Implementation of

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Implementation of ICD-10 in South-East Asia
Region
Workshop of Key Trainers on ICD-10 from cities
of Delhi and Rohtak 21-23 July 2004
Dr Anton Fric Regional Adviser Evidence
Health Information WHO Regional Office for
South-East Asia New Delhi
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Purpose of the ICD

• Systematic recording
• Analysis
• Interpretation
• Comparison of mortality morbidity data
  collected in countries or areas at different
  times
• All general epidemiological and many health
  management purposes (the general health
  situation the monitoring of the incidences
  and prevalence)

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Classification of diseases
A system of categories to which morbid entities
are assigned according to established criteria.
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Outline of the presentation

• Family of International Classifications
• Global Situation in Implementation of ICD-10
• Regional Situation in Implementation of
  ICD-10
• Country Activities, plans
• Regional Issues in the ICD-10 Implementation

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WHO Family of International Classifications
(WHO-FIC)
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Types of classification

• Reference classifications
• Derived classifications
• Related classifications

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Reference classifications

• International Classification of Diseases
  (ICD)
• International Classification of Func-
  tioning, Disability and Health (ICF)
• International Classification of
  Health Interventions (ICHI)

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Derived classifications

• Specially-based adaptations for
• Psychiatry
• Oncology
• Neurology
• Dentistry and stomatology

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Related classifications

• International Classification of Primary Care
  (ICPC)
• International Classification of External
  Causes of Injury (ICECI)
• Technical aids for persons with disabilities
  Classification and terminology (ISO9999)
• The Anatomical Therapeutic Chemical Classi-
  fication System with Defined Daily Doses
  (ATC/DDD)

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WHO-FIC Network

• WHO Headquarters Classifications
  Team
• Regional Office counterparts
• WHO Collaborating Centres
• Cooperating National Institutions

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Implementation of ICD-10 by WHO Member States
for mortality
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Sources of information

• Regional Offices
• WHO-FIC Implementation Committee
  questionnaire in 2002
• WHO-FIC Education Committee Needs
  Assessment Survey in 2003
• WHO Mortality database

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A F R O
46 Member States Six have
implemented Cape Verde 1995 Ghana
1996 Mauritius
2003 Seychelles 1995 South Africa
1996 Zambia 1999
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A M R O / P A H O
35 Member States Three have not
implemented Dominica Guatemala Trinidad
Tobago
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E U R O
51 Member States Seven have not
implemented Armenia Bulgaria Greece Kazakh
istan Monaco San Marino TFYR of Macedonia
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S E A R O
11 Member States Three have not
implemented Bhutan India Timor Leste
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W P R O
27 Member States Seven have
implemented Australia China Japan New
Zealand Niue Papua New Guinea Republic of Korea
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Global summary

• Countries Impl.
• AFRO 46 6
• AMRO/PAHO 35 32
• EMRO 22 12
• EURO 51 44
• SEARO 11 8
• WPRO 27 7
• 192 109

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Short lists for mortality

• Follows on from work on the derivation of
  leading causes
• ICD-10 has some 1,500 three-character
  categories that can be used for underlying
  cause
• In many countries 100 codes cover some
  90 of deaths.

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ICD-10 Implementation Status in SEAR countries
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ICD-10 Implementation Activities

• Many intercountry training courses have been
  organized by the Regional Office on medical
  record practice and health information management
  (MR/HIM), and ICD-10
• During 1998-1999 biennium, 68 persons underwent
  training in MR/HIM, while 67 persons underwent
  training in ICD-10 from almost all countries of
  the Region
• These training activities were conducted in
  Thailand, Myanmar, and Sri Lanka.
• Prior to that candidates for ICD-10 training used
  to be sent to ICD-10 collaborating center in
  Australia.
• Now, the full range of MR/HIM and ICD-10 training
  has been institutionalized at the National
  Institute of Health Sciences in Kalutara, Sri
  Lanka
• Health Information Division, Bureau of Health
  Policy and Plan, Ministry of Public Health,
  Thailand has also been providing training in use
  of ICD-10 to countries in the Region

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ICD-10 Implementation Activities (contd)

• Beginning with 2000-2001 biennium, national and
  subnational level trainings in MR/HIM ICD-10
  have been encouraged with technical guidance and
  training material support from the Regional
  office.
• The next step in the process of building up
  ICD-10 expertise within the Region is to develop
  capacity for assessing the quality of ICD-10
  coding in the countries.
• For this purpose, two technical core groups from
  Sri Lanka and Thailand were trained and
  established by the Regional office in
  collaboration with the National Centre for
  Classification in Health (NCCH), Brisbane,
  Australia (a WHO Collaborating Centre for
  ICD-10).
• The core groups have been trained to use the
  benchmark audit tool i.e. the Australian Coding
  Benchmark Audit (ACBA), developed by NCCH.
• The ACBA, which is user-friendly tool, is now
  ready to be adapted for use in the Region to
  assess the quality of ICD-10 coding.

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South-East Asia Region

• Most of the countries in the SEA Region use
  ICD-10 for coding of clinical data and most
  countries have adopted single condition coding.
• There is severe shortage of trained human
  resources in ICD-10, Medical record management
  ,and hospital information systems.
• Very often forms are filled by untrained staff.
• Procedure coding is not carried out in many
  hospitals of the member countries.
• Coding of diseases is not carried out in a large
  number of private hospitals.

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South-East Asia Region(ICP-I/ICP-II WORK PLAN
FOR 2004-2005)

• Organize an intercountry training course on
  ICD-10 for hospital and other relevant health
  facility staff.
• Organize an intercountry training course on
  medical record practice and health information
  management for hospital and other relevant health
  facility staff.
• Develop ICD-10 curriculum for use in medical
  colleges, paramedical institutes, and nursing
  schools.
• Organize an intercountry training of trainers for
  medical record practice, ICD-10.

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SRI LANKA

• Hospitals use ICD-10 coding system
• Country has established ICD-10 training unit at
  National Institute of Health Sciences
• Conduct regular training programmes for local and
  overseas participants
• During 2004-2005 biennium, under plan for
  developing provincial HIS, there is planned
  activity to train all those working in medical
  record keeping and ICD-10 coding.

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• No adequate MROs in hospitals
• No adequate training in medical record
  keeping
• No adequate ICD-10 Volumes
• No adequate electronic data storage
  facilities

SRI LANKA
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INDIA

• National training centre for HIS at Mohali,
  Punjab impart in service training in use of
  ICD-10 in batches of 15 persons twice a year.
• ICD-10 training activities (WHO support)
• WHO and Canada Research Chair in Health and
  Development, Ministry of Toronto are planning to
  conduct 4 regional training sessions on
  physician coding of the causes of death using
  the verbal autopsy

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Country work plans for 2004-2005BHUTAN

• ICD-10 has been introduced in 25 of districts
• All remaining districts are to be covered in
  2004-2005

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Country work plans for 2004-2005MALDIVES

• ICD-10 training through national workshops and
  fellowship are planned during 2004-2005

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Country work plans for 2004-2005NEPAL

• ICD-10 training for 4 batches have been conducted
  in BPKIHS and 4 more training courses are planned
  during 2004-2005
• Refresher training on ICD-10 and its
  implementation in few more hospitals through APWs
  has been planned
• Purchase of ICD-1o books has been budgeted.

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Country work plans for 2004-2005BANGLADESH

• National workshop on ICD-10 for hospital and
  health facility managers was conducted in
  2000-2001
• Another national workshop on ICD-10 was organized
  in June 2002
• 4 persons for training of trainers course on
  ICD-10 were sent to Sri Lanka
• Orientation training on record keeping for
  hospital managers was done
• Training on hospital record keeping for medical
  record keepers / Statisticians was done

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Regional Issues in Implementation of ICD-10 and
ICF

• Governments commitment for HIS to support Health
  system development and performance assessment
• Shortage of trained human resources for medical
  record management and hospital information
• Shortage of ICD-10 volumes (CD version may be a
  solution)
• Funds for training/sustaining of the quality
  coding
• Private hospitals involvement training
• Need for training through interactive learning
  tools use of software for ICD-10 coding
• Need for assessing Quality of coding
• There is no WHO CC on IFC in the Region
• National Institute of Health Sciences, Kalutara
  (Sri Lanka), Health Information Division of MOPH
  (Thailand), and PGIMR, Mohali, Chandigarh,
  Pondicherry (India) might have potential for
  becoming WHO CC for IFC.

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'Mandala' Platform for Evidence Based Decisions
for Strengthening Health Systems (Contd)
Analysis


Presentation
Policy Planners
Data Collection
Global Agencies
Programme Managers
Evidence-based decision making
Health System Strengthening
Unified Health Information System
Health
Service Providers

• Areas of Health
• Measurement
• Mortality
• Morbidity
• Disability
• Nutrition
• Risk Factors
• Health Services
• Access
• Coverage Quality
• Cost Expenditures
• Equity Issues
• Gender Issues

Organizations
People
Communities
Patients
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Thank you