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?
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.
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).
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 was developed on an internet-based collaborative workspace, with the World Health Organization coordinating input from member states and technical advisory groups over more than a decade.
The World Health Assembly formally adopted ICD-11 in 2019, and it took effect on 1 January 2022, replacing ICD-10-CM as the current WHO classification standard, though many U.S. healthcare systems continue to use ICD-10-CM pending a national transition timeline.
In ICD-11, each disease entity has definitions giving key descriptions. It also provides 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 are exemplified in a “Content Model,” a structured framework capturing the knowledge underpinning each definition.
Therefore, the Content Model allows for computerization. It has links to a set of definitions for formal vocabulary (ontology sites) and SNOMED-CT. The latter is a controlled terminology system for standardizing the usage of medical and other related technical terms.
Each ICD entity can be seen from different dimensions or “parameters.” For example, there are 13 defined main parameters in the Content Model (see below) used to describe a category in ICD.
ICD-11 uses a more sophisticated architecture than its predecessors, consistent with its design 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 the Joint Linearization for Morbidity and Mortality Statistics. It is the tabular format with which most traditional users are familiar.
Other linearizations (primary care, multiple sub-specialty derivatives, applications like support for clinical decision-making) are also available.
The ICD-11 Foundation Component is designed to be semantically coherent through alignment with the Common Ontology, a subset of SNOMED-CT, which anchors the Foundation Component to terms defined through description logic. ICD-11 exists in multiple languages, with translation and adoption work ongoing across WHO member states.
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