ICD-11 is the latest iteration of the International Classification of Diseases (ICD). It is preceded by ICD-10 and comprises of work completed over 10 years, involving over 300 healthcare industry experts from 55 countries. It was accepted by the members of the World Health Organization in May 2019 and is set to be the official reporting system of member states from January 1, 2022.
ICD-11 accurately reflects contemporary health and medical practice, allowing nations to identify health issues by using a clinically relevant classification system. For the first time since its inception, the international standard for the systematic recording, reporting, and analysis of mortality, and morbidity data has transformed into a fully electronic layout. It provides access to over 17,000 diagnostic categories comprising of more than 100,000 medical diagnostic index terms.
The Impact of ICD-11 on the Healthcare Industry
The index-based search algorithm incorporated into ICD-11 is capable of searching from more than 2 million medical terms. Its ease of installation and online or offline use capability through its free ‘container’ software promises easy adoption. It brings the following advantages to clinicians, researchers and other healthcare industry experts, at the outset:
- Ease of use
- Low cost of coding
- Precise data capture
- Interoperability with existing healthcare IT infrastructure
- A broad range of uses including clinical recording and the collection of morbidity and mortality statistics
- Provisions for the coding of rare diseases, medical device usage, severity scales, histopathology and more
ICD-11 has been updated to incorporate the latest advancements in medicine and healthcare for 30 years, including the impact of digital health information systems and applications.
The Salient Features of ICD-11
ICD-11 brings in many improvements over ICD-10. This includes the introduction of several new chapters. However, the most important features of the latest iteration are as follows:
Digital Format: ICD-11 comprises of software tools that can be used in the classification and generation of precise descriptions of health event information. It is designed to seamlessly integrate with existing health IT infrastructure such as EHR and Erx systems, giving clinicians the complete context of patient health conditions through codes. This includes symptoms and signs for complex degenerative diseases that undergo genetic mutation. The ICD-11 coding tool also eliminates the need to search for and memorize codes. Clinicians and researchers can now enter the medical term directly into the tool and arrive at the correct ICD code.
The Foundation Component: ICD-11 has an underlying ontological database that contains all ICD entities such as disease, disorder, injury, and symptoms. This database encompasses all the details of medical terms from the very broad to the finely specified. The structure of this database termed, the Foundation Component is very similar to the Tabular List and Alphabetical Index that ICD-10 was based on. It also contains a content model which is a framework that obtains the more traditional statistical classification of mortality and morbidity as a tabular list. The content model uses extension codes to limit the content volume, while also allowing for a detailed description of disease entities.
Updated Scientific Knowledge Base: The ICD-11 revision contains over 55000 unique entries, most of which are based on our recent understanding of degenerative diseases. Over 120000 entities are derived from updated and current diagnostic concepts. Some of the major updates included in ICD-11 are in the following areas.
- HIV
- Mental Health Disorder
- Post Traumatic Stress Disorder
- Sexual Health
- Rare Diseases
Components of the ICD-11 Package
ICD-11 Coding Tool: The tool has been designed to search for clinical terms from the ICD database and deliver three outputs. The output comprises of a word list of similar terms, matched entities with an internal link to the browser and a list of chapters associated with the search term. The tool is easy to use and the ‘suggestive’ approach of the tool ensures that a user takes away more information with every search of a medical term.
ICD-11 Browser: The web-based browser allows users to retrieve concepts by searching terms. The application is designed to be context-sensitive, which enhances its accuracy and ability to serve up the most relevant information to the user. The browser currently allows users to contribute updates and continuously improve the ICD database through a proposal based platform.
Index: The index is made up of the unpinning repository of all ICD entities. This repository contains the details and descriptions of diseases, disorders, symptoms, and co-relation between all of them. It represents the sum total of the ICD universe and the tabular list presented to the users in the search results are derived from this. The index is structured in a standardized manner to facilitate point-of-care data capture.
Application Programming Interface (API): The ICD-11 API allows programmatic access to the database. It is an HTTP based REST API that allows developers to access the up to date documentation. The latest version was published in April 2019.
The Translation Tool: The translation tool allows specific user centers to build translations that are faithful to the original. It is capable of delivering the same set of outputs in multiple languages. All the registered users of the tool receive notifications when translation changes are made. Currently, the most developed translation of ICD-11 is into Spanish, followed by Chinese.
The ICD-11 was primarily developed based on the shortcomings of ICD-10 with regards to the structure of the database. Since the formal launch of the ICD revision process in 2007, Topic Advisory Groups (TAGs) were created to review all the functioning issues of ICD-10. By using member state comments and feedback received from field trials, the latest iteration of ICD was deemed fit for adoption by the World Health Assembly in May 2019.
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Amit Manral