Historically the ICD has been revised every 10 years to ensure its continued currency and utility. The current revision (ICD-10) was approved in 1990 by the World Health Assembly (WHA), the decision making body of the World Health Organization (WHO). Australian implementation occurred in 1997 with ICD-10 being used for reporting mortality data, and in 1998 an Australian modification was developed for morbidity coding.

The process to update the classification to the eleventh revision (ICD-11) was initiated by WHO in 2007. The design of ICD-11 has a Foundation component of clinical terms which can be expressed in tabular lists according to the expected use. The main tabular list for ICD-11 is made to collect data on disease and causes of death and is called ICD-11 for Mortality and Morbidity Statistics (ICD-11 MMS). Other tabular lists will be created for other uses such as those for Primary Care, Quality and Safety and special clinical groups.

Use cases

Two of the stated goals of the ICD revision process are to:

  1. establish a classification-terminology linkage from ICD-11 to the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT), and
  2. minimise the need for country specific modifications by creating a structure within ICD-11 to accommodate such modifications.

It is envisaged the classification will serve the needs of multiple use cases, which include:

  • mortality (causes of death)
  • morbidity (diseases and related health problems), and
  • specialty adaptations and uses in different settings (for example primary care and clinical care) for different purposes (for example research, public health monitoring and safety and quality measures, and so forth).

The objectives of the ICD revision process are to:

  • revise the ICD classification in line with scientific advances, to serve multiple purposes including mortality and morbidity statistics as well as clinical use in primary care, specialty care and research
  • continue to serve as an international standard in multiple languages and settings to allow for comparable data
  • link with computerised health information systems (directly use standard terminologies and other health informatics applications to be “electronic health application ready”).

Revision Steering Group to Joint Task Force

Originally, the revision process was co-ordinated through a Revision Steering Group (RSG), that had a number of Topic Advisory Groups (TAG) reporting to it. The TAGs served as the planning and coordinating advisory body for key issues in the update and revision process, and led the work in different fields of expertise. The TAGs would either deal with a section of the classification (called vertical TAGs) for example Mental Health, External Causes of Injury, and Internal Medicine, or areas that covered the whole classification (called horizontal TAGs) such as Morbidity, Mortality and Safety and Quality.

The RSG served as a consultative expert authority in the update and revision process. This group has since been replaced with the Joint Linearization for Mortality and Morbidity Task Force, also known as the Joint Task Force (JTF).

The JTF provides strategic and technical advice to WHO for the development of ICD-11 MMS. The primary focus of the JTF is to recommend the subset of ICD-11 foundation that will be included as codes in the ICD-11 MMS as well as how to appropriately structure those codes for tabulation and aggregation.    

Revision process

An alpha draft of ICD-11 was released to the public for review in July 2011. This was the first step in allowing wider participation of the global health community and multiple stakeholders in the development process of ICD-11.

In July 2011, the AIHW (as the ACC) hosted an Australian event to announce the ICD-11 revision process. This event, titled Think before you measure, was held in association with a symposium on classifications and hosted by the University of Sydney. The event announced the ICD-11 revision and the opportunity for public review to promote participation in the process. Presentations from the event (18MB ZIP) .

The beta draft of ICD-11 was released in May 2012, in the form of a publicly viewable browser.

The WHO plans to release ICD-11 MMS in 2018 after it is presented to the WHA. The decision on adoption of ICD-11 for use within Australia is yet to be made.

Further information about the ICD-11 revision process can be found on the WHO website.

ICD-11 field testing

As part of the ICD-11 Revision project plan the WHO has sent a number of invitations to field conduct field testing of ICD-11 MMS before its release in 2018. The goals of field testing were to:

  • inform whether ICD-11 is fit for purpose
  • identify any changes and enhancements that may be required, and
  • confirm any transitional and implementation issues.

The AIHW, as the ACC, conducted ICD-11 MMS field testing for morbidity purposes. The Australian Bureau of Statistics conducted ICD-11 MMS field testing for mortality purposes. Field trial results can be found in the WHO-FIC Network Annual poster booklet.

Further information, including a link to the poster booklet, can be found on the WHO-FIC Network Annual meeting website.

Further information 

If you would like further information on ICD-11 please contact the ACC at [email protected].