WHO Releases New ICD-11

Megan Brooks

June 18, 2018

The World Health Organization (WHO) today released the 11th edition of the International Classification of Diseases (ICD-11) after more than 10 years in the making.

For the first time, the new ICD-11 is fully electronic, making it easier to use and less prone to errors, the WHO noted at a press briefing announcing the launch. Thirty-one countries were involved in field testing ICD-11. It contains 55,000 codes vs 14,400 in ICD-10.

ICD-11 will be presented at the World Health Assembly in May 2019 for adoption by member states, and it will come into effect on January 1, 2022. Releasing it now will allow countries to plan how to use the new version, prepare translations, and train health professionals all over the country.

"We are working with all WHO offices on a global implementation plan and have prepared an implementation package to help with transition from the old system to the new system," Robert Jakob, MD, team lead, classifications, terminologies, and standards at WHO, said at the briefing.

The new ICD reflects progress in medicine and advances in scientific understanding of diseases, he noted.  It includes several new chapters, including one on traditional medicine, which has never been classified in this system.

The new ICD regroups conditions in a way that corresponds to current knowledge. Dr Robert Jakob

 

One major revision takes gender incongruence out of the chapter on mental health and moves it to a newly created sexual health chapter, said Lale Say, MD, coordinator, Department of Reproductive Health and Research at WHO.

In previous editions of ICD, gender incongruence was in the mental health chapter, but in ICD-11, because of a better understanding of the issues surrounding this condition, it is now known that gender incongruence is "not a mental health disorder," Say explained. "Keeping it in the mental health chapter was potentially causing stigma, so we needed to destigmatize it," she said.

"The new ICD regroups conditions in a way that corresponds to current knowledge," added Jakob.

Gaming Disorder Added

In another change, gaming disorder has been added to the section on addictive disorders. Gaming disorder is characterized by impaired control over digital or video gaming and increased priority given to gaming over other usual activities, such as sleeping, eating, doing homework, or attending work, "leading to serious negative consequences to personal health and overall functioning," said Shekhar Saxena, MD, director of the Department of Mental Health and Substance Abuse at WHO.

"This behavior should last 12 months before it is characterized as gaming disorder," he said. "Everybody who engages in gaming does not have a disorder. In fact, it's only a small minority of people who engage in gaming who may have a gaming disorder, but countries and professionals need to be aware and look out for this and provide prevention and treatment," Saxena said at the briefing.

Globally, "the majority of people who suffer from mental health disorders do not receive any treatment. We believe that with ICD-11 there will be a new energy and new enthusiasm for improving the diagnosis and the treatment by health care providers," said Saxena.

Jakob said other sections that have been extensively updated and restructured according to current knowledge include cardiology, allergies and immune system disorders, infectious diseases, cancer, dementia, and diabetes. 

Importantly, he said, "antimicrobial resistance patterns can now be documented properly, which will help support research and produce new antibiotics." ICD-11 codes relating to antimicrobial resistance are more closely in line with the Global Antimicrobial Resistance Surveillance System (GLASS), he explained.

ICD-11 is also able to better capture data regarding safety in healthcare. "With ICD-11, patient safety events can be recorded better than ever before and prevented. This is a topic of extreme relevance that has not been possible to document properly with the old ICD. With the new ICD-11, we have a complete system to document events or near misses," Jakob said.

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