Half a century ago, a disease like schizophrenia, would probably never be diagnosed similarly in countries across the world. But now, thanks to WHO’s classification of diseases, a doctor anywhere in the world will be able to understand what the ICD code means. The ICD-11 has only taken this entire process one step further.

The International Classification of Diseases (ICD) is the international standard diagnostic tool for understanding diseases, health management and clinical purposes. Its official name is International Statistical Classification of Diseases and Related Health Problems (ICD) and it is the foundation for health statistics. It charts the human condition from birth to death: any injury or disease we encounter in life − and anything we might die of − is coded here. It attempts to provide a holistic look at every aspect of life that can affect health.

World Health Organization (WHO), the directing and coordinating authority for health within the United Nations system maintains the ICD. On 18 June 2018, 18 years after the launch of ICD-10, WHO released a version of ICD-11 which will be presented at the World Health Assembly in 2019 for adoption by countries and is scheduled to take effect from January 1, 2022.

What makes the ICD-11 better?

The ICD-11 has been updated for the 21st century and reflects critical advances in science and medicine. It is well integrated with electronic health appliances and information systems, making it significantly easier to implement, make fewer mistakes and record more details. All of this makes the tool much more accessible, particularly for low-resource settings. ICD-11 will be a digital product; the system allows connection of any software through a standard API and can also be used offline.

Standardization is the key that unlocks global health data analysis. Another important feature of the ICD-11 is that it has been produced through a transparent and collaborative manner. About 300 specialists from 55 countries, organized in 30 main working groups have provided their input to make ICD-11 scientifically up-to-date. It is also truly multilingual, ICD-10 exists in 43 Languages in electronic versions and ICD-11 has already 15 translations in progress, making ICD-11 much easier to use than ICD-10.

ICD-11: Small Code, Big Impact:

Traditional Medicine – a primary source of health care:

Millions of people use traditional medicine worldwide and it is for the first time that it has been classified in the system. The inclusion of traditional medicine is a way of recording epidemiological data about disorders described in ancient Chinese medicine, commonly used in China, Japan, Korea and other parts of the world. "We recognize that the use of traditional medicine is widespread. For many people – especially in the Western Pacific, South-East Asia, Africa and Latin America – traditional medicine is the primary source of health care," said Dr Marie-Paule Kieny, Assistant Director-General of Innovation, Information, Evidence and Research at WHO. "Throughout the rest of the world, particularly Europe and North America, use of herbal medicines, acupuncture, and other traditional medicine practices is increasing. Global classification and terminology tools, for traditional medicine, however, have been lacking."

Therefore, this will be an international platform that allows harmonization of data for clinical and statistical use.

Gender incongruence – a relief for the Transgender community:

Gender incongruence is a marked and persistent incongruence between a person’s experienced gender and assigned sex. Gender incongruence has been moved out of mental disorders in the ICD, into sexual health conditions. The rationale being that while evidence is now clear that it is not a mental disorder, and removing gender incongruence from mental health chapter will help reduce stigma and help better social acceptance of people who are transgender and therefore, increase access to healthcare. Similarly, homosexuality (classified as a mental disorder in ICD-6) was removed from the ICD and other disease classifications systems in the 1970s.

Though credit can be given to the scientific understanding of the condition, the constant advocacy from patient and professional groups has to be lauded.

Gaming Disorder – To Play or Not to Play?!

Its official now! The WHO has included ‘gaming disorder’ as a new mental health condition to its diagnostic handbook. For beginners, WHO states the following criteria as indicating gaming disorder:

1. Gaming is strongly preferred over other activities,
2. The patient does not stop even when there are negative consequences like doing badly at work/school,
3. Compulsive gaming strains the patient’s life or relationships, and
4. All this has been happening for at least a year.

So, you are thinking of all the hours you crushed the candies and yielded the farms, relax! The experts do argue that the evidence is inconsistent and the criteria too broad and we still don’t know enough to claim that gaming disorder exists. There is a lack of consistency across studies, not only in what they are measuring but how they measure it. “Most of the scales we use aren't good scales to begin with, and they provide no cutoff point for diagnosis", says Nancy Petry, a psychologist from the University of Connecticut.

So, for now, do keep the game on, but see to it, you don’t fall into the above criteria.

Simplifying Mental Health, Bridging the Gap:

According to the Global Burden of Disease study, mental health problems are found to be one of the main causes of the overall disease burden worldwide. Many people with severe mental health problems do not receive treatment at all because of a lack of access and knowledge of mental health conditions by primary health care providers. In the words of the International Advisory Group for the revision of the ICD-1O Mental and Behavioural Disorders, “People are only likely to have access to the most appropriate mental health services when the conditions that define eligibility and treatment selection are supported by a precise, valid, and clinically useful classification system.”

Globally, because of the significant treatment gap for mental disorders, as well as shortage of mental health professionals, it is suggested that the identification and management of common mental health disorders be carried out in primary care settings (ResearchGate). For this reason, WHO has made an attempt in the mental disorders section of ICD-11 to simplify the codes as much as possible to allow for coding of mental health conditions by primary health care providers rather than by mental health specialists.

This will be a critical move, says WHO, since the world still has a scarcity of mental health specialist – up to 9 out of 10 people needing mental health care don’t receive it.

Safety in Healthcare:

The new version seeks to capture data on healthcare safety more effectively. Updates have been made to help detect and minimize unsafe workflows in hospitals and other unnecessary events that may pose health risks. 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”, says WHO Classifications Terminologies and Standards Team Leader Dr. Robert Jakob.

He also points out that a key principle of the latest ICD revision was to simplify the coding structure and electronic tooling with the goal to help health care professionals to record conditions more easily and completely.

Over a decade in the making, ICD-11 is a vast improvement on ICD-10. ICD-10 which was released in 1990 took years to be implemented by member countries. ICD-11 may also take several years to come into effect, nevertheless, as and when it happens, patients, primary health care providers and physicians around the world will benefit from the simplified coding system.