ICD-11 implementation package

Post #353 Shortlink: https://wp.me/pKrrB-4R7

On Saturday, May 25, 2019, member states meeting at the 72nd World Health Assembly voted unanimously to approve the draft resolution to adopt the Eleventh revision of the International Classification of Diseases. The resolution passed with no amendments.

Adoption comes into effect on January 1, 2022, subject to transitional arrangements. After this date, member states can start using or transitioning to the ICD-11 codes when they have prepared their health systems for migration from earlier editions.

Source: Presentation slides: Dr Robert Jakob, November 2018 Information session on ICD-11

 

The two key documents for Agenda Item 12.7 Eleventh revision of the International Classification of Diseases are:

A72/29 Add.1
Eleventh revision of the International Classification of Diseases
Draft Resolution

A72/29
Eleventh revision of the International Classification of Diseases
Report by the Director-General

 

Implementation package

The World Health Organization (WHO) has prepared an implementation package. These tools can be accessed at ICD-11.

 

1) ICD-11 Implementation or Transition Guide (version 1.05, May 2019)

This document is a part of the ICD11 implementation package¹ developed by the World Health Organization. This document also provides some background related to the development of the ICD11 and its components. The document outlines essential issues that countries need to consider in the lead up to and during the transition from an existing ICD environment to the eventual implementation of ICD11.

1 The ICD-11 implementation package comprises the Classification System, the Coding Tool, Browser and all supporting documents including the Reference Guide and Implementation Guide, and a set of tools. Source: ICD-11 Implementation or Transition Guide, Geneva: World Health Organization; 2019; License: CC BY-NC-SA 3.0 IGO.

 

2) Coding tool (multilingual)

Index based search tool.

See Additional resources [1] for NHS overview of ICD-11 Coding Tool.

 

3) ICD-11 browser for Mortality and Morbidity Statistics (MMS)

Blue ICD-11 MMS platform (current release: 04 / 2019)

English: https://icd.who.int/browse11/l-m/en

Spanish: CIE-11 para estadísticas de mortalidad y morbilidad (Versión : 04 / 2019): https://icd.who.int/browse11/l-m/es

See Additional resources [2] for NHS overview of ICD-11 MMS Browser and [3] for general overview of ICD-11.

 

4) ICD-11 Reference Guide (version 11-04-2019)

Detailed guide to ICD-11 and how to use it; update and maintenance workflow; updating cycles; requirements for proposal submission.

 

5) ICD-10 / ICD-11 mapping Tables

Map ICD-11 codes to and from ICD-10 (links to Zip file; crosswalks in Text and MS Excel formats)

 

6) Orange ICD-11 Maintenance Platform

English: https://icd.who.int/dev11/l-m/en

The audience for this site is the maintainers, contributors and translators of the classification. The content of the Orange browser is not the released version of the classification. The content is updated on a daily basis to incorporate changes approved since the most recent release of the Blue ICD-11 browser for Mortality and Morbidity Statistics (MMS).

The Orange Maintenance Platform incorporates the ICD-11 Proposal Mechanism (a proposal and commenting tool for which registration is required). Once an account is registered, new proposals, comments and suggestions for changes and enhancements to existing content can be submitted and notifications set up. For help with submissions see: Maintenance Platform User Guide.

 

Specialty versions and derived classifications

Specialty versions provide more detail for particular user groups, such as Mental Health, Neurology, Dermatology and less detail for primary care or low diagnostic resource settings.

For ICD-11, the WHO Department of Mental Health and Substance Abuse has developed a companion publication to ICD-11 Chapter 06 for mental health professionals, general clinical, educational and service use.

The Clinical Descriptions and Diagnostic Guidelines for ICD‐11 Mental, Behavioural and Neurodevelopmental Disorders (CDDG) provides expanded disorder descriptions and includes: essential (required) features, severities, boundaries with other disorders and normality, differential diagnoses, additional features and culture-related features.

WHO has given no firm release date but says the CDDG will be published “as soon as possible” following approval of the overall system by the WHA¹.

Also under development is the ICD-11 PHC – a clinical guideline written in simpler language to assist non-mental health specialists, especially primary care practitioners and non medically trained health workers, and for use in low resource settings and low- to middle-income countries with the diagnosis and management of 27 mental disorders. No finalization and publication date is available. Like the ICD-10 PHC (1996), this revised edition will not be a mandatory classification for member states.

1 Reed GM, First MB, Kogan CS, et al. Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry. 2019;18(1):3-19.

 

Linkages with other classifications and terminologies

ICD11 incorporates or links with the following classifications and terminologies through the ICD11 Foundation:

• International Classification of Disease for Oncology – ICD-O
• International Classification of External Causes of Injury – ICECI
• International Classification of Functioning, Disability and Health – ICF
• International Classification of Primary Care – ICPC [Ed: developed/maintained by WONCA]
• Other terminologies such as OrphaNet and SNOMED-CT

Source: ICD-11 Implementation or Transition Guide, Geneva: World Health Organization; 2019; License: CC BY-NC-SA 3.0 IGO.

 

Additional resources:

1 NHS Digital: ICD-11 Coding Tool Overview, September 2018

2 NHS Digital: ICD-11 Browser Overview, September 2018

3 NHS Digital: ICD-11 Overview

4 Presentation: Information session on ICD-11 Dr Robert Jakob, Team Leader, WHO, Geneva, Classifications, Terminologies and Standards, November 2018

Presentation: NHS Digital: Clinical Coding for non coders – Brief overview of clinical coding and the role of the Clinical Classifications Service

6 ICD-11: The 11th Revision of the International Classification of Diseases – Site maintained by eHealth DSI Semantic Community providing resources for ICD-10, ICD-11, ICD derivative classifications and other classification and terminology systems

Seventy-second World Health Assembly (WHA72) opened Monday, 20 May 2019

Post #352 Shortlink: https://wp.me/pKrrB-4Qm

Update: Draft resolution A72/29 Add.1 (ICD-11) passed without amendments

Item 12.7 Eleventh revision of the International Classification of Diseases was transferred from the Tenth meeting of Committee A to the Sixth meeting of Committee B, for consideration on Saturday 25 May. Item 12.7 was placed as the second agenda item.

Daily Journal N° 6: Programme of meetings for Saturday, 25 May 2019

Following statements from around 30 Member States reps and 1 Non-State actor (IOGT International), and a response from the Secretariat, the draft resolution to adopt the Eleventh revision of the International Classification of Diseases was passed, with no amendments, at 10:20 Geneva time.

After the meeting has closed, a webcast of the meeting will be available for 3 months (Select Tab for Committee B; Select Sixth meeting of Committee B, 25/05/2019 9:00-).

A Draft report of the Sixth meeting of Committee B will be available in the next day or two on the WHA72 Documents page and I shall post a copy at the top of this post.

——————————————————

The Seventy-second World Health Assembly (WHA72) opened this morning, in Geneva. This year’s Assembly runs from Monday 20 — Tuesday 28 May.

WHA72 website and Documents page

Daily live webcasts

Official Twitter hashtag: #WHA72

“The World Health Assembly is the decision-making body of WHO. It is attended by delegations from all WHO Member States and focuses on a specific health agenda prepared by the Executive Board. The main functions of the World Health Assembly are to determine the policies of the Organization, appoint the Director-General, supervise financial policies, and review and approve the proposed programme budget. The Health Assembly is held annually in Geneva, Switzerland.”

 

A Daily Journal is posted each morning (links for the Daily Journals are on the left of the WHA72 website and Documents page).

Daily Journal N° 1 | Programme of meetings for Monday, 20 May 2019

Daily Journal N° 2 | Programme of meetings for Tuesday, 21 May 2019

Daily Journal N° 3 | Programme of meetings for Wednesday 22 May 2019

Daily Journal N° 4 | Programme of meetings for Thursday, 23 May 2019

Daily Journal N° 5 | Programme of meetings for Friday, 24 May 2019

Daily Journal N° 6 | Programme of meetings for Saturday, 25 May 2019

Daily Journal N° 7 | Programme of meetings for Monday, 27 May 2019

Daily Journal N° 8 | Programme of meetings for Tuesday, 28 May 2019

 

Presentation of ICD-11 MMS for WHA adoption

The Eleventh revision of the International Classification of Diseases is listed as Item 12.7 under Item 12 Other technical matters and is the purview of Committee A.

Item 12.7 is currently expected to be reached on Saturday, 25 May.

Note: Item 12.7 is now 3rd item on Committee A Agenda for Saturday, 25 May. 

Extract Page 5, Daily Journal N° 5:

Live streaming of the Tenth Meeting of Committee A should be available via the webcast page on Saturday 25 May from 9:00 Geneva time. I shall be watching the segment for Item 12.7 when this is reached and will report on any significant discussions, decisions or amendments to the Draft Resolution recommending adoption of the ICD-11 MMS.

(Webcasts for Plenary, Committee A and Committee B meetings will be available for 3 months.)

 

The two key documents for Item 12.7 Eleventh revision of the International Classification of Diseases are:

A72/29 
Eleventh revision of the International Classification of Diseases
Report by the Director-General

and

A72/29 Add.1
Eleventh revision of the International Classification of Diseases
Draft Resolution

 

Draft resolution for consideration by Committee A:

Page 1:

Page 2:

The 72nd Assembly closes on Tuesday, 28 May. Finalization of Committee A resolutions and reports is scheduled for the final day:

 

There are in the region of 55,000 codes in the Eleventh Edition of ICD compared with around 14,400 in ICD-10.

It is anticipated that some Member States and other bodies may continue to raise concerns over specific controversial additions, for example, the inclusion of Gaming disorder. There have also been statements of concern lodged by some Member States regarding the proposed timelines for adoption of ICD-11 and transitional arrangements.

I will update with any significant discussions or amendments to the draft resolution as it currently stands and will post the finalized reports and ICD-11 resolution, when these become available.

 

The Blue ICD-11 MMS platform:

The WHO released a stable version of the ICD-11 for Mortality and Morbidity Statistics (ICD-11 MMS) in June 2018 as a pre-implementation version to enable Member States to begin the process of evaluation, consultations, training, translations and preparing for eventual transition to the new edition.

This initial release was replaced with an updated release in December 2018. The December 2018 version was replaced by a further stable release, in April 2019.

The current release is dated Version : 04 / 2019: https://icd.who.int/browse11/l-m/en

It is unclear whether Version : 04 / 2019 is the version being recommended for adoption on Saturday 25 May, or whether the MMS will be updated this week to reflect the most recent content of the Orange Maintenance Platform, then frozen for presentation next Saturday. If WHO does issue a further release of the Blue Platform, this week, I will update this report.

Draft Resolution for recommendation of adoption and endorsement of ICD-11 at May 2019 World Health Assembly

Post #351 Shortlink: https://wp.me/pKrrB-4OJ

An update on World Health Organization (WHO) Executive Board and World Health Assembly (WHA) business:

The 144th Session (EB144) of the World Health Organization Executive Board took place in Geneva between 24 January — 1 February 2019.

Executive Board 144th Session website

“The Executive Board is composed of 34 individuals technically qualified in the field of health, each one designated by a Member State elected to do so by the World Health Assembly. Member States are elected for three-year terms.

“The Board meets at least twice a year; the main meeting is normally in January, with a second shorter meeting in May, immediately after the Health Assembly. The main functions of the Executive Board are to give effect to the decisions and policies of the Health Assembly, to advise it and generally to facilitate its work.”

These January Executive Board meetings generate a considerable number of documents. Documentation is available from this page EB144 Meeting Documents.

Key document for Recommendation for Adoption of ICD-11 at WHA72:

World Health Organization, EXECUTIVE BOARD 144th Session

Provisional agenda item 5.9

EB144/22 12 December 2018

Eleventh revision of the International Classification of Diseases

Report by the Director-General

On p10 (Item 53), the Executive Board was invited to consider a draft resolution.

Below is the document containing the text of the draft resolution with proposed amendments from Member States inserted in bold text:

World Health Organization, EXECUTIVE BOARD 144th Session

Agenda item 5.9

EB144/CONF./9 31 January 2019

Eleventh revision of the International Classification of Diseases

Draft resolution proposed by the Secretariat with amendments from Member States

World Health Assembly

The 72nd World Health Assembly takes place this month, in Geneva, from 20 — 28 May 2019.

“The World Health Assembly is the decision-making body of WHO. It is attended by delegations from all WHO Member States and focuses on a specific health agenda prepared by the Executive Board. The main functions of the World Health Assembly are to determine the policies of the Organization, appoint the Director-General, supervise financial policies, and review and approve the proposed programme budget. The Health Assembly is held annually in Geneva, Switzerland.”

72nd World Health Assembly (WHA72)

Documentation page for WHA72

Two key documents for Recommendation for Adoption of ICD-11 at WHA72:

WHO SEVENTY-SECOND WORLD HEALTH ASSEMBLY

Provisional agenda item 12.7 

A72/29 4 April 2019

Eleventh revision of the International Classification of Diseases

Report by the Director-General

Extract:

“1. The Executive Board at its 144th session considered an earlier version of this report,¹ containing a draft resolution.² The Board noted the report but agreed to suspend consideration of the draft resolution so that informal consultations could be held during the intersessional period prior to the Seventy-second World Health Assembly. A separate report will be submitted to provide details of the outcome of the consultations.³”


1 Document EB144/22.
2 See the summary records of the Executive Board at its 144th session, eleventh meeting and twelfth meeting, section 1.
3 Document A72/29 Add.1.

and the revised Draft Resolution on ICD-11:

Provisional agenda item 12.7 

A72/29 Add.111 April 2019

Extract:

“1. In line with the course of action agreed by the Executive Board at its 144th session in January 2019,¹ the Secretariat convened informal consultations during the intersessional period in respect of a draft resolution on the eleventh revision of the International Classification of Diseases. The consultations took place in Geneva on 22 February, 7 March and 21 March 2019. The three sessions enabled the draft resolution to be revised.”


1 Document A72/29.

Should any additional documents relating to the presentation of ICD-11 for recommendation for adoption be posted on the WHA72 documents page I will update this post.

The most recent release of the ICD-11 MMS version for preparation for implementation, Coding tool, Reference Guide and additional materials can be viewed here:

ICD-11 for Mortality and Morbidity Statistics (Version : 04 / 2019)

If adopted, endorsement would not come into effect until 1 January 2022.

 

Information session on ICD-11 slides

Document EB144/22 (Report by the Director-General) included a link for slides from a presentation given by Dr Robert Jakob, Team Leader, WHO, Geneva, Classifications, Terminologies and Standards:

Presentation slides (Dr Robert Jakob, November 2018):

Information session on ICD-11

I have been unable to find a transcript or video for this presentation. The slides include an overview of the structure of ICD-11, timelines for preparation for adoption, overview of proposed draft resolution, implementation package, post-endorsement maintenance and update process etc.

Slide 20/31:

Slide #22 notes outcomes of several CSAC and MSAC reviews and decisions, including the decision in November 2018 to retain the ICD-10 G93.3 entities (Postviral fatigue syndrome; Benign myalgic encephalomyelitis; Chronic fatigue syndrome) in the Diseases of the nervous system chapter [1][2]:

Slide 22/31:

References:

1 ICD-11 proposal submitted by Dr Tarun Dua on November 06, 2017; Processed on November 19, 2018

2 WHO’s rejection of Dr Tarun Dua’s proposal of November 06, 2017

3 For status of proposals for PVFS, BME and CFS see Post #350: ICD-11: Recently processed proposals for Postviral fatigue syndrome, ME, CFS; Fatigue; and Bodily distress disorder

and PDF: Recently processed ICD-11 proposals v3

ICD-11: Recently processed proposals for Postviral fatigue syndrome, ME, CFS; Fatigue; and Bodily distress disorder

Post #350 Shortlink: https://wp.me/pKrrB-4Nz

ICD-11 endorsement

Next month, the World Health Organization (WHO) intends to present a stable version of ICD-11 to the 72nd World Health Assembly for member state endorsement.

The WHO Executive Board will submit a Resolution for adoption of what it describes as a “preparation for implementation” version of the ICD-11 Mortality and Morbidity Statistics (ICD-11 MMS).

 

#WHA72 Geneva May 22–28, 2019 

Website: SEVENTY-SECOND WORLD HEALTH ASSEMBLY

Two key documents:

Provisional Agenda Item 12.7 (A72/29): ICD-11 Report by the Director-General

(A72/29 Add.1): Draft Resolution for adoption of ICD-11

 

If adopted, endorsement would not come into effect until 1 January 2022.

After that date, member states can begin reporting data using the ICD-11 code sets when their countries have prepared their health systems for transition and implemented the new edition.

There is no mandatory date by which member states must migrate to the new edition and for a period of time, data will be collected and aggregated using both ICD-10 and ICD-11. It’s anticipated that even the earliest implementers will take several years to prepare their countries for transition.

 

Update and revision

Once endorsed, ICD-11 will be subject to an annual update and revision process, as ICD-10 has been.

Minor changes to content can be considered for incorporation on an annual basis. Major changes would be considered for incorporation on a 5 yearly update cycle.

Responsibility for reviewing and processing proposals now lies with the Medical Scientific Advisory Committee (MSAC) and the Classifications and Statistics Advisory Commitee (CSAC), which takes over from the ICD-10 Update and Revision Committee (URC). These committees are working through a backlog of proposals.

The ICD-11 Proposal Mechanism platform will remain online and open to stakeholders for new comments and new submissions for changes, additions and improvements. Submissions for changes will also be received from member states via the WHO-FIC Network.

[See ICD-11 Reference Guide: 3.8 Annex: ICD-11 Updating and Maintenance for information on the ICD-11 update and revision cycle and protocol for submission of new proposals.]

 

Recently processed proposals

Between February and April, this year, a number of proposals were processed.

These include proposals for Postviral fatigue syndrome, Benign myalgic encephalomyelitis and Chronic fatigue syndrome; proposals for Fatigue (was Malaise and fatigue in ICD-10); and proposals for Bodily distress disorder.

Proposals submitted before March 30, 2017 were supposed to have been reviewed before the end of 2017 for consideration for potential inclusion in the initial release of the ICD-11 MMS — but many of these weren’t processed, despite having met the submission deadline.

Proposals relating to Postviral fatigue syndrome and its inclusion terms were in any case put on hold while an evidence review was undertaken. This review was not completed until late 2018.

This batch of recently processed proposals includes proposals submitted by Suzy Chapman (since 2014); by Suzy Chapman and Mary Dimmock (March 2017); and by Lily Chu MD on behalf of the IACFS/ME (March 2017).

The proposal submitted by the WHO’s Dr Tarun Dua, in November 2017, to delete Postviral fatigue syndrome from the Diseases of the nervous system chapter and reclassify ME/CFS [sic] in the Symptoms, signs chapter as a child under Symptoms, signs or clinical findings of the musculoskeletal system was processed in November 2018.

The WHO rightly rejected Dr Dua’s proposal, in a decision supported by the MSAC and CSAC Committees.

 

Status of processed proposals at April 15, 2019:

In order to access the ICD-11 Proposal Mechanism registration with the platform is required and the platform is clunky to navigate.

For ease of access, I have created a table which sets out the outcome of these processed proposals for Postviral fatigue syndrome, Benign myalgic encephalomyelitis and Chronic fatigue syndrome; Fatigue; and Bodily distress disorder.

(If you already have v1 or v2 of this document, please replace with v3 below, as this document has been updated to include the approval of an exclusion for PVFS under Fatigue.)

Download PDF Table: Recently processed ICD-11 proposals v3

Extract:

 

 

ICD-11 for Mortality and Morbidity Statistics (Version : 04 / 2019) version for preparing for implementation as it currently stands:

08 Diseases of the nervous system

8E49 Postviral fatigue syndrome

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