Representation of ICD-10- AM/ACHI using Classification Markup - - PowerPoint PPT Presentation

Representation of ICD-10- AM/ACHI using Classification Markup Language (ClaML)

Robert Smith Western Sydney University

Who are We?

• Australian Consortium for Classification Development (ACCD)
• University of Sydney, National Centre for Classification in Health (NCCH)
• Western Sydney University
• Contracted by the Independent Hospital Pricing Authority (IHPA) for

the development of the ICD-10-AM and ACHI Clinical Classifications

What is Clinical Classification?

• International Statistical Classification of Diseases and Related Health

Problems, 10th Revision, Australian Modification (ICD-10-AM)

• ICD-10-AM is the country specific version of the international standard ICD-10
• used for coding diagnosed diseases
• Australian Classification of Health Interventions (ACHI)
• Unique Australian classification for coding healthcare interventions
• Uses
• statistical tracking, funding, insurance claim processing and research

Classification Data Exchange

• The vendors of ACCD
• Software developers of Clinical Classification systems that use ICD-10-AM /

ACHI

• Needs access to ICD-10-AM / ACHI classification data
• Current data exchange is through
• Documents, text files, PDF files and database scripts / files
• Documents and text files are far from suitable to be processed in an

automated manner by IT Systems

• Is this a problem?

Classification Data Exchange Problem

• Database scripts / files
• Can lead to misinterpretation of tables and data fields
• Documents, PDF, Text Files
• Not easy to be parsed by systems
• Requires a programmer to create scripts
• A standard method is needed that is:
• machine consumable and human readable
• structure classification data

Introduction to the Classification Markup Language (ClaML)

• ClaML is an XML standard ISO 13120:2013,
• Defines how to store clinical classification data
• More easily processed by IT systems
• Established international standard
• Suitable for WHO Clinical Classifications
• ICD-10
• ICF
• ICHI

Short History of ClaML

• First published in 2003 as Technical Specification DD CEN/TS 14463:2003
• Revised in 2008 as BS EN 14463:2007
• Replaced in 2013 with BS EN ISO 13120:2013 version 1 of the ISO standard
• Currently under re-development as ISO/FDIS 13120
• Recommended by WHO-FIC (World Health Organization Family of

International Classifications Network) for:

• Maintenance
• Publishing
• Sharing

What is XML (eXtensible Markup Language)

• XML is:
• An independent tool for storing and transporting data
• Designed to be self-descriptive
• Simplifies data transports for systems
• Simplifies platform changes
• Uses for XML
• A common use case is to exchange clinical classification data between

different authorities i.e. Vendors of ACCD

• Due to the self-describing nature of XML, it can be easily processed by

different IT systems

Our Experience with ClaML

• Workshop to understand the structures of ICD-10-AM, ACHI and

ClaML

• Analyse all documentation
• ICD-10-AM and ACHI classification system mapping to ClaML tags
• Propose changes and custom modifications
• Manual transition of a few ICD-10-AM chapters into ClaML

Workshop Findings

• Items modelled differently in our system needed changing.
• Other additional information in ICD-10-AM
• ACHI has a different structure to ICD-10-AM
• ICD-10-AM / ACHI Indexes won’t fit in ClaML as-is

Structure of ClaML

• ClaML is the root item
• ClaML item can have many

Classification items

Differences with ICD-10 ClaML from WHO and DIMDI

• Modifiers - WHO applies Modifiers for 4-digit ICD-Classes to their

superclasses (3- digit classes) whereas DIMDI applies them to the corresponding 4-digit classes to build the 5-digit sub-classifications.

WHO <Class kind="category" code="D18"> <ModifiedBy code="D18.0_5" position="5" /> <SuperClass code="D10–D36 " /> <SubClass code="D18.0" /> <SubClass code="D18.1" /> </Class> <Class kind="category" code="D18.0"> <SuperClass code="D18" /> </Class> <Class kind="category" code="D18.1"> <ExcludeModifier code="D18.0_5" /> <SuperClass code="D18" /> </Class> DIMDI <Class kind="category" code="D18"> <SuperClass code="D10–D36 " /> <SubClass code="D18.0" /> <SubClass code="D18.1" /> </Class> <Class kind="category" code="D18.0"> <ModifiedBy code="D18.0_5" position="5" /> <SuperClass code="D18" /> </Class> <Class kind="category" code="D18.1"> <SuperClass code="D18" /> </Class>

Differences Between ICD-10-AM and ICD-10 with ClaML

• Other Information in ICD-10-AM
• Medicare Benefits Schedule (MBS)
• Classification of Hospital Acquired Diagnoses (CHADx)
• Australian Coding Standard (ACS)
• Australian variant
• More specific information that has different formatting
• WHO has not provided an XML standard to store and exchange Clinical

Classification Alphabetic Indexes

Adapting ClaML to Store Alphabetic Indexes

• Alphabetic indexes have

no unique identifier

• Terms must contain their

child terms in a consistent hierarchy

• Tables – only in the Index

WHO Rubrics to ICD-10-AM Attributes

• Mapping ICD-10-AM

Attributes to ICD-10 Rubrics

• More specific types
• f Information

in ICD-10-AM

ICD -10 ClaML ICD-10-AM Attribute

footnote text coding-hint definition introduction modifierlink note exclusion inclusion preferredLong preferred meta tag type range meta tag type ACS Modifiers

• - not used --

text code also code first inclusional see use additional definition introduction see note styled note excludes includes long code name code name Range ACS No code subdivision

WHO Rubrics to ACHI Attributes

• Mapping ACHI

Attributes to ICD-10 Rubrics

• Similar types of

information in ACHI

• The following rubrics

are not in ACHI

• Footnote
• Text
• Introduction
• Modiferlink
• Meta tag type Range
• modifiers

ClaML ACHI Attribute

coding-hint definition exclusion inclusion note meta tag type ACS preferredLong Preferred codeAlso codeFirst codeAlsoWhenPref inclusional see definition excludes includes note styledNote acsNo long code name code name

Validation of ClaML Export

• Automatic generation of ClaML
• After modifications to our application and database, the generation
• f ClaML files needs to go through quality assurance testing.
• For quality assurance reasons, XSL was used to generate a

graphical representation of ClaML

• Validated the graphical representation against the publications
• XSL (eXtensible Stylesheet Language)
• Converts XML (i.e. ClaML) to a presentable web page
• Provided a way to test the validity and consistency of the generated

ClaML exports

• Demonstrates the usability of ClaML, and the possibility of how it

may be represented graphically

Validation of ClaML Export (Continued)

<Class kind="category" code="D18"> <ModifiedBy code="D18.0_5“ position="5" /> <Meta name="Valid" value="False" /> <SuperClass code="D10–D36 " /> <SubClass code="D18.0" /> <SubClass code="D18.1" /> <Rubric kind="preferred"> <Label> Haemangioma and lymphangioma </Label> </Rubric> <Rubric kind="inclusion"> <Label> morphology codes M912–M917 with behaviour code/0 </Label> </Rubric> … </Class>

Into

Future Directions

• Still a work in progress!
• Using the XSL to render tables for Alphabetic Indexes
• Further quality assurance testing
• Distribute ClaML to vendors for usage and feedback
• Upgrade to upcoming ClaML 3.0 once it’s released

Thankyou.

I hope you enjoyed the presentation