OBJECTIVES: The International Classification of Diseases (ICD) acts as a common language for recording, reporting and monitoring diseases. In 2019, the WHO voted to adopt ICD-11. This research aims to map the ICD-11 implementation process and produce a usable guide on applying, with recommendations to facilitate approval.

METHODS: Desk research identified relevant processes and decision-making bodies for new coding applications, while in-depth correspondence with country-specific experts enabled understanding of the local ICD-10/ICD-11 implementation process.

RESULTS:

Applications are made to propose edits or additions to the latest release of ICD-11, submitted to the maintenance platform. The Classification and Statistics Advisory Committee and Medical and Scientific Advisory Council review the proposal. The approved proposal is passed to the WHO-Family of International Classifications (FIC) conference for final approval and subsequent ratification and implementation. Most countries follow the same format for implementation of ICD-11, via the national WHO-FIC Collaborating Centres (CC), however, some countries have additional requirements; code amends in Nordic countries must be attached to a country-specific health association. Implementation takes up to 2-3 years for English-speaking countries, and 5-6 years for non-English speaking countries to allow for additional steps such as translation. The ICD-11 maintenance platform provides a real-time tool to propose edits. A content model, consisting of rationale and evidence, is required for new proposal applications, while platform members and review committees can interact with submitted proposals. Recommendations for a successful application include proposing edits in conjunction with national CC, to ensure adequate scientific evidence and international agreement and WHO regulations are followed.

CONCLUSIONS: There are multiple bodies involved in the implementation of the ICD-11 coding system on both the national and international level. This research gives insights into the specific processes and decision-making bodies involved and acts as a blueprint to guide new submission of proposals to the ICD-11 maintenance platform.