Director-General's Office

Opening remarks at the Tokyo ICD-11 revision conference

Dr Margaret Chan
Director-General of the World Health Organization

Tokyo, Japan
12 October 2016

Excellencies, honourable ministers, distinguished participants, representatives of WHO collaborating centres on health information management and the family of international classifications, ladies and gentlemen,

WHO welcomes you to the Tokyo conference on the 11th revision of the International Statistical Classification of Diseases and Related Health Problems, or ICD-11. I thank Japan for hosting this event and the Japan Hospital Association for its generous financial support over several years.

The conference takes place as WHO releases the 2016 version of ICD-11 for comments from its member states. The work you will do during this conference will prepare ICD-11 for further refinement leading up its implementation beginning in 2018.

This has been the most challenging, complex, and far-reaching ICD revision in the 100-year history of this standard statistical instrument.

As the external review reported in 2015, revision has been a delicate balancing act between the conservatism needed to maintain statistical compatibility with ICD-10 and the innovation needed to make ICD scientifically up-to-date and fit for purpose in the digital age.

I thank all participants for giving us your time and your expertise. You are among thousands of clinicians and experts in information technology who have contributed to this comprehensive revision.

We are pleased today to welcome participants from our collaborating centre, the International Federation of Health Information Management Associations. I thank the Federation for promoting a well-trained and competent international workforce, fluent in ICD coding, to manage health information.

The opportunities opened by advances in information and communication technologies are huge. The ICD revision aims to make full use of these advances, improving both the ease of use and the specificity and consistency of the coded data.

ICD-11 has been built for use in in an electronic environment, especially as more and more countries introduce electronic health records. Coding tools, browsers, different files, print products, and web services take advantage of new technologies in the digital age. ICD-11 also aims to be consistent with other information products, such as the Standardized Nomenclature of Medicine – clinical terms, or SNOMED-CT.

Revision has been further challenged by the fact that ICD is now used by so many, for so many different purposes. For statistical purposes, it groups together medical terms reported by physicians, medical examiners, and coroners on death certificates.

In practice, ICD has become the international standard diagnostic classification for all general epidemiological and many health management purposes, including reimbursements by governments and insurers.

Ladies and gentlemen,

At the international level, gathering high-quality, specific, and comparable statistical data has never been more important. Cause-specific mortality targets and indicators abound in the 2030 Agenda for Sustainable Development, including for its supremely ambitious health targets.

As we learned during the era of the Millennium Development Goals, information systems for civil registration and vital statistics are absolutely critical to track progress and make strategic course corrections.

Moreover, in the continuing climate of financial austerity, governments and international development partners need statistical proof that their investments in health bring results. This is true everywhere, but most especially so in resource-constrained settings where the overarching SDG objective of leaving no one behind faces the biggest challenges.

Some 85 countries, representing 65% of the world’s population, do not have reliable cause-of-death statistics. This means that causes of death are neither known nor recorded, and health programmes are left to base their strategies on crude and imprecise estimates.

ICD-11 aims to provide an avenue for all countries to increase the coverage and quality of mortality data by age, sex, and cause. For the first time, we are pleased to welcome experts from many lower-income countries in Africa and Asia, whose presence here is sponsored by WHO and the Japan Ministry of Health.

Speakers during this conference will update you on the many improvements in ICD-11, including expanded content, the use of combined codes, new primary care concepts, and additional coding options.

The new foundation component contains all entities for diseases, disorders, injuries, external causes, signs, and symptoms in a network of relationships, enabling a range of improved management options.

As another new feature, diagnostic categories used in traditional medicine are covered in a separate chapter. These categories are based on traditional medicine conditions which originated in ancient China and are now commonly used in China, Japan, the Republic of Korea, and elsewhere.

Particular attention will be given to testing the chapter in integrated health care settings in target countries where both traditional and Western medicine are practiced.

In summary, this is an historical occasion and an historical opportunity to give the medical, epidemiological, and public health communities a cutting-edge statistical tool. Specific, precise, and comparable data are the foundation of everything we do.

I wish you a most successful conference.

Thank you.