We will have a better idea of this once we have developed our ICD-11 implementation plan, which is expected to be ready by the end of March 2023 and when we have completed some pilot implementations. There will be a very significant amount of work involved in making the transition from ICD-10 to ICD-11, including the formal governance process for having ICD-11 replace ICD-10 as the mandated national information standard for the classification of diseases. Our current assumption is that ICD-11 will not be mandated as a national information standard before April 1st 2026, but this is an assumption only at this stage and should not be interpreted as implying that ICD-11 will be mandated on April 1st 2026.

NHS trusts and other organisations will continue to manage their technology requirements and their relationships with suppliers in the way that best meets their local needs. The World Health Organization has provided technical guidance and products, including the ICD-11 API and embedded Browser and Coding Tool, which will enable organisations and system suppliers to take advantage of ICD-11 with a reduced technical burden.

Yes. The World Health Organization has provided bi-directional maps between ICD-10 and ICD-11 and we are reviewing these to ensure they work as required. The maps will be essential for any implementations of ICD-11 that take place before ICD-11 is mandated as a national standard, in order that data recorded using ICD-11 can be mapped back to ICD-10 for national data submissions.

We will engage with system suppliers to ensure they have the information they need about ICD-11, including the technical support available through the World Health Organization (WHO) provided API and embedded tools. We expect suppliers to work with their customers to identify the best technical approach for integrating ICD-11 within their PAS/EPR/encoder systems. The WHO has provided considerable technical resources and implementation guidance to help with this and we will work with suppliers to identify any additional support that is required for the NHS context.

We will work with stakeholders, including the World Health Organization to confirm the options available for the implementation of ICD-11, but we are keen to take advantage of the capabilities that come from the greater level of sophistication ICD-11 provides compared with ICD-10. But we are also aware that ICD-11 is a more complex classification than ICD-10 and aspects such as post-coordination will require careful review in order to determine the scale and nature of the challenges they present to system developers, clinical coders, data pipeline developers, data set developers and analysts. We will ensure the implementation of ICD-11 is guided by a full understanding of the real-world context in which it will be used and we will adjust our timeline and approach as necessary to achieve a controlled implementation that works well for all affected parties.

Local trusts will make decisions based on their priorities and informatics strategies, so we expect there will be a variety of approaches taken across the NHS. The API and its embedded browser and coding tool which are provided free of charge by the WHO will make it significantly easier for ICD-11 to be incorporated into existing IT systems than it would be if they had to be produced from scratch by each organisation, system supplier or country.

Mappings for ICD-11 and SNOMED CT have not been completed yet and there are currently no timescales available for this. There are some international mapping exercises underway and NHS Digital are contributing to these. When ICD-11 is adopted and implemented in the UK we would expect the maps to be included in the UK Edition of the SNOMED CT Browser.

Yes. We are aware that some organisations are already using ICD-11 within the UK and we are keen to connect with these early users to learn from their experiences and to support them where we can. ICD-11 cannot yet be submitted via national data sets, so if information captured locally using ICD-11 is required to be submitted as part of a national data set, then there will be a need to map from ICD-11 to ICD-10 until such time as the national data sets are able to carry ICD-11 data. Tools are available to support mapping between ICD-10 and ICD-11 and we are keen to work with early users of ICD-11 to see how we can support the mapping process.

No. SNOMED CT is a clinical terminology, designed to provide a machine-readable version of the information recorded by clinicians at the point of care in an Electronic Patient Record (EPR). It is a highly expressive terminology that supports a broad range of use cases, including interoperability, decision support and reporting, but it is not designed to be a classification. ICD is the global standard for the classification of diseases and related health conditions and ICD-11 has been purpose built to provide stable, comparable and statistically valid data. By combining SNOMED CT and ICD-11, users can benefit from both rich, machine-processible point of care data and robust statistical data.

The World Health Organization (WHO) has provided a useful ICD-11 Reference Guide and within this Annex A ICD-11 Updating and Maintenance sets out the update cycle. In summary:

• Official releases of the ICD-11 MMS (Mortality and Morbidity Statistics) linearization will be produced annually. These releases will not impact on the four and five character structure.
• Releases that do impact the four and five character structure will be released on a five yearly cycle
• Updates to mortality and morbidity rules will happen on a 10 yearly cycle

The WHO expects and encourages member countries that have implemented ICD-11 to take the annual updates and we will work with stakeholders to decide whether we should move to annual updates or retain our current 3-yearly update cycle. All versions of ICD-11 will be permanently accessible via the ICD-11 API.