Title: Implementation of
1Implementation 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
2Purpose 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.
4Outline 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
5WHO Family of International Classifications
(WHO-FIC)
6Types of classification
- Reference classifications
- Derived classifications
- Related classifications
7Reference classifications
- International Classification of Diseases
(ICD) - International Classification of Func-
tioning, Disability and Health (ICF) - International Classification of
Health Interventions (ICHI)
8Derived classifications
- Specially-based adaptations for
- Psychiatry
- Oncology
- Neurology
- Dentistry and stomatology
9Related 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)
10WHO-FIC Network
- WHO Headquarters Classifications
Team - Regional Office counterparts
- WHO Collaborating Centres
- Cooperating National Institutions
11Implementation of ICD-10 by WHO Member States
for mortality
12Sources of information
- Regional Offices
- WHO-FIC Implementation Committee
questionnaire in 2002 - WHO-FIC Education Committee Needs
Assessment Survey in 2003 - WHO Mortality database
13A F R O
46 Member States Six have
implemented Cape Verde 1995 Ghana
1996 Mauritius
2003 Seychelles 1995 South Africa
1996 Zambia 1999
14A M R O / P A H O
35 Member States Three have not
implemented Dominica Guatemala Trinidad
Tobago
15E U R O
51 Member States Seven have not
implemented Armenia Bulgaria Greece Kazakh
istan Monaco San Marino TFYR of Macedonia
16S E A R O
11 Member States Three have not
implemented Bhutan India Timor Leste
17W P R O
27 Member States Seven have
implemented Australia China Japan New
Zealand Niue Papua New Guinea Republic of Korea
18Global summary
- Countries Impl.
- AFRO 46 6
- AMRO/PAHO 35 32
- EMRO 22 12
- EURO 51 44
- SEARO 11 8
- WPRO 27 7
- 192 109
19Short 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.
20ICD-10 Implementation Status in SEAR countries
21ICD-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 -
22ICD-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.
23South-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.
24South-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.
25SRI 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
27INDIA
- 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
28Country work plans for 2004-2005BHUTAN
- ICD-10 has been introduced in 25 of districts
- All remaining districts are to be covered in
2004-2005
29Country work plans for 2004-2005MALDIVES
- ICD-10 training through national workshops and
fellowship are planned during 2004-2005
30Country 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.
-
31Country 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 -
32Regional 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
34Thank you