—from Epidemiological Bulletin, Vol. 24 No. 2, June 2003—
Updating the International Classification of Diseases, Tenth Revision
Background
The World Health Organization has coordinated the periodic revision of the International
Classification of Diseases (ICD) since 1948. As a result of a process initiated
in 1983, the three volumes of the English and French versions of the Tenth and
latest Revision of the ICD (ICD-10) were published between 1992 and 1994. The
translation to other languages followed, coordinated by 6 WHO Collaborating
Centers(1) and other institutions around the World. In particular,
the Spanish version was published by the Pan American Health Organization (PAHO)
in 1995.
Prior to the 10th Revision, updates were not published between
revisions, which occurred in ten year cycles. Thus, the ICD-1, the first revision
of the original 1893 Bertillon’s Classification, was introduced in 1900,
the ICD-2 in 1910, and so on until the ICD-9 was released in 1979. By request
of several countries, the introduction of the ICD-10 was delayed up to 1994,
when it started to be used in a few countries in Europe. It is being implemented
in the rest of the world since 1995.
Updating process
In 1989, the WHO ICD-10 International Conference recommended the definition
of an updating mechanism so that changes could be implemented between revisions.
To that effect, two separate bodies, the Mortality Reference Group (MRG) and
the Update Reference Committee (URC), were established in 1997 and 1999, respectively,
to initiate and follow-up on that process (see Figure 1).
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Figure 1: Relationship between URC, MRG, WHO Collaborating
Centers and WHO Secretariat/Heads of Collaborating Centers
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The MRG is composed of members from the different WHO Collaborating
Centers and makes decisions on the application and interpretation of the ICD
to mortality, as well as recommendations to the URC on proposed ICD updates.
The URC receives proposals from the MRG and members through the WHO Collaborating
Centers for the Family of International Classifications(2)
and submits recommendations on proposed ICD updates for mortality and morbidity
to the Collaborating Centers. Unlike in the past, these recommendations reinforce
the process of updating the ICD-10 rather than creating the foundation of an
ICD-11. This continuous process is facilitated by reports from countries to
their corresponding WHO Collaborating Center for Classification of Diseases
of any significant problems in the use of the ICD-10. In the Region of the Americas,
the English-language center is located at the National Center for Health Statistics
in the United States, the Spanish-language center is the Centro Venezolano de
Clasificación de Enfermedades in Venezuela, and the Portuguese-language
center is at the Universidade de São Paolo in Brazil. As WHO’s Regional
Office for the Americas, PAHO also serves as a fundamental link between countries
and the URC in the updating of the Classification.
Changes to the ICD vary in nature from minor corrections, which
are updated in the classification’s tabular list every year, to major alterations
that take place every three years.
Minor changes include:
– Correction or clarification of an existing index entry that only
changes the code assignment to a code within the same three-character category.
– Enhancements to the tabular list or index (such as the addition of an
inclusion term to an existing code; the addition of an exclusion note; the duplication
of an existing index entry under another main term).
– Change to a code description that enhances the description rather than
changes the concept.
– Change to a rule or guideline that does not affect the integrity of morbidity
or mortality data collections.
– Correction of a typographical error.
Major changes include:
– Addition of a new code.
– Deletion of a code.
– Movement of a code to another category or chapter.
– Change to an existing index entry that changes the code assignment from
one three-character category to another three-character category (movement of
terms).
– Change to a rule or guideline that affects the integrity of morbidity
or mortality data collections.
– Introduction of a new term into the index.
All updates are incorporated annually into the ICD index if they
do not impact on the structure of the tabular list. The official updates to
the published volumes of ICD-10 are produced in two formats: 1) a cumulative
list of all changes made to ICD-10 from 1996 onwards, and 2) an annual list
of changes made to ICD-10 since 1996. Both lists are available at: www2.fhs.usyd.edu.au/ncch/WHO%20URC/who_urc.html#WHO_Off_Updates.
The Spanish version of the cumulative updates, prepared by PAHO, will soon be available at: www.paho.org. Further, in the case of the Spanish-language ICD, the cumulative corrections and updates as of January 2003 have been incorporated in a new (2003) Edition of the ICD-10 (see Box 1). All Spanish ICD-10 volumes acquired as of now will therefore include all the changes detected between 1996 and 2003. This is useful for new buyers of the ICD-10 volumes, who will not need to look up the changes made during the 1996-2002 period. However, it is important to note that the publication of the 2003 version of the ICD-10 does not imply that current users will have to replace their volumes of the classification. Indeed, although quite a few corrections were made (nine new codes were created, eight were eliminated, some conditions formerly included in a specific code are now included in another one, and some criteria for using rules in the coding process were changed), they are ultimately not significant enough to require replacing current sets of the ICD-10. Further, corrections and updates are constantly being disseminated through different mechanisms including the electronic “Forum-CIE” in Spanish and “ICD-Forum” in English(3), allowing users to enter the changes manually in their ICD-10 volumes. A web site on available resources on the ICD is also being developed.
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Box 1: "Clasificación Estadística
Internacional de Enfermedades y Problemas Relacionados con la Salud, Décima
Revisión", Edición 2003
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This new Spanish edition of the 10th Revision of the International Classification
of Diseases includes all the updates approved between 1996 and 2003. It
is also available in CD-ROM. |
Final comments
It should be noted that many other changes to the current revision of the
ICD are not expected in the next few years, as the detection of errors and inaccuracies
dwindles down with regular use of the Classification. As mentioned above, PAHO
has already published the Spanish 2003 Edition of the ICD-10. The publication
of the English and French versions of the same will be done by WHO, and in Portuguese
by the Editora da Universidade de São Paolo (EDUSP) in coordination with
PAHO and the Brazilian Collaborating Center.
(1) Peking Union Medical College Hospital, Beijing,
China (Chinese), INSERM, Le Vésinet, France (French), University Hospital,
Uppsala, Sweden (Nordic countries), Universidade de São Paulo, São
Paulo, Brazil (Portuguese), The N.A. Semaško Institute, Moscow, Russian
Federation (Russian), and the Centro Venezolano de Clasificación de Enfermedades,
Caracas, Venezuela (Spanish).
(2) See following web site for the list of worldwide Collaborating
Centers: (http://www.who.int/whosis/icd10/collabor.htm).
(3) To subscribe Forum-CIE and/or ICD-Forum, send an e-mail
to beckerro@paho.org or hazlewom@paho.org
with your full name, city, country, position and name of your institution.
References:
- World Health Organization. Statistical Classification of Diseases and Related
Health Problems. - 10th Revision. v.3 Tabular list. Geneva, Switzerland: WHO;
1994
- World Health Organization. Meeting of Heads of the WHO Collaborating Centres
for the Classification of Diseases. Copenhagen, Denmark: WHO; 14-20 October,
1997. (WHO/HST/ICD/C/97.65)
- World Health Organization. Meeting of Heads of the WHO Collaborating Centres
for the Classification of Diseases. Paris, France: WHO; 13-19 October 1998.
(WHO/GPE/ICD/C/98.60)
- World Health Organization. Meeting of Heads of the WHO Collaborating Centres
for the Classification of Diseases. Cardiff, Wales: WHO; 17-22 October 1999.
(WHO/GPE/ICD/99.56)
- World Health Organization. Meeting of Heads of the WHO Collaborating Centres
for the Classification of Diseases. Rio de Janeiro, Brazil: WHO; 15-21 October
2000. (WHO/GPE/ICD/C/00.71)
- World Health Organization. Meeting of Heads of the WHO Collaborating Centres
for the Classification of Diseases. Bethesda, MD, U.S.A.: WHO; 21-27 October
2001. (WHO/GPE/CAS/C/01.97)
Source: PAHO’s Area of Health Information and Information
Systems (AIS).
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Epidemiological Bulletin, Vol. 24 No. 2, June
2003