There are few truer snapshots of a country’s wellbeing than its health statistics. While broad economic indicators such as Gross Domestic Product may skew impressions of individual prosperity, data on disease and death reveal how a population is truly faring.
The International Statistical Classification of Diseases and Related Health Problems (ICD) is the bedrock for health statistics. It maps the human condition from birth to death: Any injury or disease we encounter in life—and anything we might die of—is coded.
Not only that, the ICD also captures factors influencing health, or external causes of mortality and morbidity, providing a holistic look at every aspect of life that can affect health.
These health statistics form the basis for almost every decision made in healthcare today—understanding what people get sick from, and what eventually kills them, is at the core of mapping disease trends and epidemics, deciding how to program health services, allocate healthcare spending, and invest in R&D.
ICD codes can have enormous financial importance, since they are used to determine where best to invest increasingly scant resources. In countries such as the U.S., meanwhile, ICD codes are the foundation of health insurance billing, and thus critically tied up with healthcare finances.
On June 18, 2018, 18 years after the launch of ICD-10, WHO released a version of ICD-11 to allow Member States time to plan implementation. This is anticipating the presentation of ICD-11 to the World Health Assembly in 2019 for adoption by countries. Over a decade in the making, this version is a vast improvement on ICD-10.
First, it has been updated for the 21st century and reflects critical advances in science and medicine. Second, it can now be well integrated with electronic health applications and information systems. This new version is fully electronic, significantly easier to implement which will lead to fewer mistakes, allows more detail to be recorded, all of which will make the tool much more accessible, particularly for low-resource settings.
A third, important feature is that ICD-11 has been produced through a transparent, collaborative manner, the scope of which is unprecedented in its history. The complexity of the ICD has sometimes made it seem like an esoteric health tool requiring months of training—of the number of deaths reported in the world, those coded correctly were about one third. An overriding motive in this revision was to make the ICD easier to use.
The consequences that ICD coding has on provision of care, as well as health financing and insurance, means that clinicians, patient groups, and insurers, among others, take the use of the ICD extremely seriously—many groups often have strong positions on whether or not a condition should be included, or how it should be categorized.
For instance, some people working on stroke have long been pushing for it to be moved from circulatory diseases, where it has been for 6 decades, into neurological disease, where it now sits in ICD-11. Those advocating for the move cited key implications for treating the disease and reporting deaths as the main driver.
