Advocating for Standardization: The Pursuit of Uniformity in ICD-11 Global Classifications

Throughout her career, Luisa Whitelaw, head of clinical coding intelligence with Discovery Health, has helped catalyze widespread consistency within clinical coding. From pursuing her PhD in classifications and health informatics to participating in an AHIMA international ICD-11 work group, Whitelaw is poised to affect lasting change on a global scale.

Recognizing her passion for healthcare, Whitelaw obtained her nursing degree from the University of the Witwatersrand in Johannesburg, South Africa. Upon completing her undergraduate studies, she spent a year practicing as a nurse in a private hospital facility, alternating between orthopedics and the intensive care unit. Although Whitelaw intended to remain in nursing, an opportunity to shift into a new specialty presented itself.

Changing Paths

“During my second year spent in the private practice, I was offered an opportunity to experience the world of managed healthcare,” Whitelaw says. “I was hesitant at first given nursing was my world, but my parents encouraged me to explore all opportunities that life may bring, especially from a career and growth perspective. So, I took a leap of faith and joined Discovery Health in 1999 where I have since worked in clinical coding for more than 22 years.”

Whitelaw’s career shift marked the beginning of her journey in health informatics. Through her work with Discovery Health, Whitelaw’s appreciation for coding has continued to grow, allowing her to envision new possibilities for improvements.

“It became blatantly clear to me early on in my career that clinical coding is a critical component of a well-functioning and well-understood healthcare industry,” Whitelaw says. “Under the wonderful leadership of my boss and mentor at the time, I undertook my CPC with the American Academy of Professional Coders (AAPC) in 2001. CPC proved to be valuable to me in being able to participate and contribute to the health information and coding standardization processes in South Africa, which at the time were really in their infancy.”

Dedicated to advancing in her academic track, Whitelaw pursued a master’s in health informatics through the University of Bath in England in 2005 and completed the program in 2009. During that time, she joined her alma mater as an honorary researcher in the Health Classification Unit (Clinical Governance Initiative, Faculty of Health Sciences), the focus being on coding and classification systems research. Currently, Whitelaw plans to pursue her PhD.

Joining the ICD-11 Work Group

ICD-11 has been long-anticipated by health information professionals, and Whitelaw is no exception. ICD-11 will serve as the updated international standard for coding health information and causes of death. Countries can begin implementing the new version on January 1, 2022. To assist in the implementation process, AHIMA formed an international work group, which Whitelaw promptly joined.

“I follow AHIMA on LinkedIn and saw a call for volunteers to participate in an international work group to draft an international ICD-11 implementation guide[1],” Whitelaw says. “I thought this would be a great opportunity to contribute and gain exposure to how these international initiatives are approached. I applied and was gratefully accepted to participate, together with a team of great colleagues from around the globe.”

According to Whitelaw, each of the work group participants chose a section of the implementation guide for which they would create content. The sections would then be compiled to complete the guide.

“‘Issues for Consideration’ was my selected/allocated section and was built off of my experiences with the implementation of ICD-10 in South Africa in 2014,” Whitelaw says. “Additionally, governance, resource, timing, budget, communication systems, etc. were dealt with in detail across other sections later in the document.”

A New Role

Beyond her work with the ICD-11 work group, Whitelaw has accepted a new position to address and help solve for challenges within global classifications.

“My role within Discovery is evolving to a global/international role in order to better support all of our international partners and businesses,” Whitelaw says. “I have been heading up our clinical coding intelligence unit in South Africa for 16 years, where my team and I have been responsible for driving coding strategy for our business in South Africa, as well as for our international businesses in the UK, China, Australia, broader Africa, etc.”

With Discovery’s business expanding into other territories, Whitelaw will be relocating to Chicago, which will allow her to access key organizations and opportunities to foster critical relations with data classification experts in the profession and better support all areas of business, both in the US and across the globe. Whitelaw aims to establish an International Clinical Coding Center of Excellence for the Discovery/Vitality Group.

“My goal is to protect people. I truly want to make them healthier and enhance their lives,” Whitelaw says. “In line with our organization’s core purpose and values, I believe that every relevant and accurate piece of coded data matters in achieving the objectives of ‘better health and better lives for all,’ thus contributing to the greater good.”

Implementing Change

Looking ahead, Whitelaw acknowledges that regions all over the world will consider adopting ICD-11, which will further augment coding consistencies between healthcare systems across the globe. At present, South Africa awaits specific implementation guidelines from the health ministry.

“My new role will coincide with ICD-11’s January 2022 effective date, as it will allow me to steer the strategies for its adoption across our businesses, learning from each territory and, hopefully, devising a blueprint with learned efficiencies in how to do this as seamlessly as possible,” Whitelaw says. “I also believe that ICD-11 is an excellent diagnosis classification system, filled with richness in possibilities for meaningful data collection to support sustainable global healthcare.”

The launch date for ICD-11 increased Whitelaw’s sense of urgency to continue evaluating various coding challenges, which include the applicability of coding schemas across different healthcare landscapes, developing platforms for intelligent housing and maintenance of multiple classifications and terminologies, and general accuracy.

“We are very proud of the data/analytics tools (all coding based) we have developed in South Africa,” Whitelaw says. “Moving forward, it will be important to lean on, and learn from, the best subject matter experts in the US (such as AHIMA) and across the globe to circumvent some of these challenges and create true synergies.”

Whitelaw expresses that the classification amendments in the pipeline will offer a single source of truth and improve the accuracy of data on a broad scale. All of her efforts, in conjunction with other health information professionals, will positively impact sustainability in health and well-being.

“The data will be in one place and not in separate silos across multiple systems,” Whitelaw says. “A data revolution is upon us; never has there been so much healthcare and wellness data available to us.”

[1] To learn more about the ICD-11 implementation guide, visit https://icd.who.int/en.