[ICHI-International Classification of Health Interventions : A balancing act between the demands of statistics and reimbursement]. / ICHI ­ International Classification of Health Interventions : Prozedurenklassifikation im Spagat zwischen Statistik und Abrechnung.

Medical classifications systematize medical concepts (e. g. diagnoses, procedures). They are essential for statistics and reimbursement systems in health care systems. Diagnoses are classified worldwide with the International Classification of Diseases (ICD) of the World Health Organization (WHO). The situation for procedure classifications is quite different. Many countries developed their own procedure classifications in different ways and for different purposes.Since 2007, the International Classification of Health Interventions (ICHI) is been developing as a common tool for reporting and analyzing health interventions for statistical purposes as well as for the use in reimbursement systems.ICHI covers not only medical and surgical procedures but also interventions carried out by a broad range of providers across the full scope of health systems, including rehabilitation, assistance with functioning, prevention and public health.The multiaxial classification is built around three axes: target (the entity on which the action is carried out), action (a deed done by an actor to a target) and means (the processes and methods by which the action is carried out). Extension codes are provided to allow users to describe additional detail about the intervention in addition to the relevant ICHI stem-code. ICHI was designed with a low level of complexity for countries seeking a classification, while also serving as a basis for international comparisons. ICHI can also be used in reimbursement systems, by adding cost-relevant information through extension codes.The recent 2018 ICHI beta version is available on the platform https://mitel.dimi.uniud.it/ichi . This version and further ICHI tools will be tested during later reviews and field testing in 2018 and 2019. Once finalized, probably in 2020, ICHI will be freely available for adoption by member states of the WHO.

Checking coding completeness by mining discharge summaries.

Incomplete coding is a known problem in hospital information systems. In order to detect non-coded secondary diseases we developed a text classification system which scans discharge summaries for drug names. Using a drug knowledge base in which drug names are linked to sets of ICD-10 codes, the system selects those documents in which a drug name occurs that is not justified by any ICD-10 code within the corresponding record in the patient database. Treatment episodes with missing codes for diabetes mellitus, Parkinson's disease, and asthma/COPD were subject to investigation in a large German university hospital. The precision of the method was 79%, 14%, and 45% respectively, roughly estimated recall values amounted to 43%, 70%, and 36%. Based on these data we predict roughly 716 non-coded diabetes cases, 13 non-coded Parkinson cases, and 420 non-coded asthma/COPD cases among 34,865 treatment episodes.

Development of a new international classification of health interventions based on an ontology framework.

: The WHO International Classification of Diseases is used in many national applications to plan, manage and fund through case mix health care systems and allows international comparisons of the performance of these systems. There is no such measuring tool for health interventions or procedures. To fulfil this requirement the WHO-FIC Network recommended in 2006 to develop an International Classification of Health Interventions (ICHI). This initiative is aimed to harmonise the existing national classifications and to provide a basic system for the countries which have not developed their own classification systems. It is based on the CEN/ISO ontology framework standard named Categorial Structure defined from a non formal bottom up ontology approach. The process of populating the framework is ongoing to start from a common model structure encompassing the ICD 9CM Volume 3 granularity.

Comparison of ICHI and CCAM basic coding system.

While diagnoses are coded by ICD across the world, there is no universally accepted coding system for procedures. In many countries there exists not even a local classification for medical procedures. As a possible solution the International Classification of Health Interventions (ICHI) has been proposed as a common denominator for an international procedure classification. We alternatively postulate a multiaxial framework for procedure classification following the French Classification Commune des Actes Médicaux (CCAM) for the generation of a procedure shortlist. We compared ICHI and CCAM Basic Coding System focusing on the appropriateness of both systems for supporting the comparability of procedure data. Considering the ongoing standardization of health terminologies and classifications, we strongly recommend to improve the ICHI structure, capitalizing on the benefits of the CCAM architecture.

The German specialist lexicon.

The German language and in particular biomedical terms exhibit a rich and productive morphology. Beyond inflection and comparison forms frequently spelling variants, German - Greek/Latin synonyms and nominal compounds exist. For the English language, the SPECIALIST LEXICON, part of the UMLS project, covers a broad range of biomedical terms. In this paper we describe the database model and the functionality of the GERMAN SPECIALIST LEXICON, an ongoing project to develop a lexical resource for German-language medical terminology. Similar to the SPECIALIST LEXICON it is accompanied by tools for the recognition and generation of lexical variants, as well as by databases linking synonymous words, spelling variants, phrases and abbreviations.