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ICD-11 on the Horizon

ICD-10 took 7 years to implement from the publication of the tabular list.

Currently 64 Member States of the WHO are in different stages of ICD-11 implementation. The projection for the United States is October 2025.

The International Classification of Diseases (ICD) is a classification of causes of death and health conditions developed by the World Health Organization (WHO) to serve as the foundation for identifying health trends and statistics worldwide. WHO initiated development of ICD-11 in 2007. Experts from the U.S and over 90 countries participated in the Joint Task Force and Topic Advisory Groups developing ICD-11’s structure and content. WHO published ICD-11 for review in 2018 and the World Health Assembly adopted ICD-11 on May 25, 2019 to be effective beginning January 1, 2022.

ICD-11 appears to be the largest revision enterprise ever with more than 10,000 proposals received.

  • Internet platform for inputs and collaborative authoring platform (iCAT)

  • Hundreds of scientists / clinicians have contributed

  • More than 90 countries have been involved in production, reviews, testing or commenting

The WHO implemented ICD-11 specifically for the following use cases:

  • Certification and reporting of causes of death

  • Morbidity coding and reporting including primary care

  • Casemix and Diagnosis-Related Grouping (DRG)

  • Assessing and monitoring the safety, efficacy, and quality of care

  • Cancer registries

  • Antimicrobial resistance (AMR)

  • Researching and performing clinical trials and epidemiological studies

  • Assessing functioning

  • Coding traditional medicine conditions

  • Interoperability standard in WHO Digital Guidelines and for Digital Documentation of COVID-19 Certificates (DDCC)

  • Clinical documentation

According to the CDC these are the following needs and uses for ICD-11 codes:

Mortality statistics:

  • Mortality by age, sex, and cause of death is the foundation of public health, globally and in countries: Comparable mortality statistics over time.

  • Sustainable Development Goals (SDG) 2016-2030: nearly a dozen mortality by-cause targets and indicators (NCD, suicide, violence, environmentally related, maternal, etc.)

  • Morbidity statistics (incidence, prevalence, sequelae) are also an essential foundation for public health

  • Morbidity statistics are much less widely applied – Fully implemented in 41 countries – Partially implemented in 6 countries

  • Comparative morbidity statistics are often lacking – based on special surveillance systems, with limitations (e.g. HIV, TB, cancer)

  • Need for simplified lists and tools

Other needs and uses of ICD

  • Administrative tool – Used for reimbursement and resource allocation in significant number of countries; – National clinical modifications in almost 30 countries

  • Clinical research

  • Monitoring specific areas – Health care quality and safety: health-care associated adverse events including AMR – Primary care – Surveillance and identification of reportable events

The CDC further outlines the Need for an 11th Revision

  • Substantial advancements in medicine and the science of disease have occurred over the past 30 years – ICD-10 is outdated both clinically and from a classification perspective – Substantial structural changes were needed to some chapters – Changes could not be handled under the normal ICD-10 updating mechanism – Changes needed were well beyond a major update

  • Increasing need to operate in an electronic environment

  • Need to capture more information, especially for morbidity use cases

  • Decision was made in 2007 to begin work on ICD-11

The WHO identifies the following ICD-11 key features.

  • The eleventh revision contains around 17,000 unique codes, more than 120,000 codable terms and is now entirely digital.

  • Smart coding algorithm: Now interprets more than 1.6 million terms.

  • State of the art Coding tool: Easily codes all detail.

  • Digital reference guide.

  • ICD-11 Download area: Include spreadsheets, pdf version, mapping tables, updates, list of codes that should not be used alone and more.

  • Multilingual integrated API.

  • Multilingual Browser and Coding tool.

  • Offline functionality.

  • Local deployment options for ICD-API: Docker, Windows or Linux service.

  • Technical content model reference guide to define and explain the content model used for the WHO Family of Classifications (ICD-11, ICHI and ICF).

  • Implementation package to facilitate the transition from outdated ICD-10 to ICD-11. This package can be found on ICD-11 page and includes the Transition and Implementation Guide, ICD-11 Fact Sheet, information on ICD-API web services, ICD-11 self-learning training package, training platform, cause of death analysis tool (ANACoD-3), ICD-11 license and more.

CDC outlines it will Contain New Content – 27 Chapters In several instances, some new chapters:

Disorders of the Immune system

Dis. of blood & blood forming organs

Conditions related to Sexual Health

Sleep-wake disorders

Traditional medicine


Sources and Resources

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