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My email to the WHO

[edit]

To: info@who.int
From: manifestation111@gmail.com

Subject: Questions about the ICD-11

Dear sir/madam,

My name is Jimmy and I am a Wikipedia volunteer who edits under the nickname Manifestation. Back in 2020, I wrote an article about the ICD-11. You can find it here: https://en.wikipedia.org/wiki/ICD-11

By the time I submitted the article to Wikipedia, the COVID-19 pandemic had started. I therefore decided not to email you, because I could imagine you had different things on your minds. I forgot about my letter afterwards, but now, two years later, I've decided to send it to you anyway. Better late than never, right?

I am a layman and I have no background in medicine. I wrote the article out of general interest.

I have read several sources on the structure and development of the ICD-11, but there are a few things I don't get. Maybe you can help me?

My questions are as follows:

Q1: Curiously, there are *three* manuals regarding the ICD-11 on the website of the WHO. There is an ICD-11 Reference Guide, an ICD-11 User Guide, and a Foundation User Guide. Wouldn't it be better to merge them into one?

Q2: The Foundation User Guide contains a paragraph that appears to be false, or at least misleading: "Foundation Component is a collection of ALL ICD entities like diseases, disorders... It represents the whole ICD universe". However, the Foundation Component contains more than just the ICD entities. It also includes the ICF and the ICHI. See also this page from who.int, which says: "The Foundation Component represents the entire WHO-FIC universe". Should this be changed?

Q3: The Foundation User Guide uses the term linearization: "A linearization is a subset of the foundation component". The Reference Guide instead speaks of tabular lists: "Several different tabular lists can be built from the Foundation Component". The Reference Guide does not use the term linearization anywhere. Perhaps one term should be used consistently?

Q4: The Reference Guide states that, from the Foundation Component, tabular lists are derived, most notably the ICD-11 MMS. It states that its entities then become categories, and that all categories are mutually exclusive, i.e. every category except for the chapter nodes can only have a single parent. But why would that be? Why do entities become categories, and why should entities/categories in a tabular list *not* have multiple parents? And besides, the ICD-11 MMS contains gray nodes, entities with a different parent node who are also displayed elsewhere because of overlap. This does seem to imply multiple parentship. The User Guide also mentions the mutual exclusivity in a linearization, without explaining it.

Q5: The list at https://icd.who.int/dev11/downloads/ contains several dead links. Can they be repaired?

Q6: The icd.who.int website offers *two* WHO-FIC Maintenance Platforms:
https://icd.who.int/dev11/l-m/en#/
https://icd.who.int/dev11/f/en
What is the rationale behind this? Can't they be merged?

Q7: In the ICD-11 Browser, I can download a spreadsheet file of the MMS (Info -> Spreadsheet File). I have been unable to find a similar file of the Foundation Component in either maintenance platforms (mentioned in the previous question). Is there a location where I can download a spreadsheet of all Foundation entities? If not, why?

Q8: Also, the MMS spreadsheet is missing the gray nodes. It contains a column called "PrimaryLocation", but the cells' values are always "True". I can imagine having the gray nodes in the spreadsheet can be useful in certain situations. Is there a specific reason why they were omitted?

Q9: The urls of the ICD-11 Browser are very different from ordinary urls that one normally encounters on the internet. For example: https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1651053999 . It's a url with another url in it. Compare that to the more natural looking format of the ICD-10: https://icd.who.int/browse10/2019/en#/E10 . What is the reason that the ICD-11 url structure is so aberrant compared to those of other websites?

Q10: icd11.int and icd-11.int are currently not registered. icd11.org and icd-11.org are, but the WHOIS database does not state who owns them. Maybe these domains can be used as a url shortener? Like so:
https://icd11.int/mms/5A10
https://icd11.int/foundation/1651053999

Q11: What is the current status of the International Classification of Traditional Medicine (ICTM) in relation to the WHO-FIC? The Implementation Database mentions the ICTM, see here and here (curiously, it does not mention the ICHI). However, the ICD-11 Reference Guide and the main WHO site do not list the ICTM, see here, here, and here. Is the ICTM a WHO-FIC member, or not?

That would be all. Thanks in advance!

Yours sincerely,
Jimmy

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