Dr. Qin JiangChina National Health Development Research Center

30 June,2011

Content Brief introduction of CCHI Comparison study on ICHI and CCHI

Background: Why? Progress Scope Content model

Next steps

Brief introduction of CCHI China didn’t have our own health intervention classification in the past Used to follow the ICD-9-CM-3 at hospital level. More than 3 years’ work based on upgrading of national fee schedule,

about 10,000 procedures and services covered. Designed to be used both in EMR and national fee schedule

Special thanks to Richard, Lori and other international colleagues Multi-axial coding structure based on the content model of ICHI and

Clinical Reality in China Wide involvement of 508 clinical experts from 48 specialties Hard debate and compromises between medical science, classification

and politics Deep involvement of and strongly support from MOH and NDRC of

CCHI , but lagged the time of publication Finished the process of public advice and comments Hope to be publicized in one or two months as a national standard

Why comparison study In the process of developing CCHI, Extensive comparison study

on ICD-9-CM-3, ICD-10-PCS,CCI, CCAM,OPS 301, OPCS ICHI Content model

Why we did that? Great need for establishing national standard for

medical informatics quality assurance, evidence-based policy making, payment reform

More understanding of the background and international trend Understanding advantages and disadvantages of each classification Based on our situation, choose the best model :

Adaptable for the health system in China Should be flexible and have more space for future upgrading

International comparison in the future

Why ICHI? ICHI is still under development, now preparing the

pre-alpha version However,

Extensive involvement of international expertise Blending of experiences from different countries Similar developing experiences: debating, compromise

and improvement More chances to talk to the experts in specific area Most importantly, the possible use, scope and content

model of ICHI is a very useful reference to us.

Progress of ICHI and CCHI ICHI:

under development international involvement

Pilot test of structure in 2010, Mapping with ICHI content model

Medical& Surgical: pre-α version developed in June: Comparing ICD-9-CM-3

Functioning Interventions Public health interventions Traditional Medicine: ICTM

Interventions TAG

CCHI: almost finished, national

involvement, revising and waiting for publication Based on the content model of ICHI Textual definition, inclusion,

exclusion Level of Standardization: majorly

based on the medical terms provided by medical association and each specialties, therefore, it is, to some extent, standardized. Some terms kept due to doctors strong requirement

China Medical Association helped classify the terms

Possible Uses of ICHI and CCHI

ICHI Local, national,

international reporting Assist health policy

development Make all kinds of

interventions visible Possible base for:

Specialised classifications A more detailed national

classification Casemix applications

CCHI medical information

system: EMR, reporting, analysis

quality assurance, payment

reform…:casemix evidence-based policy

making

Scope for ICHI vs. CCHI ICHI will include

Medicine, surgery, diagnostics

Primary care Nursing Allied health and

rehabilitation Traditional medicine Public health

CCHI focuses on medical interventions Medicine, surgery,

diagnostics Nursing Rehabilitation Other comprehensive

services

Chapters of CCHI

Comprehensive services and procedures

Diagnostic procedures

Therapeutic procedures

Rehabilitation Procedures

Other

Comprehensive services and procedures

Pathology Laboratory tests Diagnostic Imaging Clinical exams ….. Non-surgical procedures Surgical Procedures …… Rehabilitation Procedures Assisting Procedures …… Transitional codes

ICHI Content ModelAny Intervention in ICHI is represented by:

TITLE of ENTITY: Name of intervention

1. Textual definition2. Hierarchy – Type – Use 3. Synonyms - Inclusion –

Exclusion - Index terms

Descriptive characteristics1 Target

A Body Part(s) or Anatomical site(s)

B Body FunctionC Activities and ParticipationD Traditional Target(s)E Individual/Group/Population

2. Action

Descriptive characteristics (continued)

3. MeansA ApproachB Technique (includes equipment)C MethodD Device(s)E Chemical substance(s)F Herbal substanceG Environment

References

A Devices: ISO9999 for assistive devices,Implanted devices: terms to be

developedB Chemical substance: ATCC Environment: ICFD Diagnostic test: Terms to be

developed

Target of ICHI and CCHIICHIAnatomy Based on Foundational Model of

Anatomy (FMA): FMA/SNOMED compliance desirable Nervous system Eye Ear Heart and great vessels Cerebral and peripheral vessels ...

FunctionPerson/Group/Population Monitoring, assessment, ... Allied health, rehabilitation Public health

CCHIAnatomy Based on FMA and national

teaching textbooks Nervous system Eye Ear Heart and great vessels Cerebral and peripheral vessels ...

Function Only in mental procedures and

services

Actions of ICHI VS. CCHI

ICHI: by purpose CCHI Diagnostic Actions Therapeutic Actions Managing Actions Assisting Actions Preventing Actions Unspecified Actions

In different Chapters: Diagnostic Actions Therapeutic Actions

From the least invasive to the most invasive

Assisting Actions Unspecified Actions

Means of ICHI VS. CCHI

ICHI CCHIApproach: to date, surgicalTechnique: to date, imaging

(includes equipment used during the intervention)

Method: to date, public health

More development required for each of these

Approach only based on CCI, PCS and ICHI

Coding System of ICHI VS. CCHI

ICHI Target 3 letters Action 2 letters Means 2 lettersfollowed by numbers to add

granularity

CCHI All codes are eight characters

long Each chapter has its own

structure: Some chapter has sub-groups

like CCI… Individual units for each

character are represented by a letter or number

34 possible values for each character Digits: 0- 9 Letters: A-H, J-N, P-Z

Code structure of surgical procedures

System: A: Diagnostic procedures: psychological diagnostics

Surgical procedures: anesthetic procedures

Approach: added combining approaches, other approaches, NOS

Part: much more detailed than that in ICHI

Hard debate 1: Devil is in details Targets:

parts are much more detailed than ICHI, but less detailed than PCS, diagnostic procedures deal with relative general anatomy part, while

therapeutical procedures now are in more granularity , we had to count in those two level of grannuality together

we didn’t count left, right, and bilateral sides of one part, and some combining parts, we didn’t count number of hand/foot digits

Overlapping part belong to the different systems, based on ICD-9-CM-3, NOSE, EYE, EAR and maxillary part, transplantation of heart and lung

Multi-parts that belongs to different system: radical excision System part vs. general part: abdominal cavity, where to place? procedures both have part and function: gastric /intestinal flow, (function

procedures accounted for less 20% of the whole procedures), to avoid the confusion of doctors, Body functions were deleted unfortunately

Hard debate 2: Devil is in details

Actions: Combining aims and actions in one item. E.g.: bone fracture

reduction: insert, fixation with or without resection,…. If we strictly follow the rule of part+ action, foreign bodies such

as stone, thrombus, should we remove /destruction one of the body part?

Some actions are very close: release and decompression, reposition and set

Means: devices were deleted, unfortunately, instead, medical device classification are being designed

Next steps Publication Field testing in 2-3 hospitals Mapping tool development Training for providers and related stakeholders Preparation for updating Further development of national casemix grouping

Our role China collaborating center is willing to dedicate to the

development of ICHI Sharing our experiences with international

counterparts Very similar when drill into the details

Scope Granularity Enumeration

More involvement in the developing process with a lot of resources

Content model Editorial rules and coding rules