ICD-11 presented at the World Health Assembly in May 2019 for adoption by Member States, and will come into effect on 1 January 2022. This release is an advance preview that will allow countries to plan how to use the new version, prepare translations, and train health professionals all over the country. The ICD-11 is the eleventh revision of the International Classification of Diseases. It will eventually replace the ICD-10 as the global standard for coding health information and causes of death. The ICD-11 is developed and regularly updated by the World Health Organization (WHO).
A Content Model is a structured framework for defining each ICD entity in a standard way and provides the basis for ICD entities to allow for computerisation. Items used in other 5 members of the WHO Family of Classifications have been aligned with or linked to, for consistency wherever possible, as have other classifications and terminologies. The more traditional statistical classification for mortality and morbidity is obtained from the Foundation component of ICD–11 as a tabular list. Extension codes are used to limit the content volume while allowing for a detailed description of disease entities.
ICD 11 Advantages
Improvements and additions
In the extensive review and overhaul of ICD content and structure, the ICD team in WHO headquarters received over 10 000 proposals for the revision of ICD11 and unprecedented involvement of health care workers in collaborative meetings and proposal development. The following are some of the major areas and concepts developed and included in the ICD11:
- New primary care concepts for application in settings where simple diagnoses are made;
- A section on the documentation of patient safety events has been fully overhauled and systematically tested. It allows for all necessary detail and complies with the WHO patient safety framework;
- Coding for Antimicrobial Resistance, which was missing in ICD10 to enable data documentation and analysis consistent with the WHO Global Antimicrobial Resistance Surveillance System (GLASS);
- HIV coding has been updated with new subdivisions and removal of outdated detail, as well as codes for differentiating ‘HIV with malaria or tuberculosis’;
- New supplementary section for Functioning Assessment. This section allows Monitoring of functional status through the recording before and after the intervention, and permits the calculation of a summary functioning score using the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) or the WHO Model Disability Survey (MDS) (both a domain specific or an overall summary score);
- In collaboration with several partners, including OrphaNet, ICD11 has incorporated all rare diseases. Only a few of these have an individual code, but all have their own Uniform Resource Identifier (URI), allowing rare disease Registries and researchers access to detailed epidemiological data on conditions of interest;
- The use of the URI facilitates linkage with other information interchange products and terminologies;
- Traditional Medicine is an integral part of health services provided in many countries, such as China, India, Japan, and the Republic of Korea. It has not been based on standard classification, nor been possible for health authorities to monitor or compare internationally or regionally. A new Supplementary Chapter for Traditional Medicine provides standardized descriptions for data capture and allows for country-level monitoring through dual documentation alongside mainstream practice, as well as international comparison.
Up-to-date scientific knowledge
Medicine is a continuously evolving applied science, incorporating new technologies at an unprecedented rate. Therefore, the ICD needs the ability to reflect this evolution and to capture clinical detail in the field accurately.
Since its First Edition in 1900, up to its Tenth Revision in 2016, the ICD has grown from a list of 179 categories to over 12 000 categories, demonstrating how much medical knowledge and technology has evolved. The 11th Revision contains more than 55 000 unique entities, more than 120 000 derived from the latest scientific knowledge and reflecting current practices and diagnostic concepts. These entities point to some 17000 categories. ICD11 flexibility and accuracy allow for the resulting health information to be used in a wide range of applications, including improvement of patient outcomes, patient safety and quality analysis; population health reporting; integrated care; strategic planning and delivery of health care services. Its ontological structure allows to code millions of clinical terms using combinations of above-mentioned categories and entities, and still preserving the integrity for meaningful data aggregation for the different uses of ICD.
Ease of use
The new technological infrastructure of ICD11 results in more straightforward coding. The digital structure allows the Coding Tool to be embedded into the local digital record and IT systems, using either a local or web-based version of the system provided by WHO (known as the Application Programming Interface or API). Clinicians can search for diagnosis using natural or preferred terminology, which then relates this to the correct technical code (without requiring the clinician to memorise these). Its integration with existing digital record systems combines recording with coding, reducing the number of steps needed to obtain complete documentation and increasing user compliance. This also results in lowered costs and times for training.
The ontological core of ICD11 can be quickly expanded to include new terms, synonyms, and concepts, or for improved user guidance, in all language versions. Specialty customized versions facilitate the use in departments with very focused practices, such as for mental health. For situations where paper-based documentation is used, a printed index or relevant subsets can provide quick access to the code.
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Source: ICD 11 Guide