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Implementation of

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Title: Implementation of


1
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
2
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)

3
Classification of diseases
A system of categories to which morbid entities
are assigned according to established criteria.
4
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

5
WHO Family of International Classifications
(WHO-FIC)
6
Types of classification
  • Reference classifications
  • Derived classifications
  • Related classifications

7
Reference classifications
  • International Classification of Diseases
    (ICD)
  • International Classification of Func-
    tioning, Disability and Health (ICF)
  • International Classification of
    Health Interventions (ICHI)

8
Derived classifications
  • Specially-based adaptations for
  • Psychiatry
  • Oncology
  • Neurology
  • Dentistry and stomatology

9
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)

10
WHO-FIC Network
  • WHO Headquarters Classifications
    Team
  • Regional Office counterparts
  • WHO Collaborating Centres
  • Cooperating National Institutions

11
Implementation of ICD-10 by WHO Member States
for mortality
12
Sources of information
  • Regional Offices
  • WHO-FIC Implementation Committee
    questionnaire in 2002
  • WHO-FIC Education Committee Needs
    Assessment Survey in 2003
  • WHO Mortality database

13
A F R O
46 Member States Six have
implemented Cape Verde 1995 Ghana
1996 Mauritius
2003 Seychelles 1995 South Africa
1996 Zambia 1999
14
A M R O / P A H O
35 Member States Three have not
implemented Dominica Guatemala Trinidad
Tobago
15
E U R O
51 Member States Seven have not
implemented Armenia Bulgaria Greece Kazakh
istan Monaco San Marino TFYR of Macedonia
16
S E A R O
11 Member States Three have not
implemented Bhutan India Timor Leste
17
W P R O
27 Member States Seven have
implemented Australia China Japan New
Zealand Niue Papua New Guinea Republic of Korea
18
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

19
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.

20
ICD-10 Implementation Status in SEAR countries
21
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

22
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.

23
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.

24
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.

25
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.

26
  • 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
27
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

28
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

29
Country work plans for 2004-2005MALDIVES
  • ICD-10 training through national workshops and
    fellowship are planned during 2004-2005

30
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.

31
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

32
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.

33
'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
34
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