The WHO constitution mandates the production of international classifications on health so that there is a consensual, meaningful and useful framework which governments, providers and consumers can use as a common language. The International Classification of Diseases (ICD) is the standard diagnostic tool for epidemiology, health management and clinical purposes. ICD is used to monitor the incidence and prevalence of diseases and other health problems, proving a picture of the general health situation of countries and populations.
ICD is used by physicians, nurses, other providers, researchers, health information managers and coders, health information technology workers, policy-makers, insurers and patient organizations to classify diseases and other health problems recorded on many types of health and vital records, including death certificates and health records. In addition to enabling the storage and retrieval of diagnostic information for clinical, epidemiological and quality purposes, these records also provide the basis for the compilation of national mortality and morbidity statistics by WHO Member States. Finally, ICD is used for reimbursement and resource allocation decision-making by countries.
All Member States use the ICD which has been translated into 43 languages. ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990 and came into use in WHO Member States as from 1994. ICD is currently under revision, through an ongoing Revision Process, and the release date for ICD-11 is 2018.
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The WHO-FIC leadership has created a governance structure for the revision process that positions a Revision Steering Group (RSG) above several Topic Advisory Groups (TAGs). Several content-specific, or vertical, TAGs address areas such as Neurology, Mental Health, Ophthalmology, Dermatology and Internal Medicine, while five horizontal TAGs focus on cross-cutting themes—the Mortality TAG, the Morbidity TAG, the Functionality TAG, the Health Informatics and Modelling TAG and the QS-TAG (current members)
The various TAGs have all been meeting periodically since 2009 to produce a beta version of ICD-11 (available online for viewing and comment) through use of a Collaborative Authoring Tool called iCAT.
In it’s early stages, the QS-TAG undertook stakeholder consultations with the RSG and WHO-FIC network leaders in the domains of mortality coding, morbidity coding, case-mix system development and ontology development. The information derived from these consultations, supplemented by the WHO’s past experience in developing ICD-10, produced a QS-TAG work plan that includes the following:
1. Review of existing quality and safety indicators used internationally;
2. Review of a variety of ICD morbidity coding rules (for main condition, diagnosis timing, numbers of diagnosis fields in hospital discharge records and clustering of diagnoses);
3. Substantial restructuring of the health-care related injury content in ICD-10 chapters 19 and 20;
4. Harmonization of ICD-11 with the WHO’s International Classification for Patient Safety (ICPS) and the Common Formats developed by the US Agency for Healthcare Research and Quality (AHRQ);
5. Review of content in all other chapters of ICD-11 to ensure appropriate capture of quality and safety concepts and;
6. Downstream field testing of ICD-11 prior to its official release.