Applying Medical Terminologies and

ICT for Managing Health Data

By Wondwosen Shiferaw (BSc, MSc)

Health informatics, EMR and eHMIS projects coordinator
FMoH
Disease classification and coding
 Need of HIT Professionals

• Health system: ?????

• Ethiopian health system ????
• National HIS and General Reporting
system ???
• What is HIT and deal with ????
 Disease classification System
• Defined as a system of categories to which
morbidity entities or conditions are assigned
according to established criteria (Set of rules).
• The aim of disease classification is to permit
systematic record analysis, interpretation of
mortality and morbidity data collected in
different areas and at different times.
 Historical development
• In the 18th century, diseases captured the
attention of those determined to organize
knowledge, establish orderly groupings of natural
objects, and develop encyclopedias (books
containing general information about all branches
of knowledge or a particular branch of knowledge).
• Although some groupings of diseases were evident
since early writings of the Greeks and Romans, we
will see two of the most prominent scholars that
influenced the current disease classification and
coding systems.
 Cont…
In 1839, William Farr’s (Epi.) first
attempt at a disease classification
for statistical purposes appeared
in the first annual report of the
registrar-general of births, deaths,
and marriages in England. He
divided these into three classes,
– the first for those that occur
endemically or epidemically, in other
words, the communicable diseases.
 Cont…
– The second class was for those diseases that arise
sporadically: these are further
• Subdivided anatomically into diseases of the nervous
system, respiratory organs, etc., ending with a group for
those of uncertain location such as tumors,
malformations, sudden death, and old age.
• In each anatomical group, he characterized the more
common conditions, ending with a residual category
for the less common or ill-defined conditions.
– His third group was for death due to violence.
Bertillon classification
• Groupings concerning the nature of
diseases tended to lose meaning
over time, therefore, Bertillon had
adopted the anatomical site for
main headings rather than the
nature of disease.
• Bertillon’s list included defined
diseases most worthy of study by
reason of their transmissible nature
or their frequency of occurrence.
 Cont…
• General diseases
• Diseases of nervous system and sense organs
• Diseases of circulatory system
• Diseases of respiratory system
Note: The First
• Diseases of digestive system Revision (ICD–1) had
• Diseases of genitourinary system the same basic
structure as Bertillon’s
• Puerperal diseases original list, except that
• Diseases of skin and annexes the first main heading
was replaced by two
• Diseases of locomotors organs subheadings, one for
• Malformations Epidemic Diseases and
• Diseases of early infancy one for
Other General
• Diseases of old age Diseases.
• Effects of external causes
• Ill-defined diseases
 General Principles of Disease Classification
• Classification is a method of generalization. Several
classifications methods may, therefore, be used by countries
with advantages:
– Healthcare providers, administrators and others, from their point
of view (Such as causes of death and procedures in the way that
they think it is best adapted to their information need.)
– A statistical classification of disease must be confined to a limited
number of mutually exclusive categories that able you to include
the whole range of morbid conditions.
– A specific disease condition/entity which is of particular public
health importance or that occurs frequently should have its own
category. Otherwise, categories will be assigned to groups of
separate but related conditions. Example: Immediately reportable
diseases; Epidemic prone diseases
 Cont…
– Every disease or morbid condition must have a
well defined place in the list of categories and
there will be residual categories for other
miscellaneous conditions that cannot be classified
to the more specific categories.
– As few conditions as possible should be classified
to residual categories.
 Cont…
– It is the element of grouping that distinguishes disease
classification from a nomenclature, which must have a
separate title for each known morbid condition. The
concepts of classification and nomenclature are
nevertheless closely related because a nomenclature
often arranged systematically.
– Disease classification can allow for different levels of
details if it has a hierarchical structure with
subdivision.
– Disease classification should have the ability to identify
specific disease entity and to allow useful and
understandable information to be obtained.
 Clinical coding
– Clinical coding is a process of assigning a distinct
numeric or alphanumeric value to medical
diagnosis, procedures and surgery, signs and
symptoms of disease and ill-defined conditions,
poisoning and adverse effect of drugs,
complications of surgery and medical care.
– Collecting and reporting aggregate information
through codes allows the health facility a simplified
way to provide information quickly and easily.
 Importance of Disease Classification and Coding
• The importance of disease classification and coding are summarized
below with four key areas.

A. Data collection: Coding allows for gathering of important data on a variety of

topics. For example, a code for an infection due to a needle stick may be
tracked over a period of time for risk and quality management purposes
B. Statistics: Because each code relates to a diagnosis or procedure, it allows the
health institutions to provide statistical information on specific diseases and
injuries. For example, statistics on Voluntary Counseling and Testing are
provided through codes.
C. Research: Medical codes are often tracked for research purposes. For
example, in abroad cancer-related codes are reported regularly in order to
determine the funding and resources needed for research.
D. Resource Use: Because medical codes have associated reimbursement, many
abroad hospital administrators and managers use coding reports to ensure that
resources are being utilized properly and to make further decisions about the
most cost-effective services to offer for patients.
Other advantage of classification
and coding
•         Storage,
•         Retrieval,
•         Analysis, and
•         Interpretation
 you
a n k
T h
 Types of coding system
A. Diagnostic coding system: are used to determine disease, disorders
and symptoms and can be used to measure morbidity and mortality.
Ex. ICD-10, ICD-9-CM (International Classification of Diseases, Ninth
Revision, Clinical Modification).
B. Procedure coding system: Are numbers or alphanumeric codes used
to identify specific health interventions taken by healthcare
providers? E.g. ICPM (International Classification of Procedures in
Medicine).
C. Pharmaceutical coding systems: Are used to identify medications
e.g. NDC (National Drug Code).
D. Topographical coding system: Are codes that indicate a specific
location of the body E.g. ICD-O (International Classification of
Diseases for Oncology)
N.B: You can read more about types of coding system on your
reference books listed in the introductory part of this module
 Nomenclature
• Disease nomenclature is a system of naming diseases
to produce lists of acceptable or approved disease
terminology and differs from disease classification
which refers to grouping of diseases or conditions
and organizing into categories in a systematic way .
• The purpose of disease nomenclature is to promote
the use of the most appropriate diagnostic term to
describe a particular disease or condition. A generally
accepted standard medical vocabulary comprised of
unambiguous medical terminology is essential for
precise and effective communication about disease.
 Disease Classification Concepts
• In healthcare like the human language, the words change both
their meaning and forms over time. A healthcare provider today
has very different understanding of the meaning of the word
‘Tuberculosis’ from one who leaved some 400 years ago.
Healthcare is a practical endeavor which demands health care
providers to be able to share the same vocabulary so that they
can discuss and learn from one another.

Terms:
• Medical terminologies or nomenclatures starts with a basic set
of words or terms. A term stands for some defined medical
concept such as ‘Malaria’, ‘skull’ or ‘Amoxicillin’. Most of medical
terminologies used in the healthcare system are discussed.
 Cont…
Code:
• To allow some flexibility, medical language like other languages
permits words to represent the same or similar meanings. However,
since several terms may be used for the same concept, it is necessary
to define a single alphanumeric or numeric value (code) for every
distinct concept in the medical language. This gives rise to coding
process where a set of terms describing certain medical concept is
translated into a code for analysis.
• A terminology should contain a separate name for each disease entity
and any reasonable synonyms as well. A coding system then may
collect many such terms into a single code. The terms and codes in
different terminologies vary depending on how they will be used. For
example if a coding system exists for clinical analysis, the concepts of
interest are at the level of clinical medicine rather than at the level of
public health. Thus, the level of details captured in the codes would be
less fine in the later case, and the concepts would be different.
 Groups and Hierarchies:
• The level of detail captured when terms and codes are
created for statistical analysis and patient management
may be too fine for using to other purposes such as
determining cost of service/care provided and
measuring population health outcomes. Thus, collection
of a number of different codes which are considered to
be similar for a purpose in a single category is known as
Group. For Example with interest of classifying diseases
based on the type of etiologic agents, some coded
diseases listed in the table below are categorized into
viral and parasitic disease groups/categories.
 Cont…
• Viral and parasitic diseases represented by
many terms are categorized into two groups.
Concept Term Code Group Term Code Group Term Code Group
Schistosomiasis Schistosomiasis 12.01 16 ( parasitic
Bilharziasis disease)

Herpes Zoster Shingles 22.02 72(viral disease)

Zona
Herpes Zoster
Measles Measles 54.01

Finding individual terms is very difficult once a set of terms and codes
collected together. Thus, these set of terms and codes should be organized
in such a way that searching for individual terms or codes can be easy. A
terminology need to be organized in a way that it allows concept-driven
exploration.
 Cont…
• One of the common methods of facilitating searching is
creating classification hierarchy. The essence of hierarchy is
that it provides structured grouping of ideas, organized
around some set of attributes.
• There are many ways in which terms can relate to one
another in a hierarchy, depending upon which attributes of
the concept are of interest.
• The most common types of links for hierarchies in the
healthcare are:
• Part –Whole: used to describe the way complex structure is
assembled
• Kind –of ( or Is a): used to describe underling similarities
• Casual -used to explain how chain of events unfold/cause and
effect relationship
 Cont…
Each of these different types of links allows one term to inherit
properties from other terms higher up in the hierarchy. In a Part-
of hierarchy, terms inherit their location from parent terms in
the hierarchical tree. In a kind of link, a child term inherits many
of the properties of the parent terms (See figure 4.1).

Is part of Is a kind of Casual

Body Infection Sever Bleeding

Pneumonia Hypotension
Nervous system
Bacterial Circulatory Collapse
Brain Pneumonia

Staphylococcal pneumonia Death

Cerebrum
 Using Coding Systems
• The process of using terminology to generate codes is
fairly complex task. Ideally, the person who needs coded
clinical data is actually the person best qualified to
assign the code as there is a certain amount of
subjectivity in the coding process.
• Potential distortions can be introduced in to the final
code in health facilities:
• When clinical staff interpreted what they believe is important
to be recorded
• When clinical data coder try to find a set of codes that
matches what he/she interpreted and understood from the
record
 Cont…
• This may improve where the coding might occur at the time the
record is created. Before the Health management information
system reform, in most health facilities of the country,
healthcare providers used to code clinical data at the time of
recording. The disease coding was performed using the disease
coding list derived from international classification of disease
version 6(ICD-6). However, the quality of coded clinical data was
poor for the reasons mentioned below.
– Healthcare providers were overburdened by clinical activities due to
high patient flow
– The disease coding list was outdated so that it couldn’t accommodate
newly emerged diseases such as HIV/AIDS
– No adequate training on clinical data coding
– The purpose of disease coding was poorly understood
 International Classification Diseases (CD-10)

• The Tenth Revision of the International

Statistical Classification of Diseases (ICD-10)
and Related Health Problems is the latest in a
series that was formalized in 1893 as the
Bertillon Classification or International List of
Causes of Death.
• Under this subtopic the principles and basic
structure of ICD- 10 are discussed.
The Basic Structure and Principles of ICD
• The base for ICD is a single coded list of three-
character categories, each of which can be
further divided into four-character subcategories.
• In place of the purely numeric coding system of
previous revisions, the Tenth Revision uses
alphanumeric position and a number in the
second, third and fourth positions. The fourth
character follows a decimal point. Possible code
numbers therefore range from A00.0 to Z99.9.
 Cont…
A. Volume:ICD‑10 comprises three volumes: Volume-1
contains the main classifications; Volume-2 provides
guidance to users of the ICD; and Volume-3 is the
Alphabetical Index to the classification. The focus of
discussion in this context will be the content of volume I of
ICD -10.
B. Chapter: The classification is divided into 21 chapters. Each
chapter contains sufficient three- character categories. The
first character of ICD code is a letter and each letter is
associated with a particular chapter. Letter ‘U’ is not used in
this three- character categories as it is preserved to be used
by world health organization for temporary assignment of
new diseases of uncertain cause.
 Cont…

www. ICD 10. com “Search in the web….”

 Cont…
C. Blocks of categories: Each chapter is divided into
homogeneous ‘Blocks’ of three character categories. The
range of categories is given in parentheses after each
block title. See some of the blocks of categories of
chapter I as an example:

Chapter I: Certain infectious and parasitic diseases Blocks

of Categories:A00-A09 Intestinal infectious disease
– A15-A19 Tuberculosis
– B15-B19 Viral Hepatitis
– B50-B64 Protozoal disease
– B65-B83 Helminthiases
 Cont…
D. Three character categories:
Within each block, the three-character
categories are for:
– Single Condition: Selected because of their
frequency of occurrence, severity and
susceptibility to public health intervention.
Example: A15-A19 Tuberculosis
– Groups of disease with some common
characteristics. Example: B95-B98 Bacterial, viral
and other infectious agents
 Cont…
e. Four –character subcategories:
Most of the three-character categories are
subdivided by means of a fourth numeric
character after a decimal number allowing up to
ten sub categories. Theses sub-categories are not
mandatory for reporting at international level.
Example:
– A15.0 Respiratory tuberculosis, bacteriologically and
histologically confirmed
– A18.1 Tuberculosis of genitourinary system
 Procedure for using ICD -10
This section contains information you need to know in order to utilize
this disease classification system effectively.

A. Use of the tabular list: Inclusion terms: within the three and four
character categories, there are usually listed other diagnostic terms.
These terms are not sub classifications of the category. They may
refer to different conditions or be synonyms and are known as
‘Inclusion terms’ and the lists are by no means exhaustive.
Example:
- G03 Meningitis due to other and unspecified causes
- Incl.: Arachnoiditis
Meningitis
Leptomeningitis
Pachymeningitis
 Cont…
B. Exclusion terms:
• These are terms which are although the
category/subcategory title might suggest that they
were to be classified here, are in fact classified
elsewhere i.e. they are excluded from this
category/subcategory. The code that should be
allocated, for the excluded term which is classified
elsewhere, is written in parentheses.
Example:
– G03 Meningitis due to other and unspecified causes
Excl.: Meningoencephalitis (G04.-)
Meningomylelitis (G04.-)
 Cont…
B. Conventions used in the Tabular list
I. Parentheses (): Are used in three important situations:
• To enclose supplementary words for a diagnostic term that doesn’t
bring any change on the code to be assigned to that diagnostic term.
• Example: Hypertension (Primary) (Essential)
• To enclose the code to which an exclusion term refers.
• Example: Excl.: Meningoencephalitis (G04.-)
• To enclose the three- character codes of categories included in that
block
• Example: Disease of the nervous system (G00-G99)
ii. Square brackets [ ]:
Are used for:
• Enclosing synonyms, alternative words or explanatory phrases
• Example: A07.1 Giardiasis [Lambliasis]
• Referring to previous notes; for example C09.8 over lapping lesion of
tonsil
 Cont…
Colon:
– It is used in listings of inclusion and exclusion terms when the
words that precede it are not complete terms for assignment
to the category or subcategory.
• Example: G03 Meningitis due to other and unspecified causes Excl.:
Meningoencephalitis
‘NOS’
– The letter NOS are an abbreviation for “not otherwise
specified”, implying “unspecified” or “unqualified”.

‘NEC’ stands for ‘Not Elsewhere Classifiable’.

– N.B During your computer lab sessions, you should explore the
online version of ICD-10 for the categories and sub categories
giving emphasis to those infectious diseases.
Thank you