ICD-11 Seeks to Clarify Coding, Sync with EHR, and Enable Enhanced Antimicrobial Resistance Tracking: Public Health Watch


The new edition is fully electronic and makes key changes related to antimicrobial resistance and HIV.

It’s not The Da Vinci Code. It’s not the Code of Hammurabi.

And, no, it’s not the code of ethics under which physicians and clinicians (we hope) provide care.

However, there’s no question that the codes included in the World Health Organization’s (WHO) International Classification of Diseases (ICD) are no less important. The organization released the 11th edition (ICD-11) of the manual on June 18, and the new version contains approximately 55,000 unique codes for injuries, diseases, and causes of death, compared to 14,400 in the ICD-10. It will be presented at the World Health Assembly in May 2019 and, if it is adopted by assembly member states, it will come into effect on January 1, 2022.

“The ICD is a product that WHO is truly proud of,” said Tedros Adhanom Ghebreyesus, PhD, WHO Director-General, in a statement released with the new edition. “It enables us to understand so much about what makes people get sick and die, and to take action to prevent suffering and save lives.”

Some changes, such as the inclusion of “gaming disorder” have generated a lot of buzz; however, of note for practitioners in the infectious disease/public health arena are that the codes relating to antimicrobial resistance in the ICD-11 have been reworked to more closely align them with the WHO’s Global Antimicrobial Resistance Surveillance System (GLASS). The change will hopefully enable better tracking of antimicrobial resistance patterns, which can be used to inform research and development of novel antibiotics. And, a new classification for HIV has been created to account for the growing population of those living longer with the disease, providing the ability to link the virus with conditions such as malaria, tuberculosis, and dementia, among others.

In all, the ICD-11 is organized into 30 disease categories, including new sections for sexual health, “traditional” medicine, and diseases of the immune system. In addition, the ICD-11 has been designed to be EHR-compatible—as such, it will link with the Systematized Nomenclature of Medicine—Clinical Terms.

ICD-11 is also fully electronic. Those involved in its drafting hope that this aspect will make it easier to implement, result in fewer mistakes, and allow for more detail to be recorded. The hope is that the ICD-11 will be better able to capture data regarding health care safety, including, perhaps, health care-associated infections.

“A key principle in this revision was to simplify the coding structure and electronic tooling; this will allow health care professionals to more easily and completely record conditions,” Robert Jakob, MD, Team Leader, Classifications Terminologies and Standards, the WHO, said in the agency’s statement.

Still, as with every new edition of the ICD, there are some practitioners who fear the code changes will lead to some confusion—at least initially. This is part of the reason for the 3-year implementation cycle. In addition, the ICD-11 has already been beta-tested in 31 countries.

“Designed for the global digital age, [the ICD-11] is an onscreen, multipurpose, multilingual database interconnecting with other operating systems—including electronic hospital records,” an editorial in the June 23rd issue of The Lancet notes. “It is a quantum leap forward from the ICD-10… [However] any classification system endeavoring to encompass rapidly changing descriptions of death and disease will clearly be imperfect and out of date by the time it is published. The protracted nature of these radical overhauls suggests future versions best be developed incrementally.”

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous health care-related publications. He is the former editor of Infectious Disease Special Edition.

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