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ICD-11: The Evolution of International Classification of Diseases

The International Classification of Diseases (ICD) is a crucial tool used globally to classify and code health conditions and diseases. It provides a common language for health professionals, researchers, and policymakers to communicate and compare health information across different countries and healthcare systems. The World Health Organization (WHO) is responsible for maintaining and updating the ICD, and after several years of development and consultations, ICD-11 was released in 2018. This article aims to explore the evolution of ICD and delve into the significance and improvements introduced with ICD-11.

The History of ICD

The journey of the International Classification of Diseases began in the 19th century when statistical data on causes of death and diseases became essential for public health and epidemiological research. In 1853, the first attempt at creating a systematic classification of diseases was made by the American Medical Association (AMA). However, it was not until 1893 that the International Statistical Institute (ISI) proposed a more comprehensive classification system. This proposal laid the foundation for the development of ICD, which officially came into existence in 1900.

The early versions of ICD primarily focused on mortality statistics, with subsequent editions expanding to include morbidity data. Over the years, the classification underwent numerous revisions, with ICD-6 and ICD-7 focusing on oncology and external causes of injury. The seventh revision (ICD-7), published in 1955, marked a significant shift towards a more structured and comprehensive approach.

ICD-10: A Major Milestone

The tenth revision of the International Classification of Diseases (ICD-10) was published in 1992 and represented a major milestone in the history of this classification system. It was the first version to use alphanumeric codes, which significantly improved the accuracy and efficiency of coding. ICD-10 also introduced a multiaxial framework, allowing for the consideration of various aspects of a patient’s condition simultaneously.

Despite these improvements, ICD-10 had its limitations. It was based on outdated medical knowledge, and its structure sometimes led to the inclusion of overlapping or ambiguous categories. Additionally, the increasing complexity of medical conditions and advancements in health research required a more flexible and dynamic classification system.

The Need for ICD-11

The process of developing ICD-11 began in 2007 when the WHO initiated a comprehensive revision of the existing ICD-10. The main objectives of this revision were to enhance the clinical utility, scientific validity, and global comparability of the classification. Furthermore, the new edition aimed to address the limitations of ICD-10, accommodate advancements in medical knowledge and technology, and anticipate future needs in healthcare.

ICD-11 Development Process

The development of ICD-11 was an extensive and collaborative effort, involving experts from various medical and scientific disciplines, healthcare professionals, researchers, and representatives from WHO member states. The process was conducted in multiple phases:

  1. Preparatory Phase: During this phase, the WHO established the International Advisory Group for the Revision of ICD-10 to guide the overall development process. The scope and objectives of ICD-11 were defined, and the WHO coordinated regional consultations to gather feedback and input from stakeholders.
  2. Alpha Drafting Phase: The Alpha draft of ICD-11 was released in 2010, containing initial proposals for changes to the classification. It was an open-access platform, allowing users to review and provide feedback on the proposed revisions.
  3. Beta Drafting Phase: Following the Alpha draft, the Beta draft of ICD-11 was launched in 2013. It was a collaborative platform that allowed users to contribute to the refinement of the classification. Feedback from healthcare professionals, researchers, and other stakeholders from around the world was collected and considered during this phase.
  4. Field Testing: To assess the feasibility and usability of ICD-11 in real-world settings, the WHO conducted field testing in various countries. This phase helped identify potential issues and areas for improvement.
  5. Finalization and Publication: After several iterations and revisions based on the feedback received, the final version of ICD-11 was approved by the World Health Assembly and published by the WHO in 2018.

Key Improvements and Features of ICD-11

ICD-11 introduces several important improvements and features compared to its predecessor, ICD-10. Some of the notable changes include:

  1. Structured Content: ICD-11 adopts a more structured and hierarchical format, making it easier to navigate and find relevant information. The classification uses a foundation of linearizations, each serving a specific purpose and audience, ensuring the data is readily accessible and user-friendly.
  2. Improved Clinical Descriptions: ICD-11 provides detailed and updated clinical descriptions for each condition, incorporating the latest medical knowledge and terminologies. This ensures that healthcare professionals can accurately and consistently code and document diagnoses.
  3. Inclusion of Social Determinants of Health: One significant advancement in ICD-11 is the incorporation of social determinants of health (SDH) in the classification. This addition acknowledges the impact of social factors on health and enables a more comprehensive approach to understanding health conditions.
  4. Integration of Primary Care: ICD-11 includes a chapter dedicated to primary care, facilitating the classification and recording of conditions typically encountered in primary care settings. This helps improve the relevance and applicability of the classification in everyday medical practice.
  5. Expanded Coverage of Health Conditions: ICD-11 expands the number of health conditions covered, reflecting the evolving landscape of diseases and health concerns. New chapters were added, such as one on traditional medicine conditions, acknowledging the importance of traditional healing practices in certain cultures.
  6. Enhanced Electronic Interface: ICD-11 is designed to be integrated into electronic health record systems and other health information technologies seamlessly. This ensures the smooth flow of data across healthcare settings and enables interoperability on a global scale.
  7. Integration of Mortality and Morbidity Information: ICD-11 aims to integrate mortality and morbidity information more closely, allowing for a more comprehensive understanding of diseases and their impact on populations.

Benefits and Impact of ICD-11

The adoption of ICD-11 brings about several benefits and significant impacts on various aspects of healthcare:

  1. Improved Data Quality: With its detailed clinical descriptions and updated terminology, ICD-11 enhances the accuracy and completeness of health data, leading to improved data quality for research, public health, and policy-making.
  2. Better Patient Care: The more comprehensive and specific classification in ICD-11 helps healthcare professionals provide better patient care, as it allows for precise diagnoses and improved treatment decision-making.
  3. Enhanced Global Comparability: ICD-11’s streamlined structure and international recognition ensure that health data can be accurately compared and analyzed across different countries and healthcare systems. This contributes to a better understanding of global health trends and facilitates collaborative research.
  4. Support for Health Information Systems: ICD-11’s compatibility with electronic health record systems and other health information technologies improves data collection, storage, and exchange, enhancing the overall efficiency of healthcare systems.
  5. Research Advancements: ICD-11’s incorporation of new diseases and conditions, as well as its focus on SDH, opens up new avenues for research and analysis, contributing to a deeper understanding of health disparities and disease patterns.


The International Classification of Diseases has come a long way since its inception, evolving to meet the changing needs of the global healthcare landscape. ICD-11 represents a significant step forward, providing a more comprehensive, clinically relevant, and user-friendly classification system. Its implementation brings numerous benefits, including improved data quality, better patient care, enhanced global comparability, and support for health information systems.

As healthcare continues to advance, the ICD will undoubtedly continue to evolve as well. The ongoing collaboration between the WHO, health professionals, researchers, and policymakers is essential in ensuring that ICD remains a reliable and indispensable tool for the betterment of global health.

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