ICD-10-CM/AIS Mapping Software |
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Terry Shelton
National Highway Traffic Safety Administration
June 12, 2014
[Federal Register Volume 79, Number 113 (Thursday, June 12, 2014)]
[Notices]
[Pages 33799-33802]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-13727]
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DEPARTMENT OF TRANSPORTATION
National Highway Traffic Safety Administration
[Docket No. NHTSA-2014-0062]
ICD-10-CM/AIS Mapping Software
AGENCY: National Highway Traffic Safety Administration (NHTSA),
Department of Transportation (DOT).
ACTION: Request for information.
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SUMMARY: This notice announces NHTSA's Request for Information (RFI)
and comment on the potential development of a mapping software to
translate the International Statistical Classification of Diseases and
Related Health Problems, 10th Revision, Clinical Modification (ICD-10-
CM) discharge diagnoses into Abbreviated Injury Scale
[[Page 33800]]
(AIS) pre-dot codes, injury descriptors, and severity scores. NHTSA is
issuing this RFI in collaboration with, and on behalf of, its member
agencies within the DOT Traffic Records Coordinating Committee (DOT/
TRCC), specifically the Federal Highway Administration (FHWA), the
Federal Motor Carrier Safety Administration (FMCSA), and the Bureau of
Transportation Statistics (BTS). Feedback and comments on any aspect of
the RFI are welcome from all interested public, private, and academic
entities. While all feedback is welcome, DOT is particularly interested
in feedback on the questions provided in the last section of this RFI.
DATES: Comments must be received no later than August 11, 2014.
ADDRESSES:
Comments: You may submit comments [identified by Docket Number
NHTSA-2014-0062] by any of the following methods:
Internet: To submit comments electronically, go to the
U.S. Government regulations Web site at http://www.regulations.gov.
Follow the online instructions for submitting comments.
Fax: Written comments may be faxed to 202-493-2251.
Mail: Send comments to Docket Management Facility, U.S.
Department of Transportation, 1200 New Jersey Avenue SE., West Building
Ground Floor, Room W12-140, Washington, DC 20590.
Hand Delivery: If you plan to submit written comments by
hand or courier, please do so at 1200 New Jersey Avenue SE., West
Building Ground Floor, Room W12-140, Washington, DC between 9 a.m. and
5 p.m. Eastern Time, Monday through Friday, except federal holidays
You may call Docket Management at 1-800-647-5527.
Instructions: For detailed instructions on submitting comments and
additional information see the Comments heading of the Supplementary
Information section of this document. Note that all comments received
will be posted without change to http://www.regulations.gov, including
any personal information provided. Please see the Privacy Act heading
in the SUPPLEMENTARY INFORMATION.
FOR FURTHER INFORMATION CONTACT: For questions about the program
discussed herein, contact John Kindelberger, Mathematical Statistician,
Office of Data Acquisition, Room W53-446, 1200 New Jersey Avenue SE.,
Washington, DC 20590. Telephone: 202-366-4696. Email:
john.kindelberger@dot.gov.
SUPPLEMENTARY INFORMATION: On January 16, 2009, the U.S. Department of
Health and Human Services (HHS) published a final rule adopting ICD-10-
CM to replace ICD-9-CM in transactions covered by the Health Insurance
Portability Accountability Act (HIPAA). The deadline for adopting ICD-
10-CM has been postponed several times but is currently scheduled to
take place at some point after October 1, 2015 (http://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/icd10).
The ``Moving Ahead for Progress in the 21st Century'' Act (MAP-21),
signed into law on July 6, 2012, requires the FHWA to establish
measures for State departments of transportation to assess and report
numbers and rates per vehicle mile traveled of roadway fatalities and
serious injuries. [Sec. 1203; 23 USC 150(c)]. In Notice of Proposed
Rulemaking 79 FR 13845 (Mar. 11, 2014), which can be found at http://www.regulation.gov, the FHWA recommends that States prepare themselves
so that no later than January 1, 2020, all States use a medical record
injury outcome reporting system that links injury outcomes from medical
records to crash reports.
The DOT seeks comments and information from the public sector,
private sector, and academic communities concerning the potential
development of ICD-10-CM/AIS mapping software that would address the
issues described in this RFI. While comments are welcome on any area of
the RFI, the DOT is particularly interested in responses to the
questions listed below. Responders are reminded that feedback or
comments on any aspect of this notice are welcome from all interested
public, private, and academic entities. While all feedback is welcome,
the DOT is particularly interested in feedback on the following
questions. Respondents may respond, to some, all, or none of these
specific questions:
1. Is there a need for a mapping tool that translates ICD-10-CM
codes to the AIS standard?
2. Is there a need for an updated mapping tool that translates ICD-
9-CM codes to the AIS standard?
3. Are any steps currently being taken to develop a mapping tool?
4. What capabilities should such a mapping tool possess?
5. What platforms should the mapping tool run on?
6. Should the mapping tool be non-proprietary?
Injury data enables epidemiologists, researchers, and policymakers
to better identify the severity of injuries in addition to where, when,
and why they occur. This data is, however, frequently spread among
discrete databases that are difficult to link to each other or to
injury causation data. The ability to link these datasets together is
thus critical to efforts to understand injury trends, set injury
prevention priorities, identify high risk populations and geographic
areas, and develop targeted injury prevention strategies. The DOT,
however, is particularly interested in forging and maintaining links
among vehicle crash and injury datasets as such links can provide more
complete information and better understanding of crash outcomes.
State trauma registry and hospital discharge databases are two of
the more significant sources of injury data. Trauma registries are
designed to collect large amounts of information about the most
seriously injured patients and are not typically used for injury
surveillance purposes on their own. Hospital discharge datasets are
designed primarily to monitor hospital census, utilization, and
financial information but record enough information--like diagnosis
codes and external cause/E-codes--to make them useful injury
surveillance tools. In addition, the pre-hospital emergency medical
services (EMS) patient care reports, compliant with the National EMS
Information System (NEMSIS) Standard, may be helpful, as they can serve
as good link between the crash data and hospital data. NEMSIS data is
submitted to the state level by local EMS agencies, and the collective
statewide data is submitted to the National EMS Database. The most
effective linkage point at this time is at the State level.
These datasets are generally coded using different methodologies.
Trauma registries use the Abbreviated Injury Scale while hospitals and
emergency departments use the International Statistical Classification
of Diseases and Related Health Problems for diagnosis, reporting, and
billing.
The Abbreviated Injury Scale (AIS), developed by the Association
for the Advancement of Automotive Medicine (AAAM), is an anatomically
based, consensus derived, global severity scoring system that
classifies each injury by body region according to its relative
importance on a 6-point ordinal scale (1 = minor and 6 = maximal). The
AIS is the basis for the Injury Severity Score (ISS) calculation of the
multiply injured patient. The AIS is protected by copyright, and both
individual use and site licenses can be purchased from AAAM (http://www.aaam.org/about-ais.html).
[[Page 33801]]
The maximum AIS (MAIS) severity level is a recognized person-level
injury severity indicator. For example, the Organization for Economic
Co-Operation and Development's International Traffic Safety Data and
Analysis Group (IRTAD) has recommended that MAIS of level three or
higher be used as the standard for a seriously injured person in a
motor vehicle crash (http://www.internationaltransportforum.org/irtadpublic/pdf/Road-Casualties-Web.pdf).
Maintained by the World Health Organization (WHO), the
International Statistical Classification of Diseases and Related Health
Problems (ICD) is the international standard diagnostic tool for
epidemiology, health management, and clinical purposes. While a version
of the ninth revision, ICD-9-CM, is currently still widely used in the
US, a replacement based on the tenth revision, ICD-10-CM, has been
developed by a National Center for Health Statistics (NCHS) Technical
Advisory Panel following extensive consultation with physician groups,
clinical coders, and others to assure clinical accuracy and utility
(http://www.cdc.gov/nchs/icd/icd10cm.htm).
In the early 90's researchers at Johns Hopkins University developed
a software tool (ICDMAP) that allowed analysts to generate a Maximum
AIS (MAIS) or an Injury Severity Score (ISS) for each injured patient
in the hospital discharge database using the ICD-9-CM diagnosis codes
of each patient's record. The ICDMAP enabled statewide performance
measurement by MAIS and allowed analysts to associate the severity
outcomes to with crash, vehicle, and roadway circumstances for planning
and/or evaluation of countermeasures.
While the ICDMAP-generated results are not as precise as those
derived by clinicians in trauma registries, this approach has been
validated and yields good sensitivity in estimating severity for
studying the larger universe of injury hospitalizations. Translating
ICD codes to AIS allows all crash-involved injuries to be compiled and
analyzed in terms of AIS and MAIS severity. When linked to causal
information--State crash databases, for example--ICD codes can be used
to improve measurement of crash-related injury severity.
There is not, however, currently any known software or service
capable of translating between ICD-10-CM and AIS. Once hospitals
transition to the ICD-10-CM, combining these two sets of injury data
will no longer be possible, and analyses will be less complete and less
useful. Significant effort is needed to develop a mapping tool that
will enable mapping of ICD-10-CM diagnosis codes with the corresponding
AIS severity codes.
RFI Guidelines
Responses to this notice are not offers and cannot be accepted by
the Government to form a binding contract or issue a grant. Information
obtained as a result of this RFI may be used by the Government for
program planning on a non-attribution basis. This RFI notice is NOT a
solicitation for proposals, applications, proposal abstracts, or
quotations. This RFI notice is not to be construed as a commitment on
the part of the Government to award a contract or grant, nor does the
Government intend to directly pay for any information or responses
submitted as a result of this RFI notice.
Comments
How do I prepare and submit comments?
Your comments must be written and in English. To ensure that your
comments are correctly filed in the Docket, please include the Docket
number of this document (NHTSA-2014-0062) in your comments.
Your primary comments must not be more than 15 pages long (49 CFR
553.21). However, you may attach additional documents to your primary
comments. There is no limit on the length of the attachments.
Please submit one copy of your comments, including the attachments,
to Docket Management at the address given above under ADDRESSES.
Please note that pursuant to the Data Quality Act, in order for
substantive data to be relied upon and used by the agency, it must meet
the information quality standards set forth in the OMB and DOT Data
Quality Act guidelines. Accordingly, we encourage you to consult the
guidelines in preparing your comments. OMB's guidelines may be accessed
at http://www.whitehouse.gov/omb/fedreg_reproducible. DOT's guidelines
may be accessed at http://www.rita.dot.gov/bts/sites/rita.dot.gov.bts/files/subject_areas/statistical_policy_and_research/data_quality_guidelines/index.html.
Privacy Act: Anyone is able to search the electronic form of all
comments received into any of our dockets by the name of the individual
submitting the comment (or signing the comment, if submitted on behalf
of an association, business, labor union, etc.). You may review DOT's
complete Privacy Act Statement in the Federal Register published on
April 11, 2000 (65 FR 19477-78) or you may visit http://www.regulations.gov.
How can I be sure that my comments were received?
If you wish Docket Management to notify you upon its receipt of
your comments, enclose a self-addressed, stamped postcard in the
envelope containing your comments. Upon receiving your comments, Docket
Management will return the postcard by mail. You may also periodically
access http://www.regulations.gov and enter the number for this docket
(NHTSA-2014-0062) to see if your comments are on line.
How do I submit confidential business information?
If you wish to submit any information under a claim of
confidentiality, you should submit three copies of your complete
submission, including the information you claim to be confidential
business information, to the Chief Counsel, NHTSA, U.S. Department of
Transportation, 1200 New Jersey Avenue SE., Washington, DC 20590. In
addition, you should submit a copy, from which you have deleted the
claimed confidential business information, to Docket Management at the
address given above under ADDRESSES. When you send a comment containing
information claimed to be confidential business information, you should
include a cover letter setting forth the information specified in our
confidential business information regulation (49 CFR Part 512.)
Will the agency consider late comments?
In our response, we will consider all comments that Docket
Management receives before the close of business on the comment closing
date indicated above under DATES. To the extent possible, we will also
consider comments that Docket Management receives after that date.
How can I read the comments submitted by other people?
You may read the comments received by Docket Management at the
address given above under ADDRESSES. The hours of the Docket are
indicated above in the same location.
You may also see the comments on the Internet. To read the comments
on the Internet, take the following steps:
(1) Go to the Federal Docket Management System (FDMS) at http://www.regulations.gov.
(2) FDMS provides two basic methods of searching to retrieve
dockets and docket materials that are available in the
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system: (a) ``Quick Search'' to search using a full-text search engine,
or (b) ``Advanced Search,'' which displays various indexed fields such
as the docket name, docket identification number, phase of the action,
initiating office, date of issuance, document title, document
identification number, type of document, Federal Register reference,
CFR citation, etc. Each data field in the advanced search may be
searched independently or in combination with other fields, as desired.
Each search yields a simultaneous display of all available information
found in FDMS that is relevant to the requested subject or topic.
(3) You may download the comments. However, since the comments are
imaged documents, instead of word processing documents, the ``pdf''
versions of the documents are word searchable.
Please note that even after the comment closing date, we will
continue to file relevant information in the Docket as it becomes
available. Further, some people may submit late comments. Accordingly,
we recommend that you periodically check the Docket for new material.
Authority: 49 U.S.C. 30111, 30181-83 delegation of authority at
49 CFR 1.95 and 501.8.
Terry Shelton,
Associate Administrator for the National Center for Statistics and
Analysis.
[FR Doc. 2014-13727 Filed 6-11-14; 8:45 am]
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