The World Health Organization (WHO) recognized the need to revise and update the current classification (ICD-10). The revision goals for ICD-11 included the following:

• To revise ICD in line with scientific advances to serve multiple purposes, including mortality and morbidity statistics, as well as clinical use in primary care, specialty care and research
• To build a state-of-the-art, digital-first product that can be integrated into electronic health applications to support computer-assisted data capture

ICD-11 is designed to seamlessly integrate with modern health information systems, supporting interoperability and facilitating efficient health information exchange. Developed through extensive global collaboration, ICD-11 reflects input from health care professionals, researchers and policy-makers worldwide, ensuring its relevance and applicability on an international scale. For more details about what’s new in ICD-11, refer to the ICD-11 Reference Guide, Part 3 — New in ICD-11.

ICD-11 MMS is the 11th revision of the International Classification of Diseases and Related Health Problems for Mortality and Morbidity Statistics. Its use allows systematic collection of mortality and morbidity data for analysis and reporting.

ICD-10-CA is the current standard used in Canada to collect hospital morbidity statistics. A specific date for introducing ICD-11 MMS in Canada has not yet been determined. CIHI is assessing the clinical, business and statistical implications of implementing the new version for morbidity statistics in Canada.

The decision-making process for adopting ICD-11 for morbidity has not yet been determined. It is anticipated that the same process followed for ICD-10-CA adoption will occur. That is, the Conference of Deputy Ministers of Health will make the decision. CIHI will lead the implementation of ICD-11 for morbidity and Statistics Canada will lead the implementation for mortality.

CIHI is investigating whether a Canadian version of ICD-11 MMS is required. Refer to WHO’s ICD-11 Reference Guide for information regarding what a country can and cannot do with respect to a national linearization (version) of ICD-11 MMS.

ICD-11 was designed for potential use in primary care, specialty care (e.g., dermatology, rare diseases, congenital anomalies) and research (e.g., quality and patient safety).

Refer to the ICD-11 Reference Guide, specifically 3.15: Annex D: Differences between ICD-10 and ICD-11.

Refer to WHO’s ICD-11 home page for information regarding the ICD API.

Refer to the ICD-11 Reference Guide for information regarding the structure of ICD-11 codes, extension codes, postcoordination and much more.

Go to CIHI training where you will find ICD-11 webinars developed by CIHI. Using the ICD-11 Coding Tool (released November 2022) covers the following:

• How to access the ICD-11 Coding Tool and Help content
• An overview of the icons and links used in the Coding Tool
• An explanation of the “code also” and “use additional code, if desired” instructions
• How to perform a regular and flexible search
• How to use the postcoordination tool within the ICD-11 integrated browser
• How to access the ICD-11 tabular list and quick-copy a code

The recommended prerequisite is CIHI’s webinar Introduction to ICD-11 for Mortality and Morbidity Statistics.

Refer to ICD-11-related publications in the journal BMC Medical Informatics and Decision Making. It’s a great place to start!

1. Access the ICD-11 browser from WHO’s ICD-11 home page
2. Open the ICD-11 browser
3. Go to the Info tab
4. Click Morbidity List to download the list.

WHO has developed a guide written from an international perspective. CIHI is currently using this guide as a resource. Refer to the guide on WHO’s ICD-11 home page.

WHO has prepared the ICD-11 Fact Sheet covering the following topics:

• What is ICD-11?
• Improvements in ICD-11
• Why WHO is interested in countries moving to ICD-11
• Other applications for ICD-11
• WHO response
• General aspects of implementation
• WHO Family of Classifications

See Annex A of WHO’s ICD-11 Reference Guide for information on updating and maintaining ICD-11. In summary,

• Official releases of the ICD-11 MMS linearization will be produced annually. These releases will not impact the 4- and 5-character structure.
• Releases that impact the 4- and 5-character structure will be released every 5 years.
• Updates to mortality and morbidity rules will happen every 10 years.

You can

1. Access the ICD-11 MMS browser from WHO’s ICD-11 home page
2. Open the ICD-11 browser
3. Go to the Info tab
4. Click Earlier releases and Update history
5. Download the file you’re interested in based on the release year

See ICD-11 pilot experiences above for available information.

As part of the impact assessment work, we will review the current national coding standards for ICD-10-CA to assess what will and will not be required when we move to ICD-11. We will also assess whether any new Canadian standards will need to be developed.

There are no current plans to replace CCI.

SNOMED CT (Systematized Nomenclature of Medicine — Clinical Terms) and ICD-11 serve different but complementary purposes in health care data management, with specific but interconnected roles.
SNOMED CT is used primarily for clinical documentation, electronic health records (EHRs), decision-support systems and interoperability between health care systems. ICD serves as the global standard for categorizing diseases and health-related conditions, and ICD-11 has been designed to ensure consistent, comparable and statistically reliable data. 
SNOMED CT does not replace the need for ICD-11 but rather complements it by providing detailed clinical information that can be mapped to ICD-11 codes for various applications.

ICD-11 is designed to be integrated with electronic health applications such as electronic health records. One of the WHO’s revision goals was to build a state-of-the-art, digital-first product that can be integrated into electronic health applications. The digital format and flexible structure of ICD-11 can support integration into various health information systems, enabling automatic coding, better data capture, reporting and interoperability. Refer to the WHO’s ICD-11 home page for information regarding the ICD API and embedded classification tool (ECT). The ECT allows easy integration of a complete ICD-11 Coding Tool and/or ICD-11 browser into any web-based software.

CIHI examined the statistical continuity between ICD-10-CA and ICD-11, and our preliminary assessment indicated that 59% (n = 9,161) of 15,488 v2018 ICD-10-CA codes maintain continuity. This suggests that a significant portion of the ICD-10-CA codes corresponds effectively to ICD-11 MMS codes in terms of meaning and specificity.

For a comprehensive overview of the mapping results between v2018 ICD-10-CA and ICD-11 MMS, please refer to the information sheet Canadian Stability Analysis: Comparing v2018 ICD-10-CA With ICD-11. Go to Getting ready for ICD-11 > Progress reports.

The ICD-11 Foundation is the core component of ICD-11. 

The WHO Family of International Classifications (WHO-FIC) is a suite of classifications. One of its components — the WHO-FIC Foundation — in the context of ICD-11 is the overarching repository for all ICD entities. The ICD-11 Foundation is built on a content model that ensures that entities are defined in a standardized way. The Foundation stores these entities with filled parameters and holds the operational knowledge to generate a linearization, such as the ICD-11 MMS.

Unlike previous versions of ICD, the ICD-11 Foundation is a flexible framework that can be adapted to meet the needs of various countries and health systems. It includes a vast range of health-related conditions and better alignment with modern medical practice. The ICD-11 Foundation’s structure allows for continuous updates and improvements, ensuring it stays relevant and up to date with advances in medicine and changes in health care practices. A unique feature is the ability to develop specialty classifications (e.g., primary care, dermatology), technically known as linearizations. These linearizations can be derived from the Foundation and tailored to meet the specific needs of different medical specialties, health care practices or researchers, ensuring greater flexibility and precision in coding and classifying health information. 

A code (entity) displayed in grey means that it has more than one parent. An entity that is secondarily parented is displayed in grey under its secondary parent in the ICD-11 MMS tabular list. For more information on multiple parenting, refer to the ICD-11 Reference Guide, Section 3.3: Multiple Parenting, and/or watch Kuwait’s training video ICD-11 Workshop (Part 2): Introduction to Multiple Parenting, Residual Categories and the Foundation. 

Stay up to date on Canada’s ICD-11 activities, such as implementation planning, progress reports and CIHI training. Go to Getting ready. You can also visit the ICD-11 pages of the WHO’s website. 

WHO’s User Guide for the maintenance platform includes information about the development of ICD-11 and the proposal process. For details, refer to the following sections in the guide: 

• Contributing to ICD-11 Development
  • General Information
  • Commenting
• Proposal System
  • General Information
  • Browsing Existing Proposals
  • Creating/Editing Proposals

If you have identified ambiguities, missing content or potential errors while using ICD-11 and require assistance to ensure your ICD-11 proposal is complete, you can submit the ICD-11 change request form to CIHI. CIHI’s Classifications and Terminologies (C & T) team offers a new service to help clients avoid having an incomplete or ambiguous ICD-11 proposal returned to them by the WHO. Refer to the WHO’s ICD-11 Reference Guide, Section 3.12.3: Proposal completeness. If necessary, we can also provide guidance on how to submit a proposal on the WHO’s maintenance platform using the appropriate template.

If you do not require CIHI’s C & T team to review your proposal for completeness or do not require assistance with submitting your proposal on the WHO’s maintenance platform, you do not need to complete CIHI’s ICD-11 change request form. 

Note: The WHO Classification and Statistical Advisory Committee (CSAC) determines whether a proposal is implemented in ICD-11. For more details on the CSAC process, refer to the ICD-11 Reference Guide, Section 3.12.1: Background.