ICD coding training worldwide

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Lucia Otero Varela
Catherine Eastwood
Pallavi Mathur
Hude Quan
Published online: Aug 28, 2018

The International Classification of Diseases (ICD) is globally used for coding morbidity statistics, however, its use, as well as the training provided to individuals assigning codes, varies greatly across countries.

Objectives and Approach
The goal is to understand the quality of coder training worldwide. After an in-depth grey and academic literature review, an online survey was created to poll the 194 World Health Organization (WHO) member countries. Questions focused on hospital data collection systems and the training provided to the coding professionals. The survey was distributed to potential participants that meet the specific criteria, as well as to organizations specialized in the topic, such as WHO-CC (WHO Collaborating Centers) and IFHIMA (International Federation of Health Information Management Association), to be forwarded to their representatives. Answers will be analyzed using descriptive statistics.

This ongoing project aims to capture responses from as many countries as possible, and thus far, data from 45 respondents from 20 different countries has been collected. Initial results reveal worldwide use of ICD, with variations in the maximum allowable coding fields for diagnoses and interventions. Coding specialists are the main personnel assigning codes, followed by physicians, and although minimum training is not mandatory in all countries (Sweden, Italy, Germany and Thailand), in those where it is, college/university degree is the most common requirement. Coding certificates most frequently entail passing a certification exam. Continuing education for coders is offered in all countries except one (Nigeria). Once more information is available, countries will be ranked and those depicting a better performance will be highlighted.

These survey data will establish the current state of ICD use and coding training internationally, which will ultimately be valuable to the WHO for the promotion of ICD and the rollout of ICD-11, for better international comparisons of health data, and for further research on how to improve ICD coding.


Integration of health and social care services is a potential solution to improving care despite budgetary constraints and increased demand for services. Little is known about how having two-or-more long-term conditions (multimorbidity) and socioeconomic status affect social care use, or how all these factors affect unscheduled health care use.

Objectives and Approach

The project aims to describe the demographic, geographic, and socioeconomic differences in the receipt of social care for over 65s in Scotland and how multimorbidity status influences amounts of social care received. Additional analyses will consider the influence receipt of social care has on use of unscheduled health care services and mortality.

Social Care Survey (SCS) data collected by the Scottish Government is linked to administrative health and mortality records. Linkage includes; prescribing information service and USC data which records episodes of A & E attendance, emergency admission to hospital, GP out-of-hours attendance, Scottish Ambulance Service use, and NHS24 contact


The cohort includes 1.1million individuals over the age of 65 (54.8% Female), of which 274,011 (24.2%) people died during the study period.

The linkage rate of the SCS to records with a CHI number in the National Records of Scotland population spine was 90.5%, with one local authority removed for very low linkage rates and the remaining 31 with rates between 76.7% and 97.9%.

As of February 2018, all requested data has been transferred to the National Safe Haven and data cleaning and analysis has begun. Significant results are expected to have been produced by August 2018.


This research will help understand if receipt of social care is equitably distributed among the population of Scotland after allowing for multimorbidity and socioeconomic status. Understanding the influence health status has on social care receipt and the influence social care has on unscheduled healthcare use has important implications for policy development.

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