FIFTH REGIONAL STEERING GROUP

MEETING
BANGKOK
17-19 SEPTEMBER 2019

Dr. Azza Badr,

Technical officer, Vital Statistics and Country Support
WHO/EMRO
icd.who.int
ICD-11
Global Standard for Health Information

is the international standard for recording,

reporting and measuring health & health
services
➢ Mortality Statistics
➢ Morbidity Statistics
➢ Quality and Safety
➢ Primary care
➢ Health Care Costs
➢ Clinical documentation
➢ Progress towards SDGs

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ICD-11
Multiple Uses
ICD-11
Much more than diagnoses

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 WHO Family of International health related
Classifications (WHOFIC)
RELATED Classifications REFERENCE Classifications Special versions
Covering other relevant Derived from reference
dimensions in health classifications

International Classification
I nternational
C lassification of Application of the International
of Primary Care (ICPC)
Classification of Diseases to
D iseases • Dentistry and
The Anatomical, Therapeutic,
Stomatology
Chemical (ATC) classification
• Dermatology
with Defined Daily Doses I nternational • Neurology
(DDD)
C lassification of • Paediatrics
F unctioning, • Pain
ISO 9999 Technical aids for
• Oncology
persons with disabilities – Disability & Health • Mental and
Classification and
Behavioural Disorders
Terminology
I nternational ICD national applications
International Classification C lassification of
of Nursing Practice
H ealth ICHI national applications
I nterventions

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WHO Family of International health related
Classifications - Terminology view

ICF ICD-11 ICHI

Related Classifications
and terminologies

Extension Codes ICNP, ICPC, ATC,

WHO INN (medicaments) ISO 9999, SNOMED,
WHO Devices Orphanet
Histopathology (tumours)
Anatomy
Details of external causes
Severity
 ICD Revisions

30 28

25
Interval (years)

20

15
15

10 10 10 10 10
10 9 9
7 7

0
ICD-1 ICD-2 ICD-3 ICD-4 ICD-5 ICD-6 ICD-7 ICD-8 ICD-9 ICD-10 ICD-11
1900 1909 1919 1929 1938 1948 1955 1965 1975 1990 2018

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 ICD-11
Revision was more than necessary
 Improve usability
– Less training

 Update scientific content

 Enable coding of all clinical detail

 Make eHealth (digital) ready for use in electronic(digital)

environments

 Linkage to relevant other classifications and terminologies

 Full multilingual support on translation and output

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 ICD-11 Timeline

2001 Start planning

2007 Start ICD-11 editing

2019 Adoption World Health Assembly

2022 Official reporting with ICD-11

Note: national use can start earlier

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 ICD-11 Scientific clinical input

 Extensive participation by national and international

scientific societies

 Over 300 clinical specialists organized in 30 topic

advisory groups, 270 Institutions, 55 countries

 Input from clinical modifications of old ICD-10 – and

they were based on clinical needs

 Reviews, testing, commenting => 99 countries

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 ICD-11 Foundation – input from ICD-10 and
derived classifications, links
National needs
Clinical needs (ICD-10 national modifications Australia,
(ICD-10MM, ICD- Canada, Germany,…) ICF
10 DA…) (Functioning)
• Index
• ICD 11 for
Mortality and
Cancer Morbidity Statistics Terminologies,
registratio • Specialty versions eg SNOMED
n • Content model Orphanet
(ICD-O) • Extension codes ICPC

Substances External causes of injury

INN (=> ATC) ICHI dimensions (International ICECI
Classification of Health Interventions)

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 Examples of problems solved with ICD-11
 Antimicrobial resistance - essentially missing in ICD-10

 HIV subdivisions - outdated detail in ICD-10

 Skin cancer - melanoma types missing – basalioma missing in ICD-10

 Valve diseases - outdated structure, need by valve, less rheumatic

 Postprocedural conditions - clarify when use 19 and when not for

postprocedural

 Diabetes coding clinically more relevant and flexible

 External causes - Loosing detail in non-accidents; traffic accidents

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 ICD-11 IT friendly –

 Web services – full functionality available in the software of

choice - you keep your preferred software user interface
– Online services – everybody can use ICD without any local
software
– Offline services –all the functionality on a local computer
and updates when internet is available

 Output files – formats include CSV, ClaML and others as

necessary

 Print version – Real paper version gives look and feel of the past

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Web services

https://icd.who.int/icdapi
 ICD-11 User friendly

 Easier coding – coding tool, more instructions built in

 Guidance how to use code combinations

 Specialty versions focus on needs for particular

specialties

 And all features are available for every language

version

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 Browser and Coding tool

https://icd.who.int

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 The ICD-11 browser

 Blue browser is the official release of ICD-11

 Not only a search tool, but (orange brower) also the

mechanism to add proposals and comments after registering

 Registered users are able to:

– Comment on the content
– Submit proposals for change
– Read comments and proposals from others
– Access PDF or Word versions of the classification

 Multiple languages – controlled translation platform

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 ICD-11 Browser

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 ICD-11 Coding tool

 This tool works by searching all ICD-11 terms and is the

ICD-11 index

 Generates and dynamically updates two different outputs

– Word list
– Matched entities

 Synonyms, word completion… - like online search engines

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 Simple search

Type a diagnostic statement into the Coding Tool

e.g. cancer of stomach

The Coding Tool will find the best match

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 Simple search

Type a diagnostic statement into the Coding Tool

e.g. Osteoarthritis of right knee

The Coding Tool will find the best match including the code
combination (postcoordination) information for left or right
(laterality)

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 Flexible search

Type a diagnostic statement into the Coding Tool

e.g. splenic flexure colonic liposarcoma

The Coding Tool does not find a match but …. there is flexible
search

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 Flexible search cont.

Try flexible search

The Coding Tool now finds

an almost exact match

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 No change to ICD-10

 Conditions included in following chapters have not been

subjected to moves:
– Maternal
– Perinatal
– Injury
– Tumour

 Mortality coding rules have kept their intent

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 ICD-11

 26 chapters, (17000 codes)

– Special tabulation lists
(for analysis only, e.g. infections by agent)

 Functioning section (for assessment)

 Supplementary chapter traditional medicine

diagnoses

 Extension codes

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 Special Topic gaming disorder

 Only for very serious cases

– impaired control over gaming
– increasing priority given to gaming - takes
precedence over other life interests and daily
activities;
– continuation or escalation of gaming despite the
occurrence of negative consequences.
– over a period of at least 12 months
.

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 Reference Guide

 Detailed description of structure of ICD

 Detailed description of differences between ICD-11 and ICD-

10

 Rationale for changes

 Updated mortality rules

 Fully rewritten morbidity rules

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 Mortality Rules – Principles for revision

 Basically no major changes in the rules

̶ Minimizing the rule change would allow assessing the impact of
structure change better

 Text has been formatted using more easy wordings

̶ In order to enhance user understandings

 Detailed review reflects the classification structure change to

the mortality rules

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 Morbidity rule sets

 Based on many countries experience with ICD-10

 Rules for coding an episode (main diagnosis)

– Additional rules for coding patient safety
– Additional rules for coding traditional medicine

 Recommendations for recording

– Main diagnosis
– Main intervention
– Additional diagnoses
– Additional interventions

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 Morbidity Rules

New definition of main diagnosis:

Reason for encounter
after assessment at the end of the stay!!!

Patient comes with cough

=> examinations
=> has pneumonia (that explains the cough)
=> Main diagnosis is pneumonia

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OPTIONAL Extension codes – add all the detail you
need, if you want
Type 1 Type 2
 Severity  Main Condition
 Temporality (course of the condition) – Reason for encounter
 Temporality (Time in life) – Reason for admission
– Main Resource Condition
 Aetiology
 Anatomic detail Topology Anatomic  Present on Admission
location – Developed after admission
– Uncertain timing relative to admission
 Histopathology (ICD_O)
 Biological Indicators  Provisional diagnosis
 Consciousness  Diagnosis confirmed by…
Medicaments (WHO INN*)
 Substances Chemicals
– Lab
–
 External Causes detail –
Serology
Histology
 Injury Specific detail – Genetics
 Health
. Devices, Equipment and Supplies – Imaging –
– Unspecified means

 Differential Diagnosis
*International Nonproprietary Names: https://www.who.int/medicines/services/inn/en/

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ICD-11 - Devices
24.09.2019
34

Patient safety

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ICD-11 - Devices
24.09.2019
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A clinical example - device

A respirator malfunction causes a barotrauma with air

embolism in a patient

Coding:

 PK9C.1& XD4M09 Cause of harm (medical devices

associated with injury or harm & Ventilator, Adult)

 PL12.1 Mode/mechanism (Functional device failure)

 NF0A.0 Harm (Air embolism, traumatic)

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ICD-11 - Devices
24.09.2019
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A clinical example - medicament

A patient presents with an intracranial hemorrhage arising while
on warfarin anticoagulation. INR found to be 7.0 and careful
history reveals patient to have accidentally taken double doses
over several days.

Coding:

– PH80 & XE9AC Code for the cause of harm (exposure to

drug in therapeutic intent & warfarin)
– PH92.0 Code for mode/mechanism (overdose)
– 8B00.Z Code for actual harm (intracranial hemorrhage)

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 Spanish

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 Chinese

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 Bilingual version

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 Implementation package

 Browser, Coding tool, API

 Reference Guide (user manual - online)

 Information material (online)

 Transition guide

 Translation tool

 Mapping between ICD-11 and ICD-10

 Training material (in preparation)

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 ICD-11 for you – by you – for best possible health for all people
Thank you

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