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Brand New Day: ICD-11 On Its Way

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A Brand New Day: ICD-11 On Its Way

Today we are witnessing the advent of technological advancements and complexities. For some, it is a cumbersome challenge. Indeed, for healthcare-related professionals nowadays, some are still transitioning from the previous coding system to the latest iteration. Most have yet to hear the resounding virtues of the coming modifications in the coding system.

Health information managers throughout the world will have to keep up with the constantly changing times. One question lingers, though. Are our establishments and offices battle-ready to cope with the onslaught of this new, radical system?

Definition and Design of the ICD

The International Classification of Diseases (ICD) is now on the verge of its 11th modification. Particularly, the ICD is a compendium of alphanumeric codes compressed into a book. It is specifically structured to describe and identify the diagnoses or symptoms of a patient under medical encounter or care. Currently, each code can run up to seven characters, the basis for establishing necessity for an individual’s medical condition.

Furthermore, the ICD literature contains a description of all known diseases and injuries. Moreover, each disease has detailed diagnostic characteristics and a unique identifier. Experts use this identifier to code mortality data on death certificates and morbidity data from patient and clinical records.

The core of the ICD-10-CM uses one single list of four-alphanumeric-character codes from A00.0 to Z99.0. The first letter of the code designates a different chapter. There are a total 22 chapters (several letters are included in a single chapter together).

Within each chapter, the four-character codes are divided so that they specify different classification axes. The fourth to the seventh characters (numbers after the decimal) are also required for reporting and is used in various ways.

History and Synopsis of ICD

It was during the 1600s and 1700s when the first attempts to systematically classify diseases began. However, users consider the resulting classifications to be of little value. This is largely the result of inconsistencies in nomenclature and poor statistical data.

In the 1800s, experts underscored the importance of creating a uniform coding system. As a result, many medical statisticians commissioned the completion of this task. Then the International Statistical Institute adopted the first international classification of diseases in 1893. With the French statistician and demographer Jacques Bertillon developing the system, it became known as the Bertillon Classification of Causes of Death.

In 1898, the American Public Health Association recommended that Canada, Mexico, and the United States use the same coding system. It also recommended that medical professionals revise the system every decade. In the following years, Bertillon’s classification became known as the International List of Causes of Death, before ultimately becoming ICD.

The ICD became increasingly detailed as several revisions ensued, particularly after 1948. This was when the World Health Organization (WHO) assumed responsibility for publishing the ICD. Also, this was when the WHO began collecting international data for general epidemiological surveillance and health management purposes.

The WHO significantly revised the ICD in the 1980s and early 1990s. The resulting three-volume work, known as ICD-10 (International Statistical Classification of Diseases and Related Health Problems) was published in 1992. Eventually, it replaced the two-volume ICD-9 in countries worldwide that used the classification. The ICD became a core classification of the WHO Family of International Classifications (WHO-FIC).

Uses of the ICD

Every country subscribing to the ICD system uses it in varying degrees. Most countries subscribe to the whole ICD system, whereas some use it only in hospitals, while others only for morbidity. Some countries have opted to partially use the code. However, differences in mortality classification between ICD-9 and ICD-10 prevented direct comparisons between the two. However, code users introduced a method to adjust for this change.

Most noteworthy, the U.S. Department of Health and Human Services (HHS) felt that the ICD needed to provide better clinical information. The HHS then developed a system referred to as the ICD 9th revision: Clinical Modification (ICD-9-CM).

The CM codes were more precise and allowed for stronger analyses. Hospitals and other health care facilities used ICD-9-CM particularly for reporting morbidity. Meanwhile, coders used ICD-10 back then primarily to report mortality data. By 2015, ICD-10-CM officially replaced ICD-9-CM. Presently, ICD-10-CM is the current modification of use.

ICD-11: Prospects + Classifications to Healthcare Conditions

For ICD-11, developments are taking place on an internet-based workspace called the iCAT (Collaborative Authoring Tool) platform. Somewhat similar to the Wiki online content management system, the iCAT platform requires more structure and peer review process. The WHO collaborates through this platform with all interested parties.

It was in April 2015 when medical professionals completed the first draft review for ICD-11. By the end of 2017, the collaborators of the final draft will submit and officially endorse the document to the WHO’s World Health Assembly (WHA). The WHA will be expecting a final version for approval sometime in 2018.

In ICD-11, each disease entity will have definitions giving key descriptions. It will also provide guidance on the meaning of the entity/category in easily readable terms, for easy access. This is a quantum leap over ICD-10, which had title headings only.

The Definitions have a standard structure according to a template with standard definition templates. Further features will be exemplified in a “Content Model,” a structured framework capturing the knowledge underpinning each definition.

Therefore, the Content Model allows for computerization. It will have links to set of definitions for formal vocabulary (ontology sites) and SNOMED-CT. The latter is a controlled website for knowing the correct usage of medical and other related technical terms.

Each ICD entity can be seen from different dimensions or “parameters.” For example, there are currently 13 defined main parameters in the Content Model (see below) to describe a category in ICD.

The current ICD-11 Beta draft

ICD-11: Review and Completion

Stakeholders have completed an external review of the ICD-11 revision. Their report noted the progress in the revision, and made clear recommendations about forward progress in the revision.

1. ICD Entity Title – Fully Specified Name
2. Classification Properties – disease, disorder, injury, etc.
3. Textual Definitions – short standard description
4. Terms – synonyms, other inclusion and exclusions
5. Body System/Structure Description – anatomy and physiology
6. Temporal Properties – acute, chronic or other
7. Severity of Subtypes Properties – mild, moderate, severe, or other scales
8. Manifestation Properties – signs, symptoms
9. Causal Properties – etiology: infectious, external cause, etc.
10. Functioning Properties – impact on daily life: activities and participation
11. Specific Condition Properties – relates to pregnancy etc.
12. Treatment Properties – specific treatment considerations: e.g. resistance
13. Diagnostic Criteria – operational definitions for assessment

ICD-11 displays a more sophisticated architecture than its predecessors, consistent with its generation as a digital resource. The core of the system, called the Foundation Component, is a semantic (study of meaning in communication) network of words and terms. It is where any given term can have more than one parent.

ICD-11 supports the serialization of the Foundation Component into an arbitrary number of linearizations, optimized for use cases. This is to address the requirement that statistical classifications must exhibit mutual exclusiveness (so events are not counted more than once) and exhaustiveness (so there is a place to tally all events).


The main linearization is presently called the Joint Linearization for Morbidity and Mortality Statistics. It is the tabular format with which most traditional users will become familiar.

However, other linearizations (primary care, multiple sub-specialty derivatives, applications like support for clinical decision-making) are possible.

Ultimately, preliminary efforts in partnership with the International Health Terminology Standards Development Organization (IHTSDO) are under way. This is to ensure that the ICD-11 Foundation Component is semantically coherent through the development of the Common Ontology.

This will be a subset of SNOMED-CT, which will anchor the Foundation Component to terms defined through description logic. It exists in 41 languages in electronic versions. Additionally, users will systematically pursue its expression in multiple languages, in its current form.


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