(THE LANCET)
The 11th version of the International Classification of Diseases (ICD) launched on June 18 is the latest attempt at systematically describing and categorising all human mortality and morbidity. Designed for the global digital age, it is an onscreen, multipurpose, multilingual database interconnecting with other operating systems—including electronic hospital records. It is a quantum leap forward from the ICD-10, which, although revised several times over the past two decades, was originally published in 1992, when internet use was minimal, smartphones were unheard of, and patient records were paper based.
Hours of often heated debate (frequently documented in the pages of this journal) involving clinicians and other health professionals from countries across the globe have gone into the production of the ICD-11. Notable changes include a new chapter on sexual health that brings together conditions previously controversially classified (eg, transgender disorder—now renamed gender incongruence—is no longer listed under mental health diseases). Psychiatrists have insisted a dimensional classificatory system of personality be adopted. A section on traditional medicine conditions has been introduced. And neurologists now have stroke classified as a brain disease. Antibiotic resistance can be linked to individual diseases and HIV to specific infections such as tuberculosis and malaria. Pulmonary hypertension is now classified on the basis of severity. Diseases of the immune system—including allergies—have a separate section and an extra chapter has been created for sleep disorders. A final example in this almost inexhaustible list is the addition of a section coding treatment side-effects.
The ICD-11 now enters a period of testing; the new system will be adopted by the World Health Assembly's member states in 2019, finally coming into widespread use on Jan 1, 2022. Any classification system endeavouring to encompass rapidly changing descriptions of death and disease will clearly be imperfect and out of date by the time it is published. The protracted nature of these radical overhauls suggests future versions best be developed incrementally. Perhaps employment of the latest technological advances such as artificial intelligence might help?