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

• 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)

A system of categories to which morbid

entities are assigned according to

established criteria.

• 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

• Reference classifications

• Derived classifications

• Related classifications

• International Classification of Diseases (ICD)

• International Classification of Func- tioning, Disability and Health (ICF)

• International Classification of Health

Interventions (ICHI)

Specially-based adaptations for:

• Psychiatry

• Oncology

• Neurology

• Dentistry and stomatology

• 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)

• WHO Headquarters Classifications Team

• Regional Office counterparts

• WHO Collaborating Centres

• Cooperating National Institutions

• Regional Offices

• WHO-FIC Implementation Committee questionnaire in 2002

• WHO-FIC Education Committee Needs Assessment Survey in 2003

• WHO Mortality database

46 Member States

Six have implemented

Cape Verde 1995Ghana 1996Mauritius 2003Seychelles 1995South Africa 1996Zambia 1999

35 Member States

Three have not implemented

DominicaGuatemalaTrinidad & Tobago

51 Member States

Seven have not implemented

ArmeniaBulgariaGreeceKazakhistanMonacoSan MarinoTFYR of Macedonia

11 Member States

Three have not implemented

Bhutan

India

Timor Leste

27 Member States

Seven have implemented

AustraliaChinaJapanNew ZealandNiuePapua New GuineaRepublic of Korea

Countries Impl.

• AFRO 46 6

• AMRO/PAHO 35 32

• EMRO 22 12

• EURO 51 44

• SEARO 11 8

• WPRO 27 7

192 109

• 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.

ICD-10 Implementation Status in SEAR countries

Sl.No. Country Mortality Morbidity

1. DPR Korea 1994 X

2 Thailand 1994 X

3. Indonesia 1995 X

4. Maldives 1996 X

5. Myanmar 1996 X

6. Nepal 1997-1998 X

7. Sri Lanka 1999 X

8. Bangladesh 2000-2001 X

9. Bhutan X X

10. India X X

11. Timor Leste X X

• 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

ICD-10 Implementation – Activities

• 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.

ICD-10 Implementation – Activities (cont’d)

• 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.

South-East Asia Region

• 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.

South-East Asia Region

(ICP-I/ICP-II WORK PLAN FOR 2004-2005)

• 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.

SRI LANKA

• 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

• 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

INDIA

• ICD-10 has been introduced in 25% of districts

• All remaining districts are to be covered in 2004-2005

Country work plans for 2004-2005BHUTAN

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

Country work plans for 2004-2005MALDIVES

Country work plans for 2004-2005

NEPAL

• 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.

Country work plans for 2004-2005

BANGLADESH

• 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

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.

Areas of Health Measurement

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

Health

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

Studies

NHAs

Surveys

Routine HIS (including private sector)

Vita

l Reg

istr

atio

n

Mod

el b

ased

esti

mate

s &

p

roje

cti

on

s

Disease Surveillance

Resou

rces fo

r Health

(Hu

man

, Fin

an

cia

l, Facilitie

s, D

rug

s

& S

up

plie

s)