
[Federal Register Volume 79, Number 161 (Wednesday, August 20, 2014)]
[Notices]
[Pages 49372-49374]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-19744]


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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; reopening of comment period.

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SUMMARY: This document announces the reopening of the comment period on 
a Request for Information (RFI) regarding 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 (AIS) pre-dot codes, injury descriptors, and severity 
scores. The original RFI was issued on June 12, 2014, and had a 60-day 
comment period ending on August 11, 2014. In response to continued 
interest in this issue, NHTSA is reopening the comment period for this 
RFI until September 30, 2014.

DATES: The comment period for the RFI published on June 12, 2014 (79 FR 
33799) is extended. Comments must be received no later than September 
30, 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

[[Page 49373]]

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, Chief of the Evaluation 
Division, Office of Regulatory Analysis and Evaluation, Room W53-312, 
1200 New Jersey Avenue SE., Washington, DC 20590. Telephone: 202-366-
4696. Email: john.kindelberger@dot.gov.

SUPPLEMENTARY INFORMATION: On June 12, 2014, NHTSA published a notice 
(79 FR 33799) requesting comment and information 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 (AIS) pre-dot codes, injury descriptors, 
and severity scores.
    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).
    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.

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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 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.

    Issued in Washington, DC.
Terry Shelton,
Associate Administrator for the National Center for Statistics and 
Analysis.
[FR Doc. 2014-19744 Filed 8-19-14; 8:45 am]
BILLING CODE 4910-59-P


