ICD Update and Revision Platform is a web based system that is designed to facilitate communication within expert workgroups. It will also make the expert workgroup processes transparent to the field by requiring expert groups to post interim products of their deliberations on a regular schedule for comment.
ICD-10 Plus is the first web application included in the platform which allows users to enter structured proposals for ICD update or revision.
The basic functionality of the software can be summarized as follows:
· This is a web application which means that the users access it from a web site without the need for downloading or installing any programs. All of the information collected and shared by the application resides on a central location in the WHO servers.
· The application collects update and revision proposals in a structured and organized manner. This is done by asking the user to fill a form in which the user explains the proposal as well as the rationale behind the proposal. In addition to this, he/she can provide links to web pages such as publication references from PubMed or can upload documents that are relevant to the proposal.
· The proposals are organized according to the existing ICD-10. So the users may browse through the classification and see what is proposed in each and every part of the classification.
· The application is not only for collecting the proposals but also works as a workflow engine which starts when the proposal is created and ends when it is removed from the system or it is implemented in the ICD. The workflow is in line with the present updating process.
· Different users have different levels of authorization in the workflow. For example, standard users can submit proposals but cannot decide whether they are accepted or when they are going to be implemented, etc. More information on which type of users can perform which functions is available in the Proposal Lifecycle section of this document.
· All old versions of proposals due to editing, all deleted and rejected proposals are stored in the system for review and cannot be edited any more.
In our platform, each new proposal is attached to a location in the ICD hierarchy. Therefore, the users start by deciding the primary code affected by the proposed update. This is where the proposal will be visible in the ICD-10+ tree. A proposal can be attached to an item as specific as a 4 letter code or as broad as chapter.
Before becoming visible to the other users of the system, each proposal must be seen and accepted by a moderator. Moderators are users of the system with special access rights to accept or reject the proposals. They check whether the proposal has been entered correctly and whether there is any kind of abuse (such as sending the same or similar proposals many times, etc.). If necessary, they may modify the proposals or request the originator to update or clarify certain points. Moderators are the first level in the control therefore they look at the proposals from a broader perspective and do not have to check the details or scientific validity of the proposal. Moderator role is domain specific. For example, a person can be a moderator of one chapter of ICD but be a regular user for the other parts.
All proposals are moderated with the exception of the proposals that have been sent to closed groups by their members. For example, if a member of the MRG closed group sends a proposal to MRG this will not be moderated and will be automatically visible.
The concept of closed groups is created in the platform to allow starting the work on a proposal in a closed group of experts before opening it up to general discussion. Initial closed groups of our system are Mortality Reference Group (MRG) and the Morbidity Reference Group (MBRG). More groups are expected to be generated for the ICD-11 revision process.
Only members of the groups can submit proposals to the closed groups. Commenting is also limited to the group members. However, the proposals will be visible to other users of the platform.
The administrator of the group decides whether or when to send a proposal to the “open discussion layer”. Once this is done, the proposal will be open to comments by other users just like any other proposal.
When a proposal is in the closed group layer, only the administrator of the closed group or the originator of the proposal can modify them.
In this layer the proposals are open for discussion by all users of the platform.
In this layer, editing can only be performed by the originator of the proposal or the Update and Revision Administrators (URC secretariat and WHO ICD officer)
In this layer,
§ Commenting can only be done by the General Update and Revision Group members. (Update and Revision Committee (URC) members are members of this group)
§ A voting process may be used as a consensus building mechanism. The Voting Members are a subset of General Update and Revision Group Members. There may be one voting member per country and in addition to that the chairs of Reference Groups have voting rights. (See the section Voting )
§ In this layer editing can be done by the owner of the proposal (if a member of General Update and Revision Group) or by the Update and Revision Administrators
Proposals may be marked as rejected or deleted at any layer by the users who have privileged access to in the system. The system will not display the rejected or deleted proposals on main proposal lists or in the ICD-10+ screen any more. However, they will remain in the system and can be accessed through the Search mechanism. The difference between “rejected” and “deleted” is the following:
§ Proposals are marked as rejected if they are rejected after some discussions in the platform
§ They are marked as deleted if they do not include any information that might be needed in the future (such as a proposal created for testing the system etc.)
Everybody: Users that are not part of any closed group and do not have any privileged access to the system.
§ Have read access to all proposals in all layers.
§ Can submit proposals. Their proposals are moderated.
§ Can comment on proposals when they are in the open discussion layer
§ Can edit their own proposals when they are in the moderation layer or open discussion layer.
Moderators: Checks whether the proposal is in line with the guidelines.
§ Can reject the proposal or pass it to the next layer.
Members of closed groups: In addition to what ‘Everybody’ can do, they can do the following:
§ Submit proposals directly to their group bypassing the moderation.
§ Can comment on proposals that are in the closed group layer.
§ Can edit their own proposals at the closed group layer.
Administrators of closed groups: In addition what ‘Members of closed groups’ can do, the administrators can do the following:
§ Reject proposals that are in their group.
§ Pass the proposals to open discussion layer.
Update and Revision Committee (URC) members of the WHOFIC network are members of this group
§ Can comment on the proposals that are at the closed discussion Layer.
§ Can edit their own proposals at the closed discussion Layer.
§ Can vote on the proposals when they are at the Closed Discussion Layer.
Decides when to move the proposals to a different layer. (i.e. Open discussion layer to closed discussion layer, etc.)
§ Can also send proposals to an upper layer if necessary.
§ Can reject proposals at any layer.
§ Can mark the proposals as “Accepted”.
§ Set the opening and closing dates for voting rounds for the update proposals.
Note: Most of these decisions are taken by the General Update and Revision Group but they can be implemented in the platform by the Update and Revision Administrator.
§ Assigning users to groups
§ Assigning the administrators of the groups and moderators
The ICD Update and Revision Platform can be accessed from the following web link:
The only requirement is an internet connection and a web browser. For best user experience you need to use Internet Explorer 6.0 or Mozilla Firefox 1.5 or a newer version of these browsers. We strongly recommend you to upgrade your browser if you are working with an older version.
When you enter this site the first thing you see is a log-in screen. If you don't have a user account yet, you may create one for yourself by clicking on the "Create an account in our system link"
This will take you to the screen below in which you provide basic information for your account. Fill in the form and click on "Create User"
Finally, you will see the following screen once your account is created.
The program has icons where ever there is any additional help available. Clicking on this icon will give you more information about that particular feature of the site.
In addition to the help pages, the platform has tooltip functionality for most of its features. This means that when you move your mouse pointer on an icon or text on the screen, it gives you more information on that item in a small popup window as shown below. Please note that you do not need to click on the item. Just move the mouse pointer.
User Profile is the place where you provide more information on yourself and your preferences. You may always update this information from the User Profile/Edit User Profile menu.
In addition to your contact information, we have two more fields in the user profile:
It is a list of ICD items that you are more interested in. If specified, the system will customize the home page accordingly to emphasize the changes in these sub-domains.
Syntax: A comma separated list of entries.
Eg: Ch02, F30, A00-A09 means that you are interested in the whole Chapter 2, code F30 and its children and block A00-A09.
The system may send you notification emails when:
§ there is a new proposal,
In order to set up this functionality you need to fill the “Notification Domains” field in your profile.
Syntax: A comma separated list of entries.
Eg: Ch02, F30, A00-A09 means that you'd like receive notifications for the whole Chapter 2, code F30 and its children and block A00-A09. The system will send you notifications on every change in the system if you type ICD in this field will
The email notifications will be cumulated and sent to you either once a day or once a week depending on your choice in the Notification Type field.
Check Limited Notification if you would like to receive notification emails only after the proposal reaches the Closed Discussion layer. Note that in this case you will not receive any more notifications for the proposals that are in the Open Discussions layer. See the Proposal Lifecycle section of this document for more information on the states of proposals.
The home page consists of two columns. On the left side we have news that relate to the platform and the right side of the home page is used as a quick access to a list of proposals. By default this page will display all active proposals. However, if you have customized your “selected ICD domains” in your profile it will only list the relevant proposals. For example, if a user has marked chapter 1 and 2 as selected domains in her user profile then she will only see the active proposals in these domains. (See “Updating your User Profile” section for information on how to set this up)
If the user is a moderator, he/she will also see the proposals waiting for moderation in this part of the screen.
In this screen you will see the ICD-10 classification hierarchy on the left side
You may click on the + to expand the tree and see the children items. When you click on an item text in the ICD hierarchy, the application will display you the list of proposals in that part of the classification. The numbers near the ICD titles show the number of active proposals in that domain including the proposals attached to the children items. The [add] button can be used to add a new proposal to a domain.
Once you see the list of proposals, you may click on any proposal title to see the details on a new screen. If you have the necessary access rights you will also see the [Edit] text near the proposal title. Clicking on this [Edit] will take you to new page in which you will be able to edit the proposal. Domain moderators and administrators and the originator of the proposal can modify proposals using this button. (See “Groups and Access Rights” section for the details on who can perform which operations)
The small clock icon at the top right can be used to set notifications on the selected ICD domain so that the system sends you an email whenever there is a new proposal or when the existing proposal is updated or when there is a new comment. This is equivalent to setting notifications using the User Profile.
The platform displays list of proposals in several different screens. For example, in the home page it displays the list of proposals that are in your selected ICD domains or in the ICD-10+ screen it displays the list of proposals that are linked to the ICD code that you have selected in the ICD hierarchy. And in the search output, it displays the list of proposals that matches your search criteria. In all of these lists, several icons are displayed in the list which gives some more information on the proposal. It is not necessary to know the meanings by heart as you may always drag the mouse on any icon read the tooltip.
Basically these icons show the following:
The arrow shape (displayed only in the ICD-10+ screen) shows whether the proposal is attached directly to the selected ICD10 item or to one of its children.
Yellow or red small page icon shows whether this is a major or a minor update proposal.
Colored squares show which layer (state) the proposal is in. (See Proposal Lifecycle section for the list of layers). The colors used here are similar to the colors used in Figure 1
R or U icon shows whether the proposal is an Update or an ICD-11 Revision proposal.
IMPORTANT! Everything that you type is saved AFTER you click the “Save changes” button at the bottom of the screen. If you'd like to cancel the changes simply click on the "Home" or ICD-10+ menu button.
Some proposals may affect multiple parts of the classification and in this case the most relevant is used as the primary code and the rest can be given in the "secondary codes affected" field in the proposal screen.
If the proposed action is an addition of a code, it should be attached to the parent category.
If the proposal is about a change in the rules and guidelines that does not specifically deal with a code or a group of codes then it should be attached to relevant part under the OTH category which is displayed at the bottom of the ICD hierarchy. In this category we have non-code specific parts of Volume I and the full Volume II so that the user may be specific about where the updates need to be made.
Normally, the changes in the index should also be marked as using the primary and secondary ICD codes that they affect. However, if the proposal is about a lead term change in the index that affects many codes (greater than 10), the proposal can be attached directly at the OTH area.
See the section Fields of the Add and Edit Proposal Screens for the details
This is done by simply clicking on the proposal text in the proposal list located at the right side of the home page or the ICD-10+ page or in the search results. This will take you to a new page where you may read the details of the proposals and send your comments on this proposal. Adding comments is done by clicking on the “Add new Comment” link.
This is done by clicking on the [Edit] button located in the list of proposals. Note that this button is available only if you have sufficient access right to modify the proposal.
When you are in the Edit screen, the program will display the proposal to you in a format that you may make changes. Once you make your modifications click on the "Save Changes" button located at the bottom of the page. The updates will be saved and the old version will be archived in the system.
See the section Fields of the Add and Edit Proposal Screens for the details
This is also done from using the [Edit] link as above.
If you have sufficient rights, the system will give you options on changing the state of the proposals. For example a moderator can change the state of a proposal from “Moderation Layer” to “Open Discussion Layer”. Similarly, administrator of the closed groups may send the proposals to “Open Discussion Layer”. See the Proposal Lifecycle section for more details on the possible states of a proposal.
Standard users cannot perform this action even on their own proposals.
If the user has sufficient rights, he/she will see rejecting and deleting options in Edit screen under the “Proposal State”. Changing the state as “Rejected” or “Deleted” will mark the proposal so that it will no longer be an active proposal and can only be accessed via the “Search” function.
Title: A short title for your proposal
Proposal State: See the Proposal Lifecycle and the Changing the State of a Proposal sections
Update or Revision Proposal: This field shows whether the proposal suggests an update that can be achieved in the usual ICD update cycle or whether it is made for the ICD-11 revision.
Primary Code affected: This is automatically filled after you click Add. See also the section: Selecting where to attach the proposal.
Secondary Codes affected: See the section: Selecting where to attach the proposal
Volumes Affected: Check all of the ICD Volumes that will be changed as a result of your proposal.
Proposal Type: The program lets you pick only one from the selection. However, in some cases the proposal may be suggesting more than one of the listed options. In such cases, the user should pick the most important one.
Adjustments of this kind of selection rules may be made in consultation with the URC.
Change Reason: Similar to the field above, the user should pick one item from the list.
Updates Specific to a Language Version: By default it is set to "not language specific". Change this if the proposal is specific to one language version. (for example a typo correction proposal specific for one language version of the classification.)
Detailed Description: This is where the user explains the proposal. He/She may provide the updated version of the ICD text using strikethrough text for the removed parts.
Rationale: Place here why this change is necessary.
Supporting web links: You may link to Web pages that are related to your proposal. The main usage for this feature is to link to relevant publications included in PubMed.
To do this find the article from PubMed (http://www.pubmed.com) and then copy the URL from the address bar to the Web Address field. Provide a title for the link and click Add. You may add more than one link per proposal.
Supporting Publications (File Upload): You may also upload files (pdf, doc, rtf, txt, xls) with your proposals. Please make sure not to upload any copyrighted material.
Proposal Summary: If the proposal is a revision proposal, a summary of the proposal and the discussions are prepared by the editor and placed in this field after the discussions.
Reason for Deletion: If the proposal is deleted the reason for deletion can be placed in this field. This field is accessible only when the proposal is Deleted or Rejected.
Scheduled Implementation Date: Available only after the state of the proposal is changed to “Accepted”. It consists of Month and Year fields.
Search functionality is accessed from the Search/Filter/Report tab of the main menu.
In addition to simple text searching functionality, the system allows you filtering the results according to many different parameters that can be used in combination with others.
For searching, you need to define your criteria on the search page and then click on the Search button.
This takes you to second screen where you see a list of proposals that match your criteria. You may open these proposals by clicking on them. You may also edit them using the [Edit] link if you have updating right on the proposal.
Below you may find detailed explanations of the search fields shown in Screenshot 9
Search text: This is the field to use if you'd like to search for a text within the proposals. If you type multiple words here, you may tell the system to use "all words match", "any words match" or "exact phrase match".
Limit results to my selected ICD Domains: If you have defined “selected domains” in your profile, then by checking this you are asking the system to give the results that are only in your selected ICD domains.
Limit results to certain ICD domains: Use this field if you'd like to manually list the ICD domains to be included in your search. For example, typing 01 will limit the results to the proposals under the Chapter 1. Typing F30 will give the list of proposals under F30 code and its children. You may use a comma separated list if you'd like to include multiple parts of the ICD, e.g. F32, F60, I10.0
Find proposals that affect: You may also limit the results according to ICD volumes that are affected.
Limit results to the ones originated by me: Checking this will list the proposals that have been originated by you.
Include Major/Minor: You may use this field if you’d like to limit the results to Major or Minor update proposals.
Limit the results according to the proposal state: This feature helps you filter the proposals according to their states. For example, if you just want to see the proposals that have been accepted but not yet implemented you just check “Accepted”. Note that you may use a combination of them. For example, if you’d like to see the deleted and rejected proposals than you need to select “Deleted” and “Rejected” from the list.
Originated by: You may search for the proposals that have been originated by a certain user of the platform. Please note that this field gives a list of users who has entered more than 2 proposals in the system.
Creation date between: You may limit the results according to creation date of the proposals.
Proposals open for voting and have not been voted by: By using this field, you may search the proposals that are open for voting but has not been voted by the selected voter.
Limit the results to ones with the Implementation date: This helps you to limit your search results according to the implementation dates.
For example, if you'd like to see the proposals that have been implemented in the ICD, in year 2006. You need to type 2006 in the “To” and “From” fields.
You may use the criteria above in any combination. But please note: If you are too choosy, you may get no results. After you click the Search button the system will you the results as shown in Screenshot 10.
Sorting: Sorting the results is possible by selecting sort criteria in the search screen (See Screenshot 9 ). One may choose one or two sort criteria.
Predefined Searches: Several predefined searches are available in the search screen (See Screenshot 9). You may click on them to access the predefined selection of proposals. For example, if you click on the “Accepted Proposals” link the system will automatically give a list of proposals that have been accepted but not yet implemented.
Printing a single proposal is done by simply opening the proposal and using the Print function of your browser.
If you’d like to print multiple proposals, you need to start from the “Search/Filter/Report” main menu as explained in the Searching and Filtering section. Here, you define the criteria and the sort order for the proposals to be printed. Once you have the list of proposals as shown in Screenshot 10, you may then click on the “Generate Report”. The resulting page will display all of the proposals with the degree of detail you have chosen. This page can be printed with the “print” functionality of your browser.
The concept of closed groups is created in the platform to allow starting the discussions in a closed group of experts before opening it up to all of the users. If you are a member of a closed group, you will see an additional tab in your main menu as shown in Screenshot 11.
In addition to this you will have read only access to all of the closed groups and their proposals from the “All Groups” tab of the main menu. This tab is available even if you are not a member of any closed group.
Voting for a proposal is possible, when the proposal reaches the “Closed discussion” layer. (See the section Proposal Lifecycle ) When the proposal is at this stage the voting function becomes visible right after the Proposal text and before the user comments.
Here, the system let the "voters" submit their votes on the proposals. Ordinary users do not have this right. They can only see the votes but cannot vote themselves.
Each vote can be accompanied by a voting comment in which the voter can explain the reason for his/her vote.
By default, the system shows only the summary of the votes but clicking “Show Details” button will make the system display the votes and voting comments of each voter. Voting comments are also displayed in the Comments subsection.
Voting can be done in several rounds and the Update and Revision Administrator (See the section Groups and Access Rights) defines the starting and ending dates of these rounds.