The World Health Organization’s ICD-11 classification has been completely restructured to take advantage of today’s digital capabilities. This redesign aims to enhance coordination with other classifications and terminologies, provide greater flexibility to minimize the need for national clinical modifications,  improve the comparability of translations, and support online services to reduce implementation costs.

Let’s think of this in terms of a universal language, like music. Consider the song Coca-Cola used in the 1970s to connect the idea of happiness with a universal love for their product. Similarly, the WHO is promoting their new classification in the same way. Starting with “I’d Like to Teach the World to Sing”, imagine the WHO planning to record this song. They establish the key and scale using ICD-11-MMS as their foundation.

Each country has both global and localized reasons for engaging with music, much like their reasons for using the ICD classification—funding, reimbursement, clinical outcomes, government reporting, health policy, patient care, and more.

To address these needs, each country has tailored its own set of requirements into specialized adaptations, each with its unique “voice.” Canada, for example, sings tenor, transforming ICD-10-WHO into ICD-10-CA; the US sings soprano with ICD-10-CM; Australia sings baritone with ICD-10-AM; and Germany sings bass with ICD-10-GM.

These countries, having created their clinical modifications, must now evaluate whether ICD-11-MMS meets their specific needs or if further modifications are necessary.

There are many factors to consider when harmonizing:

• Do all songs need all voices? This parallels the need for modifications—can some be condensed or eliminated? Not every song (or classification system) requires the full range of voices or adjustments.
• What about timing? When should each group start singing, or in this case, when should each country implement? Establishing an initial implementation date is crucial, but it’s also essential to account for future updates and version releases.
• How does everyone learn this new song and master their parts? Implementation and training are vital. While the WHO has provided excellent references and tools, each country will need to address its unique nuances, workforce, and processes. This may involve creating localized coding standards that go beyond the WHO’s reference guide.
• What if the new song is a hit? If the system succeeds, what comes next? We must consider the downstream uses of codified data, such as groupers, patient safety measures, and funding mechanisms. These will evolve from the base classifications, much like remixes—hip-hop, blues, rock, and more—tailored to meet diverse needs. After all, music and dance, like health data, have a universal resonance.

The WHO has established numerous committees, reference groups, and task forces to harmonize diverse pitches, often by adhering to a specific key and using chord progressions to create movement and resolution. Acting as the orchestral conductor, the WHO holds the baton, while each instrument section (or region/country) has its own principal leading the way.

For Canada, the principal is the Canadian Institute for Health Information (CIHI), which oversees implementation timing, processes, and impacts. In the US, the National Committee on Vital and Health Statistics (NCVHS) Workgroup fills this role, while in Australia, it’s the Australian Institute of Health and Welfare (AIHW), and in Germany, the Federal Institute for Drugs & Medical Devices (BfArM).

Each principal collaborates closely with their conductor, and these regions regularly meet with the WHO to address implementation challenges and propose solutions. Representatives from each country also participate in WHO-FIC Collaborating Centres, committees, and resource groups to ensure alignment and global coordination.

The WHO’s objective is to orchestrate a round—a musical arrangement where multiple performers join in with the same melody, each starting at a different time. The WHO introduced the melody in 2019, and each subsequent performer, or region, joins in when the time is right.

Now, it’s time to warm our collective vocal chords, and begin!

♫ I’d like to teach the world to sing,

In perfect harmony,

I’d like to hold it in my arms,

And keep it company.

I’d like to see the world for once,

All standing hand in hand,

And hear them echo through the hills,

For peace throughout the land. ♫