Frequently Asked Questions
Frequently discussed topics
ICD-11 Implementation
last updated 2025-02-12
What is the ICD?
The International Classification serves to record and report health and health-related conditions globally. ICD ensures interoperability of digital health data, and their comparability. The ICD contains diseases, disorders, health conditions and much more. The inclusion of a specific category into ICD depends on utility to the different uses of ICD and sufficient evidence that a health condition exists.
What is ICD-11 and why should countries transition from ICD-10 to ICD-11?
ICD-11 is the latest revision of the World Health Organization’s (WHO) International Classification of Diseases (ICD). It incorporates current medical knowledge and clinically intuitive coding structures for healthcare providers, researchers, and decision-makers.
WHO stopped maintaining ICD-10 in 2018, and future enhancements will be introduced only in ICD-11.
Transitioning to ICD-11 ensures improved global interoperability and comparability of health data, accurate disease surveillance, and more efficient decision-making worldwide.
Why is ICD-11 recognized as the global standard for health data classification?
The constitution of the World Health Organization, the international nomenclature regulations mandates ICD in its most recent revision as the international standard for health data recording and reporting, nationally and internationally. ICD ensures global interoperability, consistency and comparability in health information.
WHO Member States have agreed in the World Health Assembly (WHA) resolution to implement ICD-11.
Further ICD-11 is comprehensive and detailed, aligns with modern healthcare needs, has a digital-friendly design, and has received input from scientific societies and more than 90 countries
Since when is ICD-11 in effect?
The new Revision of ICD was endorsed by the World Health Assembly at the 72nd meeting in 2019, and came into effect globally on 1 January 2022. From that date, health statistics will be reported in ICD-11.
Countries are encouraged to start implementation and reporting with ICD-11 in line with their commitment. To that end WHO’s Classifications and Terminologies Unit has developed an implementation package to make the eventual transition from the old system to the new system easier. These documents can be found on ICD-11 page and include the Transition or Implementation Guide, ICD-11 Fact Sheet, information on ICD-API web services, ICD-11 training package, ICD-11 License and more.
What is the timeline for ICD-11 implementation, according to the World Health Assembly (WHA)?
In May 2019, the World Health Assembly (WHA) adopted ICD-11. On 1 January 2022, ICD-11 formally came into effect for Member States.
Countries can continue to use ICD-10 for as long as necessary, but prompt adoption of ICD-11 is encouraged to ensure interoperability, consistency with global standards, benefit from ongoing enhancements, and compliance with international commitments.
Is there a penalty if a country does not complete ICD-11 implementation within five years?
No. There is no penalty for countries that do not meet the implementation timeline. WHO recognizes that each country may face unique technical, financial, or organizational challenges. Nonetheless, delaying implementation may impede the benefits of up-to-date medical classification and hamper global data comparability and interoperability.
Who needs to be part of the implementation of ICD-11?
Transitioning to ICD-11 is a collaborative and iterative process involving stakeholders from the clinical, administrative, research, and policy sectors. By staying informed, actively sharing updates, and embracing the global momentum, countries and organizations can ensure a smooth and timely transition that benefits patients, health systems, and global health surveillance efforts.
What resources does WHO provide to help with ICD-11 implementation?
- Technical Guidance: WHO publishes documents like the “Implementation or Transition Guide.”
- Advisory Services: These include ICD-11 API integration in national Terminology Servers and the CodeFusion tool for creating streamlined workflows, DORIS for processing cause-of-death certificates, ANACOD for cause-of-death data plausibility checking, and a DRG system under development for use with ICD-11 and ICHI.
- Core Health Indicators: WHO maintains a reference list linked to WHO-FIC classifications to help countries align their health indicators.
Do we need a special license to use ICD-11?
Open Access: ICD-11 is available as a global public good. The World Health Organization (WHO) provides free access to ICD-11 for all users. It can be accessed through the official WHO website, including the online platform and downloadable versions. However, planned use needs to comply with the ICD-11 license.
What is the recommended approach for successful ICD-11 implementation?
- Purpose-Driven Integration: Member States should define their interoperability needs early and utilize WHO’s guidance and tools to achieve targeted results.
- Sustainability: Member states should consider the level of information system technology and what level of detail can be run and maintained sustainably with national resources.
- Balanced Framework: Ensure high-quality data by empowering the people who collect and use that data and choosing technology that fits the job and that you control. With high-quality data, governments and healthcare providers can make better-informed decisions to improve public health outcomes.
How should countries communicate their progress on ICD-11 implementation?
Countries are encouraged to update their official websites (e.g., national health authority pages) with the current status of ICD-11 implementation.
Social media can be used to highlight important milestones, share best practices, and direct stakeholders to more detailed resources.
WHO also maintains a global implementation map, and countries are being invited to contribute information to keep international stakeholders informed of the progress.
Will WHO continue to maintain ICD-10 or introduce emergency codes in ICD-10 for future pandemics?
WHO stopped maintaining ICD-10 in 2018. In an emergency (such as a pandemic), WHO would deploy the relevant specific emergency codes in ICD-10 and ICD-11.
Can we use mapping tables from ICD-10 to ICD-11 instead of fully transitioning to ICD-11?
Mapping tables, also called crosswalks, are designed to help users compare data across ICD-10 and ICD-11.
Mapping tables between ICD-10 and ICD-11, as well as between updates of ICD-11 can be accessed at the “Info” tab of the ICD-11 browser.
They are not intended for directly converting data from one revision to the other (e.g., automatically generating ICD-11 codes from ICD-10).
Significant changes in medical knowledge and coding structures limit direct equivalence between ICD-9, ICD-10, and ICD-11. Therefore, relying solely on mapping tables instead of full implementation will likely result in data gaps and inaccuracies and limit their utility.
What makes ICD-11’s tooling and features more advanced than previous ICD versions?
- Integrated information framework: ICD-11 is built on a semantic knowledge base (the Foundation), a biomedical ontology linked to the Foundation and classifications derived from the Foundation, merging clinical terminology with statistical classification.
- Automation and Smart Tools: Advanced capabilities like Natural Language Processing, an Embedded Coding Tool, CodeFusion, and an ICD-11 API improve coding accuracy.
- Ongoing Enhancements: Upcoming releases (e.g., the 2025 Coding Tool) offer expanded spelling error handling and greater precision in coding.
Can we use subsets of ICD-11 for specific use cases, even if our country has not fully adopted ICD-11?
Yes. ICD-11 is more than a set of diagnostic codes. It also provides “extension codes”that include information such as verification status, admission status, anatomical location, and severity. Even if your country has not officially transitioned to ICD-11, you can still use selected ICD-11 codes in information models (e.g., HL7 FHIR or openEHR). These codes are maintained by WHO and the WHO-FIC Network, ensuring they stay accurate and up to date. For example, the ICD-11 list of allergens is regularly updated by a group of allergology experts, or the list of vaccine-preventable diseases, maintained by WHO.
What is the maintenance process for ICD-11, and how does it facilitate global consensus?
ICD-11 has an open and transparent maintenance process that involves ongoing input from civil society, clinicians, statisticians, researchers, national institutions, and many others worldwide.
This process is designed to include the latest medical and scientific knowledge, providing global consensus on disease definitions, terminology, and coding rules.
Regular reviews ensure timely updates and continuous enhancement, safeguarding ICD-11’s relevance and accuracy.
How will ICD-11 evolve over time?
- Ongoing Maintenance: WHO updates ICD-11 regularly, reflecting new medical knowledge and discoveries, coding best practices, and users’ feedback.
- Continuous Refinement: Tools like the Coding Tool receive periodic enhancements (e.g., improved spelling variation support in 2025), ensuring the system remains future-proof.
Is ICD-11 dependent on other WHO classifications or terminologies to work?
No. ICD-11 is a standalone system and does not require additional external terminology or classification systems.
Its self-contained design minimizes complexity and streamlines adoption.
What about using SNOMED CT mappings for reporting to WHO?
The outcomes of the WHO–SNOMED Int. collaboration for mapping ICD-11 and SNOMED CT are still under discussion and are not guaranteed.
ICD-11 and ICD-10 are the primary documentation and classification systems for official reporting nationally to WHO, and WHO reports are published with ICD-11. Mappings will influence the data. ICD-11 is an international standard that incorporates clinical terminology and provides the mechanism for aggregating detailed information in a classification for reporting and statistical purposes.
Do I need terminologies like SNOMED CT to use ICD-11?
No, you don’t need any additional terminology to use ICD-11. ICD-11 is fully equipped to function independently, offering the terminological depth required for clinical recording in multiple languages. Its design incorporates natural language processing to support accurate documentation and coding.
Additionally, short pieces of code available on GitHub in various programming languages enable seamless integration of ICD-11 coding tools into existing software systems, both online and offline.
Why is global comparability and health data interoperability important, and how does ICD-11 improve it?
Global comparability is essential for effective health surveillance, epidemiological work and research, and informed policymaking.
ICD-11 was built to be more detailed, user-friendly, and interoperable with other health classifications and systems. This design fosters seamless data sharing across borders, enabling robust tracking of diseases and health trends worldwide.
Global interoperability allows the design of health information systems and the exchange of information across systems.
ICD-11 was designed for use in digital information systems, integrating clinical terminology and classification into a single, common ontology. Using ICD-11 in clinical settings allows clinicians to record details at the required level of specificity needed for patient care and then aggregate this information into standardized categories for analysis. In doing so, ICD-11 ensures comparability and consistency across all the languages it has been translated into.
How does ICD-11 support clinical, research, and administrative needs?
- Broad Use Cases: From clinical decision-making and billing to global epidemiological surveillance, ICD-11 offers precise coding solutions.
- Improved Data Quality: Its intelligent tooling helps reduce manual coding errors, leading to higher data reliability for research and policymaking.
- Clinical Support:
- Comprehensive Terminology: Provides detailed, up-to-date classifications for precise documentation.
- Multilingual Functionality: Enables global usability in various languages.
- Digital Integration: Seamlessly integrates with EHRs to streamline workflows and reduce administrative burdens.
- Research Support
- Standardized Data Collection: Ensures consistent classification for global comparability in studies.
- Enhanced Data Granularity: Allows for detailed analysis of diseases and health trends.
- Support for Emerging Fields: Aligns with modern research needs, including genomics and mental health.
- Administrative Support
- Health Policy and Planning: Provides data for evidence-based policymaking and resource allocation.
- Billing and Reimbursement: Ensures accurate billing aligned with insurance requirements.
- Global Comparability: Enables tracking of health trends for international reporting and collaboration.
- Innovative Features
- User-Friendly Design: Digital-first tools support coding and natural language processing.
- Flexible Adaptation: Modular structure allows customization for local healthcare needs.
How does ICD-11 fit into the broader digital health transformation?
- Semantic Backbone: ICD-11, along with other WHO classifications like ICF (International Classification of Functioning, Disability and Health) and ICHI (International Classification of Health Interventions ), provides a unified structure for health data capture and exchange.
- National Health Systems: By integrating ICD-11 into national digital health strategies, countries enhance efficiency, interoperability, and data-driven decision-making.
What role does interoperability play, and how is ICD-11 prepared for it?
- Robust API: ICD-11’s API enables smooth integration with existing software and supports FHIR compatibility.
- Collaboration with Standards: WHO offers technical guidance on mapping principles and works with other terminology providers (e.g., SNOMED, LOINC, MedDRA) to ensure seamless data exchange.
- Defined Scope: WHO recommends defining clear interoperability goals to maximize impact.
Do clinicians need to know which code system they are using?
Ideally, clinicians would be agnostic of the system because the tooling would provide the necessary guidance.
It is crucial to know which code system is used from a clinical, research, and epidemiological standpoint, as different coding systems have different methods for representing content, codes, and rules.
Uncertainty about which code system is in use may limit the usefulness and comparability of data, as coding criteria and structure (e.g., in mental health) vary between systems such as ICD-10, ICD-11, DSM, ICPC, or SNOMED CT.
Clear information and some basic training facilitate proper recording, interoperability and interpretation of coded information, consistent data collection, and robust analysis.
Is ICD-11 a "purpose-built ontology"?
ICD-11 is a “purpose-built ontology” or a “purpose-built code system.”
These terms reflect that ICD-11 is explicitly designed to record and classify diseases and health conditions comprehensively and consistently, accommodating modern healthcare and statistical needs, as for epidemiology, all clinical care levels, research, quality and patient safety, resource allocation, funding or decision support.
What is the plan for aligning ICD with other WHO classifications like ICF and ICHI?
WHO continues to coordinate efforts to align its family of classifications (including the International Classification of Functioning, Disability and Health (ICF) and the International Classification of Health Interventions (ICHI)) with ICD-11.
This planned alignment fosters a more holistic approach to health information, from diagnosis (ICD) to functioning (ICF) and interventions (ICHI).
How might artificial intelligence (AI) play a role in future code system collaborations?
As AI technologies evolve, they may support automated coding, natural language processing, and data analytics, potentially bridging gaps between multiple code systems.
The digital design of ICD-11 facilitates innovative research and development. WHO and partner organizations will, for example, explore collaborations to harness AI to enhance health data accuracy and consistency.
Where can I find more information on ICD-11, including technical support implementation guidance, documentation, resources, and references on using and transitioning to ICD-11?
- ICD-11 Portal: https://icd.who.int offers comprehensive resources, including coding tools, API documentation, official guidance, and implementation guidance.
- WHO Technical Support: WHO provides advisory services and collaborates closely with Member States, NGOs, industry, and other stakeholders, ensuring a smooth transition and full utilization of ICD-11’s capabilities ([email protected]).
- National health authority websites often provide regular updates, guidelines, or local transition plans.
- Peer-reviewed articles on the ICD-11 transition, ICD-11 in general, and the development of parts of ICD-11 can be found in medical journals or cited on WHO’s website.
- Engage with social media platforms, such as LinkedIn, to discuss best practices and success stories from early adopters.
- WHO-FIC Network: Global collaboration in support of maintenance and development of WHO-FIC and promoting the implementation of WHO-FIC in WHO Member States.