Training and experience of coding with the World Health Organization's International Classification of Diseases, Eleventh Revision.

BACKGROUND: The new International Classification of Diseases, Eleventh Revision for Mortality and Morbidity Statistics (ICD-11) was developed and released by the World Health Organization (WHO) in June 2018. Because ICD-11 incorporates new codes and features, training materials for coding with ICD-11 are urgently needed prior to its implementation. OBJECTIVE: This study outlines the development of ICD-11 training materials, training processes and experiences of clinical coders while learning to code using ICD-11. METHOD: Six certified clinical coders were recruited to code inpatient charts using ICD-11. Training materials were developed with input from experts from the Canadian Institute for Health Information and the WHO, and the clinical coders were trained to use the new classification. Monthly team meetings were conducted to enable discussions on coding issues and to select the correct ICD-11 codes. The training experience was evaluated using qualitative interviews, a questionnaire and a coding quiz. RESULTS: total of 3011 charts were coded using ICD-11. In general, clinical coders provided positive feedback regarding the training program. The average score for the coding quiz (multiple choice, True/False) was 84%, suggesting that the training program was effective. Feedback from the coders enabled the ICD-11 code content, electronic tooling and terminologies to be updated. CONCLUSION: This study provides a detailed account of the processes involved with training clinical coders to use ICD-11. Important findings from the interviews were reported at the annual WHO conferences, and these findings helped improve the ICD-11 browser and reference guide.

Enhanced capture of healthcare-related harms and injuries in the 11th revision of the International Classification of Diseases (ICD-11).

The World Health Organization (WHO) plans to submit the 11th revision of the International Classification of Diseases (ICD) to the World Health Assembly in 2018. The WHO is working toward a revised classification system that has an enhanced ability to capture health concepts in a manner that reflects current scientific evidence and that is compatible with contemporary information systems. In this paper, we present recommendations made to the WHO by the ICD revision's Quality and Safety Topic Advisory Group (Q&S TAG) for a new conceptual approach to capturing healthcare-related harms and injuries in ICD-coded data. The Q&S TAG has grouped causes of healthcare-related harm and injuries into four categories that relate to the source of the event: (a) medications and substances, (b) procedures, (c) devices and (d) other aspects of care. Under the proposed multiple coding approach, one of these sources of harm must be coded as part of a cluster of three codes to depict, respectively, a healthcare activity as a 'source' of harm, a 'mode or mechanism' of harm and a consequence of the event summarized by these codes (i.e. injury or harm). Use of this framework depends on the implementation of a new and potentially powerful code-clustering mechanism in ICD-11. This new framework for coding healthcare-related harm has great potential to improve the clinical detail of adverse event descriptions, and the overall quality of coded health data.

ICD-11 for quality and safety: overview of the WHO Quality and Safety Topic Advisory Group.

This paper outlines the approach that the WHO's Family of International Classifications (WHO-FIC) network is undertaking to create ICD-11. We also outline the more focused work of the Quality and Safety Topic Advisory Group, whose activities include the following: (i) cataloguing existing ICD-9 and ICD-10 quality and safety indicators; (ii) reviewing ICD morbidity coding rules for main condition, diagnosis timing, numbers of diagnosis fields and diagnosis clustering; (iii) substantial restructuring of the health-care related injury concepts coded in the ICD-10 chapters 19/20, (iv) mapping of ICD-11 quality and safety concepts to the information model of the WHO's International Classification for Patient Safety and the AHRQ Common Formats; (v) the review of vertical chapter content in all chapters of the ICD-11 beta version and (vi) downstream field testing of ICD-11 prior to its official 2015 release. The transition from ICD-10 to ICD-11 promises to produce an enhanced classification that will have better potential to capture important concepts relevant to measuring health system safety and quality-an important use case for the classification.

Development of a new international classification of health interventions based on an ontology framework.

: The WHO International Classification of Diseases is used in many national applications to plan, manage and fund through case mix health care systems and allows international comparisons of the performance of these systems. There is no such measuring tool for health interventions or procedures. To fulfil this requirement the WHO-FIC Network recommended in 2006 to develop an International Classification of Health Interventions (ICHI). This initiative is aimed to harmonise the existing national classifications and to provide a basic system for the countries which have not developed their own classification systems. It is based on the CEN/ISO ontology framework standard named Categorial Structure defined from a non formal bottom up ontology approach. The process of populating the framework is ongoing to start from a common model structure encompassing the ICD 9CM Volume 3 granularity.

The development, evolution, and modifications of ICD-10: challenges to the international comparability of morbidity data.

BACKGROUND: The United States is about to make a major nationwide transition from ICD-9-CM coding of hospital discharges to ICD-10-CM, a country-specific modification of the World Health Organization's ICD-10. As this transition occurs, the WHO is already in the midst of developing ICD-11. Given this context, we undertook this review to discuss: (1) the history of the International Classification of Diseases (a core information "building block" for health systems everywhere) from its introduction to the current era of ICD-11 development; (2) differences across country-specific ICD-10 clinical modifications and the challenges that these differences pose to the international comparability of morbidity data; (3) potential strategic approaches to achieving better international ICD-11 comparability. LITERATURE REVIEW AND DISCUSSION: A literature review and stakeholder consultation was carried out. The various ICD-10 clinical modifications (ICD-10-AM [Australia], ICD-10-CA [Canada], ICD-10-GM [Germany], ICD-10-TM [Thailand], ICD-10-CM [United States]) were compared. These ICD-10 modifications differ in their number of codes, chapters, and subcategories. Specific conditions are present in some but not all of the modifications. ICD-11, with a similar structure to ICD-10, will function in an electronic health records environment and also provide disease descriptive characteristics (eg, causal properties, functional impact, and treatment). CONCLUSION: The threat to the comparability of international clinical morbidity is growing with the development of many country-specific ICD-10 versions. One solution to this threat is to develop a meta-database including all country-specific modifications to ensure more efficient use of people and resources, decrease omissions and errors but most importantly provide a platform for future ICD updates.

The Implementation of New Morbidity Classifications in Canada.

Canada is in the midst of a staggered implementation of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada (ICD-10-CA) and the Canadian Classification of Health Interventions (CCI). These classifications are more comprehensive than historical standards and their capacity extends beyond the scope of their predecessor classifications. Canada is the first country to produce the new classifications in a database, with the final product in an infobase format. The Canadian Institute for Health Information (CIHI) was responsible for the enhancement of ICD-10-CA, the development of CCI, the education of coders, and the provision of post-implementation support.