PONE-D-22-34808Harmonization of ICF Body Structures and ICD-11 Anatomic Detail: one foundation for two classificationsPLOS ONE

Dear Dr. Martinuzzi,

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Ernesto Iadanza

Academic Editor

PLOS ONE

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Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

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Reviewer #1: Yes

Reviewer #2: No

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: N/A

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3. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: It's always a useful step to begin creating such links across classification systems, and this appears to be a responsible, exploratory effort to begin building those bridges of equivalence and similarity where existing terminologies and hierarchies permit. However, this represents an admittedly small subset (434 relations) of all the complex and dnamic relationships that exist between the FIC terminologies. ICF has 1400 categories, and ICD-11 has 17,000 unique codes and more than 120,000 codable terms. If we consider the varieties of co-morbid conditions where multiple anatomical, physiological, and interventional factors may interact, our models will require both broader and more precise classifications. It's not clear to me what clinical advantage is gained by mapping 434 relations, in the midst of so many other un-mapped relations. It would be helpful in the Abstract to specify what specific scientific or clinical benefits can be expected from this improved cross-classification mapping.

I'm also a bit concerned about the accepted constraints implicit in the harmonization initiative, which prioritize compliance "with the WHO approach to classification modeling and maintenance." This risks constraining future terminologies and relationships within pre-existing frameworks which may simply be, or become, outdated or too crude to represent emerging complexities of scientific discoveries (e.g., chemotherapy vs. bioelectric field therapeutics). The "least common denominator" of harmony may end up giving us classification models that are less usefully precise.

Finally, I think we need to consider the growing relevance of semantic web data science and graph knowledge-base technologies as relevant platforms for making the vast scope of medical classifications and individual patient informatics more dynamically evolvable, make research more precisely and rapidly searchable, and make health informatics more interoperable. WHO's operational conservatism in classification may be locking the world of clinical research and services into obsolescent relational database frameworks of classification that will increasingly not mirror the dynamism and complex interdependencies of human health, Social Determinants of Health, clinical sciences and technological innovation.

Reviewer #2: The authors describe the three WHO classification systems (ICD-11, ICF, ICHI) and their different usage. Developed a user-friendly interface for coders to map the ICD-11 with ICF. Elaborated on the detail different between ICD-11 and ICF in anatomy entities.

The article needs to be revised majorly for publication:

1. Describe the usage of this harmonization? Where and under what situation will the scientists or healthcare workers/administrators use this?

2. Consider artificial intelligence methods. Use the experts’ results as training data for developing a model to reduce the experts’ efforts.

3. Map ICD-11, ICF and ICHI.

4. Supplement the Conclusion part.

5. Describe the innovation of this research.

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Reviewer #1: No

Reviewer #2: Yes: Qiong Wang

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PONE-D-22-34808R1Harmonization of ICF Body Structures and ICD-11 Anatomic Detail: one foundation for multiple classificationsPLOS ONE

Dear Dr. Martinuzzi,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Apr 28 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Ernesto Iadanza

Academic Editor

PLOS ONE

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Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: No

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: I deeply appreciate the authors' efforts in advancing the WHO-FIC through their work. It’s always useful to start from the coding step to try to manage and utilize healthcare data. But the author did not expound on the significance of their work. The WHO-FIC Foundation initially comprised the International Classification of Diseases (ICD), International Classification of Functioning, Disability and Health (ICF), and International Classification of Health Interventions (ICHI), which were designed to categorize distinct domains of health information. From a statistical and data analysis perspective, it is unclear how their work will be used in the future. In terms of medical terminology, pairing ICD and ICF appears to conflict with the primary aim of separating different fields of classification. It is worth noting that the citation does not indicate that the WHO-FIC Foundation intends to amalgamate the three coding systems.

Based on my understanding, the involvement of human interaction in the development of natural language processing (NLP) methods for healthcare is critical but can be both time and cost-intensive. If the authors make their data publicly available, it could prove to be a valuable resource for training NLP methods. In this regard, I would encourage the authors to present their matching results in such a way that they could serve as golden standards for algorithm training, particularly with regard to entity recognition.

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Reviewer #2: Yes: Qiong Wang

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.<quillbot-extension-portal></quillbot-extension-portal>

Harmonization of ICF Body Structures and ICD-11 Anatomic Detail: one foundation for multiple classifications

PONE-D-22-34808R2

Dear Dr. Martinuzzi,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Ernesto Iadanza

Academic Editor

PLOS ONE

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Reviewers' comments:

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