The new International Classification of Diseases (ICD), , was revealed by the World Health Organization (WHO) on Monday, with changes to gender incongruence, the addition of gaming disorders, and better tracking of antimicrobial resistance.
This is the first revision of the codes to be completely electronic, which WHO officials said was a better way to group conditions, and would enable patient safety to be recorded more easily.
The bulk of the changes discussed at a press conference today centered around the change that "gender incongruence" has moved from a classification of mental health to one of sexual health, and that a new gaming disorder has been added to the mental health part of the codes.
The WHO described ICD-11 as a "once in a lifetime event," and noted that the world will likely have to wait a few more years until the updated classification is implemented into healthcare systems around the world. ICD-11 will be presented to the World Health Assembly to be voted upon in May 2019, and will go into effect in January 2022.
Adoption in the U.S. will likely take much longer, if past experience is repeated. The WHO released ICD-10 in 1993, but it was not finally implemented in the U.S. until 2015.
Today was the first preview of the new ICD-11 codes, which included updates to designations for antibiotic resistance to better align with the Global Antimicrobial Resistance System (GLASS), so that "antimicrobial resistance patterns can be documented properly." WHO officials also touted more detail on cancer, specifically different types of skin cancer, as well as on heart health and weight disorders; there is also a new chapter on immune system disorders, which will enable better study of allergies.
However, the main topics of discussion surrounded the new chapter of conditions related to sexual health -- namely the addition of "gender incongruence."
"We now have a better understanding of the issues surrounding this condition, and they are not related to a mental health condition," a WHO official said. "Treating [gender incongruence] in a mental health chapter was causing additional stigma for an already stigmatized condition."
WHO officials added the hope that adding this condition to a sexual health chapter of the ICD codes would "help increase access to care for health interventions" and "destigmatize the condition."
The other notable addition was a diagnosis of gaming disorder, which is new to ICD-11. Gambling disorder was in ICD-10, but gaming disorder relates to "digital or video gaming."
"This does not mean everyone who engages in gaming has a disorder," emphasized Shekhar Saxena, MD, the WHO's director of the Department for Mental Health and Substance Abuse, who noted that the definition involves impaired control over gaming and increased priority given to it over usual activities.
Additional criteria for a diagnosis of gaming disorder include that the individual has to have had the condition for at least 12 months before it can be so classified.
"There is no evidence-based treatment for this behavior as of now," Saxena said, adding that psychological as well as social interventions have shown promise in treating the disorder.
ICD-11 also promises to be more user-friendly, he noted. "Healthcare providers with less training will be able to use ICD-11 in the best possible manner ... the system is not only for specialists.
Robert Jakob, MD, WHO's team lead, Classifications, Terminologies and Standards, said that the organization is developing an implementation package to make the eventual transition from the old system to the new system easier. In addition, the development of ICD-11 was a collaborative process, including proposals from scientific societies: "We had more than 10,000 proposals coming in saying amend this, change that, change that. This is progress in knowledge representation. People will be better informed about health conditions, how to prevent them and how to get the best treatment possible."
Jakob encouraged clinicians and healthcare personnel to become involved in this "open process" and to propose any potential changes they might have to ICD-11 at the .