French ICD-10 to ICD-11 transition impact study and implementation project

Ines Bozinovic ^a, Sophie Guéant ^a, Yasmine Mokaddem ^a, Etienne Joubert ^a, Joëlle Dubois ^a

Introduction
At present, medical data collection in French hospitals is based on the 10th version of the International Classification of Diseases (ICD) for the coding of medical diagnoses, according to instructions and standards issued by the Technical Agency for Information on Hospital Care (ATIH). The 11th version of the International Classification of Diseases (ICD-11), officially adopted by the WHO in 2019, replaces the ICD-10, which will no longer be updated. As the state of the art in medical nomenclature, ICD-11 represents an upgraded version which contains new chapters and new concepts, like the "post-coordination" and the "extension codes". By 2023, 64 countries (out of 194 WHO member states) had initiated ICD-11 deployment. At the national level, ICD-11 deployment is led by the French WHO Collaborating Centre - CC-OMS, coordinated by the Digital Health Agency (ANS).

ATIH, as part of the CC-OMS, is responsible for the morbidity use case. To have a better scope of the ICD-11 implementation project and build a road map, ATIH carried out an impact study of the transition from the French ICD-10 to ICD-11.

Methods
The impact study was based on a total of 22 interviews, conducted with hospital representatives, institutional players, and software editors. Interviews were also conducted with the project leaders of the ICD-11 transition in 5 European countries: Denmark, Sweden, Norway, Germany, and the United Kingdom.

Results
Thanks to those interviews, a SWOT analysis of the transition from the French ICD-10 to ICD-11 was produced and was further completed by an international comparative study. Based on this impact study, we identified the necessity to discuss further the level of integration of this new classification to the current French classification of diseases, and the different digital tools that were going to be needed for a successful implementation, such as automated coding. All in all, as the different European project leaders pointed out, the deployment of ICD-11 in France will necessarily take place over a long period and will rely on good coordination with all the stakeholders involved in this transition project.

Discussion
The discussions based on the conclusions of this impact study will allow the definition of a global strategy for the implementation of the ICD-11 in France, the selection of priority milestones, and finally the definition of the project roadmap by 2026.


^a French Technical Agency for Information on Hospital Care (ATIH), France

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