Towards ICD-11 for Malaysia

The World Health Organization (WHO) International Classification of Diseases (ICD) is the global health information standard for mortality and morbidity statistics. ICD (WHO 2012) “is the foundation for the identification of health trends and statistics globally. It is the international standard for defining and reporting diseases and health conditions. It allows the world to compare and share health information using a common language.”

The  version 10 (ICD-10 ) was constructed between 1982-89 and was endorsed in May 1990 by the Forty-third World Health Assembly. In a sense 117 countries around the world, including Malaysia are using a 20-25 year old medical information standard!

An alternative to ICD-10 is the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT), used on electronic medical record ontologies to catalog problem lists (diagnosis) of patients.

According to the International  Health Terminology Standard Development Organisation (IHTSDO) which owns, maintains and distributes the SNOMED CT, it claims that “SNOMED CT is the most comprehensive, multilingual clinical healthcare terminology in the world.”

The alpha phase of ICD-11 has been used as the first phase where the development was limited to “in-house”. ICD-11 development is now open to “public” but is not a functional tool yet, ICD-11 is now in beta phase.

The base version of ICD-11 from WHO is expected in May 2015. In the future, there is a proposed merger of sorts between ICD and  SNOMED in ICD-11.

Malaysia, are we ready for ICD-11? Here are some questions we need to find answers. These are known issues, but I think not given much emphasis, direction, motivation,  and mission and vision. Anyways these issues are not peculiar to Malaysia and other countries who have implemented ICD-10 or still using ICD-9  will need to address for continuous improvement.

• Is ICD-10 implemented correctly in Malaysia?
• Who will check the balance between scientific accuracy and completeness?
• Who will continuously monitor by scientific peer review and other quality assurance methods?
• The earliest ICD-11 would be available for study would be let’s say 2017. When can Malaysia implement ICD-11? If ICD-11 is available for example in 2017, would we need another 4 years to implement it? – which brings us out to 2021. What do we do from now 2012 to 2021 – 9 long years more from now or 4 years from 2017 to 2021 or if ICD-11 is ready for adoption in 2015 – 6 years from  2015 to 2021? After all Malaysia only started using ICD-10 in 1999, some 9 1/2 years since May 1990!
• Malaysia is member of the Morbidity Topic Advisory Group (MbTAG) – an ICD-11 Revision committee – Revision Steering Group (RSG). Is there someone or a group preparing Malaysia for ICD-11?

However, let us not forget that there are then several other standards for various disciplines such as Logical Observation Identifiers Names and Codes (LOINC) to think about.  LOINC is a response to the demand for electronic movement of  clinical data from laboratories that produce the data to hospitals,  physician’s offices, and payers who use the data for clinical care and  management purposes.