Innovative approaches to ICD-11 implementation: A look at what's working around the world

As countries around the world work to implement the latest version of the International Classification of Diseases (ICD-11), some innovative approaches are emerging. From social media engagement and text messaging to community-based academia, these implementation strategies are showing promising results. 

During a recent International Federation of Health Information Associations (IFHIMA) Congress, 19 different regions discussed a multitude of topics related to this new version of the ICD classification system. In addition to the hosting country, Australia, there was representation from the United States, Canada, Kuwait, Japan, the Cook Islands, Fiji, New Caledonia, Papua New Guinea, Samoa, Solomon Islands, Tonga, Vanuatu, as well as several regions in Africa including Nigeria, Uganda, Tanzania, Ghana, Kenya and Mauritania. The session topics ranged from building a national roadmap for transition from ICD-10 to ICD-11, changes in coding for stroke doctors, coder and provider education and reasons to adopt (or not) the new system. Attendees were reminded that globally, some of the implementation concerns are not just system and staff readiness, but things like internet and electrical connectivity.

In Australia, the focus is on education and field testing while a national decision to implement and associated timelines are made. The Australian ICD-11 Task Force (AITF) was established by the Australian Institute of Health and Welfare (AIHW) at the end of 2021. The AITF has created a roadmap of activities that will inform the decision to implement ICD-11. The initial education focuses on identifying the structure and purpose, as well as benefits of using ICD-11, the difference between the Foundation and the ICD-11 Mortality and Morbidity Statistics (ICD-11-MMS) Tabulation and the new classification conventions. Coders can then apply the codes and conventions to classify cases using stem and two types of extension codes.

In Kuwait, educational materials were developed for a large hospital considering the varying user base (coders, providers, health information managers, etc.) and later shared with a wider audience on YouTube. Training delivery included in-person education, WhatsApp surveys, YouTube analytics and virtual simulation. These innovative methods have led to the successful implementation of ICD-11.

Another promising approach is the use of technology to help implement ICD-11 in African nations with basic technology challenges. Some of these challenges are irregular internet connectivity, erratic power supply and inadequately trained clinical coders. Google Forms was used to collect data on the readiness and workforce preparedness for ICD-11, and the analysis of the data was conducted using Statistical Package for the Social Sciences (SPPS) software. 

In Canada, a third party was hired to conduct a comprehensive assessment of the benefits, challenges and readiness associated with the new classification system. While ICD-11 is digital health ready, not all jurisdictions across the country have reached that level of readiness as some sites still rely on paper charts. Others are in the process of implementing new electronic health records (EHRs) and would like all the changes to happen at once. 

In the U.S., preliminary work has begun to conduct research to evaluate the impact of different approaches to the transition and implementation of ICD-11 for mortality and morbidity classification. The U.S. Department of Health and Human Services (HHS) will provide timely leadership on strategic outreach and communications to the U.S. health care industry about the transition to ICD-11 and the inherent technological barriers. 

These are just a few examples of the innovative approaches that are being used to implement ICD-11 around the globe. Is there an opportunity to leverage artificial intelligence? Can we not just track progress but predict learner behaviors and recommend paths from that? Can we further automate the administrative tasks related to coding, like code assignment? As more countries adopt the new classification, we can expect to see even more creative solutions emerge.  

The World Health Organization (WHO) has provided training courses and is building a WHO Academy in France. These learning experiences are expertly designed, applying the latest adult-learning science and making use of new technologies. Digital micro-credentials will be offered, and while most learners will access the Academy’s courses online, the platform will be available via desktop and mobile devices, in low bandwidth settings, and with downloadable, offline options. 

It’s important to be aware of how ICD-11 differs from ICD-10. There are many educational resources that can help explain those differences. The WHO has self-paced virtual training offerings in several languages. Look for webinars like this one hosted by Kaycie LeSage and myself for HCPro. Check out this ICD-11 implementation guide to help you through this transition. You can learn more in our Inside Angle blogs as we continue to release the latest ICD-11 transition information.

Michelle Badore, global clinical and nosology content manager at Solventum.