015.

The additional dimension of the concurrent DSM-V development process towards its own alpha draft, the ICD-DSM commitment to congruency and “harmonization” between the two systems and the involvement of DSM Task Force members in the Advisory Group for Mental and Behavioural Disorders needs to be borne in mind. The APA plans to publish DSM-V in May 2012, several years ahead of ICD-11.

We don’t have an ETA, yet, for the launch of iCAT.

“The starting point for the ICD-11 alpha draft will be the “Start-Up List” of categories which has been drafted by WHO/HQ to initiate the editing process. This list includes all the proposals received to revise the existing ICD as well as the input from ICD national modifications. During alpha drafting, detailed structured definitions will be added to these ICD categories according to a common model…”    Agenda, ICD-11 Alpha Draft Training Meeting

It’s not yet known whether other proposals that have relevance to the ME community have already been submitted for review, over and above those proposals evident from the ICD Update and Revision Platform; or what input coming from ICD national modifications, WHO affiliates or other sources may have significance for us. That is, we do not know what will be the starting point for the reviewing of those sections relevant to our patient community.

“The ICD-11 will be a collaboratively authored project, and many people will be submitting proposals for content, much like wikipedia. Unlike Wiki, however, the ICD will be peer reviewed with the TAGs serving as the editorial boards. The Managing Editor for each TAG…will collect, synthesize, and present the information for each proposal, and they are responsible for ensuring that the correct team of reviewers is selected…”

“The beauty of a collaborative authoring tool like the iCAT is that it allows the creation of the ICD-11 to draw on the expertise of anyone at anytime, anywhere in the world. After a proposal is created, the Managing Editor will serve as “postmaster”, ensuring that each proposal is complete and correctly formatted, as well as thoroughly supported, before forwarding the content proposal on to the specifically chosen team of independent peer reviewers. It is also the job of the Managing Editor to filter out or address those proposals which do not fulfill the necessary criteria.

“Those content proposals which receive the appropriate percentage of approvals by the peer reviewers will be passed along to the Topic Advisory Group for further review. The TAG is responsible for further evaluation of the content proposal and the supporting information provided. Each content proposal which reaches this stage may also require the review of other, parallel, TAGs, if the content of the proposal overlaps between multiple TAG areas. Each proposal which meets the exacting requirements of the TAG or TAGs will be passed along for further evaluation by the Revision Steering Group…”

The Summary of the December 2008 Meeting of the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders reported that the Advisory Group for the Revision of Diseases of the Nervous System (that is TAG Neurology and Chapter VI) had been approved and its members appointed and that the WHO Department of Mental Health and Substance Abuse would be managing the technical part of the revision of Chapter VI, as it is doing for Chapter V.

The 5th Meeting of the now reconstituted Advisory Group for the Revision of Mental and Behavioural Disorders was scheduled to take place this week, on 28 – 29 September.

Following this meeting, I hope to be in a position to provide information about the appropriate channels of communication with TAG Neurology and TAG Mental Health, the process through which stakeholders will be able to submit proposals and what will be required of them.

In the meantime, I recommend familiarising yourselves with the documentation and processes evolving at:

There’s a lot of material here, but we need to be informing ourselves around these processes, now.

*According to a discussion paper on ICD-11 rules, conventions and structure, it is proposed that Arabic should replace roman numerals throughout the classification (eg chapter numbering), except where they are the standard for a disease concept.  So for ICD-11, we might anticipate Chapter 5, Chapter 6 etc. rather than Chapter V, Chapter VI.

Suzy Chapman
30 September 2009