The classification of disease began as a statistical study of disease.

This post looks back to the past from 1853 when William Farr (1807–1883) who was a medical statistician of the the General Register Office of England and Wales, laboured to use this imperfect classifications of disease available at the time. With the progress of preventive medicine and to embody the advances of medical science, Farr worked to secure better classifications and international uniformity in their use. Farr’s model survived as the basis of the International List of Causes of Death.

In 1983, The Bertillon Classification of Causes of Death by Jacques Bertillon (1851–1922), Chief of Statistical Services of the City of Paris was adopted as the revision to the International List of Causes of Death.

Revisions to The Bertillon or International List of Causes of Death were carried out in 1900 (ICD 1), 1910 (ICD 2) and 1920 (ICD 3).

With the lack of leadership after Bertillon’s death in 1922 and in preparation for subsequent revisions, the International Statistical Institute and the Health Organization of the League of Nations – which had taken an active interest in vital statistics, cooperated and prepared the expansion in the rubrics of the 1920 International List of Causes of Death into the Fourth (1929) and the Fifth (1938) revisions of the International List of Causes of Death.

The classification of disease remained almost wholly in relation to cause-of-death statistics.

But there was a growing need for a corresponding list of diseases, a classification of diseases for morbidity statistics.

Farr had actually recognised back in 1855 that it was also desirable to extend the cause-of-death statistics system for morbidity. It is interesting to note that 5 years later in 1860, Florence Nightingale urged the adoption of Farr’s classification of diseases for the tabulation of hospital morbidity in the paper, “Proposals for a uniform plan of hospital statistics”. Subsequently, all three revisions of ICD 1, ICD 2 and ICD 3 had adopted a parallel classification of diseases for use in statistics of sickness, however this parallel classification failed to receive general acceptance.

The International Classification of Diseases, Injuries, and Causes of Death as a single list was endorsed by the First World Health Assembly in 1948 as ICD 6. This list provided for the first time a common base for comparison of morbidity and mortality statistics that greatly facilitates coding operations.

The Seventh Revision (ICD 7) and The Eighth Revision (ICD 8) of the International Classification of Diseases were revised under the auspices of WHO in 1955 and 1965 respectively.

The Ninth Revision (ICD 9) was accepted in 1975 and included the dagger and asterisk system as an optional alternative method of classifying diagnostic statements, including information about both an underlying general disease and a manifestation in a particular organ or site.

The Tenth Revision (ICD 10) was originally scheduled for 1985, following the established 10 year interval between revisions

The WHO decided to delay ICD 10 until 1993 as it then realised the great expansion in the use of the ICD which necessitated a thorough rethinking of its structure. The WHO needed to devise a stable and flexible classification, which should not require fundamental revision for many years to come.

ICD 11 is not due until May 2015 when it is due to be presented to the World Health Assembly. As of May 2011. the Open ICD-11 Alpha Browser was open to the public for viewing and for commenting in July 2011. The ICD-11 Beta version was open to the public in the ICD revision process to make comments, make proposals, to change ICD categories, participate in field trials and assist in translating.

Below is an infographic (you can view a larger image by first clicking on the image below which will open in a new tab of your current window and then clicking again on the image in the new tab) I have designed as a display in a showcase way of all the past revisions of ICD leading to ICD 11 expected in 2015.

With the historical background of ICD and the run-up to ICD 11, I present this post as a pre-cursor to the previous post ICD 10 & ICD 11 Development – How, What, Why & When (this link will open in a new tab of your current window) and for my coming posts on ICD 11.

References:
International Statistical Classification of Diseases and Related Health Problems, Volume 2 Instruction manual 2011, 2010 edn, World Health Organization, Geneva, Switzerland

World Health Organization, 2012, Classifications, viewed 18 December 2012, < http://www.who.int/classifications/icd/revision/timeline/en/index.html >

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.