Workshop of Key Trainers on ICD-10 from cities of Delhi and Rohtak 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 1995 Ghana 1996 Mauritius 2003 Seychelles 1995 South Africa 1996 Zambia 1999

35 Member States Three have not implemented Dominica Guatemala Trinidad & Tobago

51 Member States Seven have not implemented Armenia Bulgaria Greece Kazakhistan Monaco San Marino TFYR of Macedonia

11 Member States Three have not implemented Bhutan India Timor Leste

27 Member States Seven have implemented Australia China Japan New Zealand Niue Papua New Guinea Republic of Korea

CountriesImpl. AFRO46 6 AMRO/PAHO3532 EMRO2212 EURO5144 SEARO11 8 WPRO

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.CountryMortalityMorbidity 1. DPR Korea1994X 2 Thailand1994X 3. Indonesia1995X 4. Maldives1996X 5. Myanmar1996X 6. Nepal X 7. Sri Lanka1999X 8. Bangladesh X 9. BhutanXX 10. IndiaXX 11. Timor LesteXX

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 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 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 )

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 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 Country work plans for BHUTAN

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

Country work plans for NEPAL ICD-10 training for 4 batches have been conducted in BPKIHS and 4 more training courses are planned during 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 BANGLADESH National workshop on ICD-10 for hospital and health facility managers was conducted in Another national workshop on ICD-10 was organized in June 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) Vital Registration Model based estimates & projections Disease Surveillance Resources for Health (Human, Financial, Facilities, Drugs & Supplies)