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ICD Revision Manual for TAG and


ICD Revision Project 


Executive Summary


Please find information on the overall revision process and access to the revision platform on the Internet at www.who.int/classifications/icd/ICDRevision.



The International Classification of Diseases (ICD) is a key instrument of the World Health Organization.  Upon the formation of WHO in 1948, ICD was adopted and has been maintained ever since, representing the basis for national and internationally comparable and up-to-date consistent collection, classification, processing, and presentation of disease-related data. ICD was initially developed for coding causes of death.  However, continuous evolution now renders ICD useful for coding morbidity, as well as recording specific diseases, injuries, signs, symptoms, complaints, social circumstances, reasons for presentation and external causes of both injury and disease.

ICD informs public health bodies, clinicians and researchers alike in the evolving environment of increasingly complex health systems, ensuring the provision of language and system-independent definitions that are applied for:

  • National and international health statistics (mortality and morbidity);
  • Epidemiology, surveillance, and monitoring:
  • Individual patient records and  electronic health records;
  • Reimbursement and health system financing;
  • Reference for treatment guidelines, scientific literature and research;
  • Quality assessment at the level of individual cases up to assessment of health system outcomes and monitoring.

WHO leadership in health information, and the role of ICD was reemphasized in the WHO Nomenclature Regulations1 that stipulate ICD in its most up to date version is to be used for mortality and morbidity reporting in all Member States.

The success of ICD-10 is unequivocal:

  • 70% of the world��s health expenditures (3,500 Billion USD)II are allocated using ICD directly for reimbursement and resource allocation;
  • 110 countries that collectively account for 60% of the world��s population use cause of death data coded with ICD for health planning and monitoring in a systematic fashion.
  • ICD-10 is cited in more than 20,000 scientific articles.

Developing countries bear a large burden of disease with many of their health systems lacking resources in the face of an overwhelming tide of urgent and life threatening demands.  Consequently, planning of interventions may be less than optimal and their effectiveness limited accordingly and once established; such vicious circles are an obstacle to achieving the best possible health for a population from an already limited amount of resources.2 Effective deployment of ICD-derived tools would facilitate the use and collection of health information under such challenging circumstances and therefore facilitate quantitatively informed decisions.    

ICD is a core member of the WHO Family of International Classifications.  These core classifications form the basis for numerous additional derived & related modifications.  WHO owns all rights and processes that relate to ICD and its other core classifications and has the responsibility to ensure conceptual consistency in all the changes that are introduced accordingly.

Historically, ICD is revised approximately every 10 years, with the exception of the 20-year period between the last two revisions, ICD-9 and the most recent version, ICD-10.  ICD-10, was completed in 1990 and the WHA requested that it should be revised as necessary, with such revision being organized and coordinated by the WHO Secretariat in order to provide support for the eventual transition from ICD-10 to ICD-11.  Below we present the revision goals, the organizational structure and the plan.  

Goals for the current ICD revision: ICD-10 to ICD-11

  1. Update ICD to accommodate new scientific, clinical and public health knowledge

Since ICD-10 was issued, health-related knowledge and related applications have expanded dramatically.  For example, progress in biotechnology and genome sequencing and disease gene mapping, novel disease and epidemiology and intervention effectiveness modelling (e.g. GBD, cost-effectiveness), as well as web-driven information sharing and computer-based analysis have widely impacted many aspects of our current understanding and interpretation of health.

  1. Integration of broad consultations and new, internet-based technologies for information gathering, integration and sharing

The revision has two facets: firstly, building from a backbone of expert reviews and stakeholders�� consultations and secondly, expanding to embrace internet-based technologies enabling knowledge capture from a broader, multi-discipline global community and ensuring effective facilitation of integration with a broad spectrum of health systems.

  1. Integration and cross-referencing with health-related terminology systems

The current revision links ICD-11 to modern terminology systems that form reference bases for medical definitions and accordingly ensure seamless integration with electronic health information systems.

  1. Harmonize with ICD-related and derived classifications as well as other members of the WHO Family of International Classifications

Revision of ICD-11 establishes procedures and mechanisms that enable ICD-11 to co-evolve and capture the valuable synergies offered by complementing health information systems, keeping up with fast development of knowledge, and the associated evolution of computer applications and classifications.

  1. Build in needs-driven adaptations to the revision process around priority ICD Use Cases, including public health mortality and morbidity surveillance, phenotype stability, quality and patient care, financial management applications.
  2. Accelerate global implementation plans with particular focus on developing countries

ICD-11 implementation success will depend on ease of integration with current applications and other health system technologies and methodologies. Developing countries will not only participate early in the revision process, but also will be able to articulate their specific needs for information presentation and tools that can build capacity for accelerated introduction, implementation, and transition from ICD-10 to ICD-11.

I WHO Nomenclature Regulations, 1967; ICD-10, 1st edition Volume 1 ; p.1241ff

II WHOSIS Health expenditures 2008, data year 2005, ICD implementation in reimbursement and resource allocation, WHO Implementation database




Project milestones and budget, and organizational overview

Needs analysis executed Sep 2008 $190,000 $190,000
Revision team is formed Oct  2009 $994,000 $1,184,000
Revision Platform ready for all types of inputs and outputs Dec  2012* $1,500,000 $2,684,000
All information relevant to revision is compiled Mar 2011** $4,738,000 $7,422,000
Alpha-draft released Feb  2010 $2,115,000 $9,537,000
Beta- draft released Nov 2011 $1,405,000 $10,942,000
Field trials completed July 2012 $1,590,000 $12,532,000
Pre-final draft released Mar 2013 $725,000 $13,257,000
ICD-11 endorsed by WHA May 2013 $255,000 $13,512,000
ICD-11 implementation package ready July 2013 $2,850,000 $16,362,000
ICD-11 published in six official languages Mar 2014 $6,000,000 $22,362,000
Pilot countries implemented ICD-11 Mar 2014 $13,338,000 $35,700,000

*functionality for relevant revision work will be available by 2010.  Advanced output functionality will be available for preparation of the pre-final draft

** major input will be ready for the alpha draft.  The process allows additional input until beta version for field testing.

Total budget of USD 42,600,000 includes USD 6,900,000 project coordination cost fully supported by the WHO.



  ICD-11 Revision plan chart





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