Table 3.

Challenges to ICD-11 implementation identified by key informants and corresponding CFIR 2022 domain and constructs, and ERIC-aligned implementation strategies

CFIR domain	CFIR construct	Challenges	Implementation strategies
ICD-11	Complexity	Rigorous coding process	• Promote adaptability
	Adaptability	Partial customization of ICD-11 Embedded Coding Tool based on local needs
Outer setting	Critical incidents	Lack of support by decision-makers	• Alter incentive/ allowance structures
	Local conditions	• Potential high transition cost for proprietary systems • Physician’s inadequate documentation
Inner setting	Structural characteristics	• Outdated infrastructure • Potential for data duplication • Lack of data validity • Inadequate personnel • Adjustments to the current workflow	• Access new funding
	Available resources	Insufficient funding for ICD-11 transitions of all systems
Individuals	Implementation Leads and Team Members	Lack of technical expertise on ICD-11-related matters	• Identify and prepare champions • Make training dynamic