The World Health Assembly formally adopted the International Classification of Diseases (ICD) Eleventh Revision (ICD-11) in 2019. It will officially go into effect on January 1, 2022 at which time the World Health Organization’s (WHO) member nations can begin reporting morbidity and mortality statistics using ICD-11. It is hard to believe that countries around the world have been utilizing ICD-10 since its adoption in 1990. Given advancements in health science and medical practice over the last 30 years, the WHO has updated the classification for the 21st century with the goal to better reflect contemporary medicine while aligning it with enhancements in information technology—including electronic health records (EHRs). This is demonstrated by the fact that ICD-11 contains 17,000 codes in 26 chapters compared to the 14,000 codes in 21 chapters in ICD-10.
As health information management (HIM) professionals, we know that quality health information underpins all facets of healthcare policy, delivery system design, patient engagement, and economic advancement of health. Information must be accurate, readily available, and understandable at numerous levels of the global health community. Furthermore, we understand that the ever-increasing role of analytics, machine learning, and artificial intelligence requires accurate and timely data to meet its full potential in improving health outcomes and access to care, while reducing costs.
Therefore, the International Federation of Health Information Management Associations (IFHIMA) believes that it is timely and appropriate that the adoption journey of ICD-11 is underway.
“The structure of ICD-11, along with its ability to integrate to EHRs, will allow it to meet the goals and needs of diverse national and global stakeholders,” said IFHIMA President Lorraine Fernandes, RHIA. “IFHIMA’s international reach provides us with an opportunity to highlight how ICD-11 is assisting innovation and supporting our vision of a healthy world enabled by quality health information.”
A white paper written by a group of global HIM professionals and published by IFHIMA discusses how early planning, coupled with HIM leadership, is critical for countries transitioning to ICD-11 in an increasingly digital and data-oriented world. Ministers of Heaths (MOH), policy makers, health system executives, HIM professionals, revenue cycle/coding consultants, and vendors should find it especially helpful.
The white paper provides an overview of the content and characteristics of ICD-11 and how it is different from previous versions of ICD. For example, ICD-11 is the first version that is specifically designed for electronic environments. It includes an automated coding tool as well as an application program interface (API) that allows for real-time integration to EHRs, thus facilitating point of care capture. Additionally, new to the ICD-11 structure is the Foundation Component, which is a large semantic database of all ICD concepts, codes, and synonyms, including broad clinical concepts to a very specific clinical detail. The WHO has defined specialized linearizations such as Mortality and Morbidity, Dermatology, and Primary Care and Traditional Medicine. Because the unique architecture of ICD-11 ensures that it can support diverse use cases, the WHO hopes that countries can leverage it to avoid the need to create their own country-specific ICD version (for example, Canada created ICD-10-CA and the United States created ICD-10-CM, etc.).
The WHO has developed an ICD-11 implementation package to support the introduction and use of ICD-11 by member nations. The IFHIMA white paper provides adaption and implementation recommendations to complement the WHO materials. It addresses activities that should be considered to ensure that ICD-11 meets global and national purposes. They may be conducted at various levels including government, private sector, or in a collaborative public-private approach. Applying these activities to a specific country and their respective health systems requires an understanding of health policy decision-making, healthcare funding, and resource allocation. Considerable variance in the activities and approaches are expected given these factors, as well as other factors such as economic priorities, public health status, and current level of health data digitization, etc.
Critical to any implementation plan is the planning for workforce development and identifying the ICD-11 competencies and skills needed by the coding professionals. Included in the white paper is a self-assessment intended for practicing HIM professionals to evaluate their skills and knowledge in comparison to the competencies recommended for ICD-11.
According to Valerie Watzlaf, PhD, MPH, RHIA, FAHIMA, vice chair of education and associate professor at the University of Pittsburgh Department of Health Information Management, “Workforce development is a key to the successful transition to ICD-11. HIM professionals should assess their competencies and skills to determine how their role may change with the implementation of ICD-11 and what skills they may need to obtain. These competencies may include increased use of technologies such as computer assisted coding and other artificial intelligence coding tools as well as the development of novel training approaches and useful methods to examine coding productivity and cost.”
Case studies included in the white paper explore how countries are building their ICD-11 workforce. The Canadian case study explores an initial assessment of ICD-11 Morbidity and Mortality Statistics (MMS) and the skills needed to transition to ICD-11. Both the WHO/Eastern Mediterranean Region and Japanese case studies explore, at a regional and country level, preliminary work assessing the workforce and associated training needs. Additionally, the challenges and opportunities of building an ICD-11 coding workforce in developing nations are explored.
Furthermore, case studies from Spain and the WHO’s Family of International Classifications (WHO-FIC) Education and Implementation Committee (EIC) clearly illustrate critical success factors and the value of HIM participation.
Call to Action
The transition to ICD-11 indicates a strong call to action for HIM professionals as it presents a golden opportunity for HIM professionals to support global health goals and digital transformation.
In order to accomplish this, HIM professionals must:
- Actively participate in the task forces, committees, and workgroups that will define and execute strategy at a national, regional, and local level.
- Break down any data silos through collaborative leadership with diverse stakeholders, ensuring decisions and associated expenditures support a successful implementation.
- Ensure quality and usefulness of data by implementing processes, roles, controls, and metrics to ensure the quality and usefulness of data.
- Develop a solid understanding of the ICD-11 data content and structure in comparison to ICD-10. Use IFHIMA and WHO resources to stay abreast of the ICD-11 journey.
- Promote the need for education, training, and workforce development for ICD-11 and advocate for the allocation of necessary resources at all levels.
- Adopt lifelong professional learning, recognizing opportunities and developing a plan to leverage the emerging opportunities presented by ICD-11.
As governments and the global healthcare community advance their planning and implementation of ICD-11, it is important that challenges be identified and addressed early on to ensure the anticipated high-quality, usable data to advance diverse use cases and global health. The engagement of HIM professionals early in the planning process is critical. The multi-stakeholder community that develops the plan, as discussed in the white paper, will benefit immensely from the HIM practical knowledge and core commitment to clinical coding and data management as reflected in the case studies.
IFHIMA published this white paper to facilitate awareness and foster readiness within the global healthcare community for the implementation of ICD-11. We encourage our colleagues in the HIM profession around the world to be passionate, collaborative advocates for a healthy world enabled by quality health information.
To download the white paper, visit IFHIMA.org.
Ann Chenoweth (firstname.lastname@example.org) is AHIMA national director to IFHIMA.