Preparing for ICD-11 transition: lessons from case studies in Argentina and Mexico

ABSTRACT

Objectives.

To explore the early stages of the International Classification of Diseases 11th Revision (ICD-11) implementation in Argentina and Mexico, focusing on mortality coding, to identify essential elements and key considerations for successful adoption.

Methods.

Qualitative analysis was conducted using case studies from Argentina and Mexico. Data were collected through interviews, workshops, and document analysis to uncover opportunities, challenges, and strategic decisions in ICD-11 implementation.

Results.

Key findings highlight the critical role of comprehensive system assessments, strategic partnerships, financial planning, technological readiness, targeted training initiatives, and structured evaluation mechanisms. Both countries emphasized the importance of tailored strategies aligned with their unique contexts and highlighted the need for collaboration across sectors and the establishment of national task forces. Challenges included navigating the complexities of integrating ICD-11 within existing systems and enhancing interoperability through accelerated development of tools and establishment of expert networks.

Conclusions.

Tailored strategies are essential for integrating ICD-11 into national health information systems. Greater collaboration, establishment of national task forces, and clear monitoring frameworks are crucial for successful implementation. Guided by digital health and health informatics expertise, countries can overcome challenges and align with broader health care objectives, thereby ultimately enhancing global health outcomes through effective ICD-11 adoption. By learning from early adopters such as Argentina and Mexico, other countries can better prepare for their own transitions to ICD-11.

The International Classification of Diseases (ICD) is a standard for classifying causes of death and health conditions that ensures consistency and comparability of mortality and morbidity data (1, 2). This system transforms medical conditions into an alphanumeric code set, enabling the aggregation and analysis of data.

The World Health Organization (WHO) took responsibility for the classification in 1948 with the adoption of the sixth revision of the ICD (3). Since then, WHO has supported five revisions in response to medical advances and public health needs (3, 4). ICD-11 was officially launched at the 72nd World Health Assembly in 2019 and became operational on 1 January 2022 (2, 5).

The 11th revision of the ICD is an important milestone in the classification given its improvements over previous revisions: ICD-11 is based on formal ontology; incorporates advances in medical knowledge; and expands the coverage of diseases and conditions (3). ICD-11 includes new chapters on topics such as traditional medicine and sexual health (6). Unlike earlier revisions, ICD-11 is entirely digital and optimized for seamless integration into local health information systems with a multilingual capability (7). ICD-11 can be used online or offline through a free software container provided by WHO (8). It provides access to 17 000 diagnostic categories and more than 100 000 medical index terms. The index-based search algorithm interprets more than 1.6 million terms.

While ICD-11 offers advantages over previous revisions, it also adds complexity to an already complex health information ecosystem. WHO outlines several important steps for transition to the ICD-11 including a comprehensive re-evaluation of the foundational processes within morbidity and mortality data management systems, adjustments to local coding systems, training professionals, and updating electronic health record systems (9).

Countries of the WHO Region of the Americas started the transition to ICD-11 through a series of regional and global webinars, and country-level workshops and training (10). Belize and Colombia have made significant progress by piloting ICD-11 integration into electronic medical records through application programming interface (API) technology. Moreover, countries with WHO Family of International Classifications (WHO-FIC) collaborating centers, including Argentina, Brazil, Canada, Mexico, and the United States, contributed both at regional and global levels by participating in the development of the ICD-11 (11). Despite these advancements, implementation of the ICD-11 is still in its early stages. Given the complexity of morbidity coding, Argentina and Mexico have focused on mortality coding in their early transition to ICD-11 and adopted a phased approach for integration into their health information systems.

In this study, we use a qualitative approach to identify essential elements and key considerations in preparing for the transition to ICD-11 mortality coding through two case studies in Argentina and Mexico. By examining the opportunities, challenges, and strategic decisions made during the early implementation stages, our aim is to provide lessons to guide other countries as they begin their ICD-11 journey.

METHODS

We used a qualitative approach, combining document review and a participatory consultation with relevant actors.

The status of national ICD-11 implementation is assessed through a structured five-level coding system, ranging from 1 (familiarized) to 5 (data reported) (12).

We selected Argentina and Mexico (Table 1) for this study because of their strategic affiliations with the Pan American Health Organization (PAHO) and their roles as collaborating centers within the WHO-FIC network. These affiliations facilitated engagement with key actors in the early stages of the ICD-11 transition.

TABLE 1. Main features of the mortality information systems in Argentina and Mexico.

Feature	Argentina	Mexico
Population	44 494 5021 (8% in rural areas, 2018)	126 014 024 (21% in rural areas, 2020)
Administrative distribution	Federal system with 23 provinces and one autonomous city	Federal republic with 32 federal entities
Ministry responsible for civil registration and vital statistics	Ministry of Interior, Public Works and Housing; Ministry of Health	Ministry of Home Affairs; National Institute of Statistics, Geography and Informatics
Civil registration agency	Civil registration offices	National Population Registry; National Institute of Statistics, Geography and Informatics
Death registration document	Medical certificate of cause of death and the deceased identification (paper based)	Medical certificate of cause of death with the corresponding death act. If not available, accidental and violent deaths notebooks (paper based)
Cause of death certification system	Paper-based; electronic system has been developed in house and tested in two provinces.	Paper based; electronic system ready for deployment, pending integration with the Epidemiological and Statistical Subsystem of Deaths (SEED) software developed by a public institution and adapted by the Ministry of Health.
Medical certificate of cause of death	2016 WHO standard certificate, but with three lines	2016 WHO standard certificate
Coding level	Provincial level	Subnational level (validated at the central level)
ICD currently used	ICD-10, 2015 Spanish edition	ICD-10, 2018 Spanish edition
Coding	Manual (application of ICD mortality coding rules usually by a non-medical coder)	Combination: 30% manual (application of ICD mortality coding rules by a non-medical coder) and 70% automated (Irisa) using code only mode)
Data quality audits	For selected topics, such as maternal mortality or infant deaths	Deaths due to causes subject to epidemiological surveillance, all maternal deaths and those suspected of concealing a maternal death
Deaths registered (2019)	100%	94%
Ill-defined and unknown causes of death (2019)	6.8%	1.2%
Mortality garbage codes (2019)	28.7%	13.1%

ICD, International Classification of Diseases; WHO, World Health Organization.

^aIris is an automatic system for coding multiple causes of death and for the selection of the underlying cause of death.

Source: Prepared by authors from the findings of their review and consultations.

Data collection

Data collection was done between October 2022 and October 2023, following the WHO ICD-11 transition guide (9), which outlines five priority areas of action for transition: (i) language version; (ii) capacity-building; (iii) information technology (IT) infrastructure; (iv) comparability and quality of data; and (v) advocacy and dissemination (13). We conducted a document review including scientific literature, grey literature, policies, reports, and country presentations from the WHO Digital Open Rule Integrated Cause of Death Selection (DORIS) workshop in early 2019. To complement this review, we conducted separate virtual meetings with representatives from Argentina and Mexico on January 17 and April 4, 2023, respectively, where each country presented its progress towards ICD-11 implementation. Additionally, a virtual consultation meeting was held in June 2023, which gathered experts from both countries. PAHO and the WHO–PAHO collaborating centers in each country helped identify stakeholders, including decision-makers, ICD experts, medical coders, and IT experts. Invitations to the consultation meeting were sent by e-mail. Fifteen participants attended the meeting, which was moderated by one of our authors (DCM), with another author (CLB) documenting the discussion. The agenda included the project aims, conceptual framework and facilitated group work. Participants discussed different domains of ICD-11 implementation by answering questions on a digital platform. The meeting was recorded, transcribed in Spanish, and translated into English.

Data analysis

The information collected during the document review was organized according to the five priority areas in the WHO ICD-11 transition guide. Key informants (authors CG and MY) provided detailed descriptions of the preparatory stages of the transition to ICD-11.

The meeting notes and transcriptions were analyzed by two authors (CLB and MT) to identify key themes. To draw lessons learnt, we used the mHealth assessment and planning for scale toolkit (14) as a theoretical framework to structure and analyze the information. This toolkit is a comprehensive self-assessment and planning instrument designed to improve the capacity of projects to scale up and achieve long-term improvements. It has six areas: groundwork; partnerships; financial health; technology and architecture; operations; and monitoring and evaluation.

RESULTS

Preparatory stages of the transition to ICD-11 for mortality coding

The document review highlighted the proactive efforts of both Argentina and Mexico. The Argentine Centre for Classification of Diseases and the Mexican Center for Classification of Diseases, in collaboration with the WHO-FIC network, participated in the translation into Spanish of ICD-11 (in 2018) and training materials for the eLearning tool (10). This effort helped build a comprehensive understanding of the classification system and its tools. It also laid the groundwork for familiarity before the official ICD-11 implementation. Figure 1 shows the preparatory phases of the transition to ICD-11 in Argentina and Mexico and Figure 2 outlines the main activities undertaken by each country.

FIGURE 1. Preparatory stages of the transition to ICD-11 in Argentina and Mexico, by year.

API, application programming interface; ICD, International Classification of Diseases; DORIS, Digital Open Rule Integrated Cause of Death Selection.

Source: Prepared by authors from the findings of their review and consultations.

FIGURE 2. Summary of the main activities carried out by each country within the framework of the World Health Organization recommendations for implementation of ICD-11.

ICD, International Classification of Diseases; DORIS, Digital Open Rule Integrated Cause of Death Selection.

^a National Health Information System.

Source: Prepared by authors from the findings of their review and consultations.

Argentina

The Ministry of Health leads ICD-11 implementation in Argentina through the Centre for Classification of Diseases, within the Directorate of Health Statistics and Information. However, no dedicated task force has been established for the transition. Initial efforts began in 2021 (Figure 1) with a survey assessing human resources, systems, processes, and data quality in provincial health statistics offices (15). The results showed frequent turnover of staff, but a notable presence of experienced coders interested in training programs. Thereafter, a customized virtual training plan was developed for 2021–2022, which was later extended to 2023 (16).

Simultaneously, the Centre for Classification of Diseases, together with PAHO–WHO Argentina and supported by the organization Vital Strategies, launched an initiative to improve mortality data quality at the subnational level. This involved bridge coding trials with ICD-10 and ICD-11 (collection and comparison of the same mortality or morbidity data episodes coded using the two ICD versions) in three provinces and the development of the GAMMA bespoke software (Generation of Mortality Files for Monitoring with ANACoD3) to integrate ANACoD3 into the provincial information systems as a tool for assessing data quality (17).

As part of the efforts to establish an automated coding system, in 2022 the Centre for Classification of Diseases conducted several tests using DORIS to evaluate its accuracy for batch coding. The EPSILON platform was developed, which resulted in a database of about 2 500 precoded death certificates produced by ICD-11-trained coders in three provinces. The high level of agreement between the automated selection of the underlying cause of death and the manual selection (about 75%) led to the decision to implement the automated coding tool and training (17).

The Directorate of Health Statistics and Information identified several next steps, including scaling up mortality analysis with ANACoD to all provinces, conducting a comparative analysis of ICD-10 and ICD-11 using real certification cases for training, and modifying the EPSILON platform for practical training activities.

Mexico

The Ministry of Health leads the efforts in implementing ICD-11 through the Mexican Center for Classification of Diseases, which is housed within the Directorate of Health Information Systems. It is a collaborative effort that entails continuous coordination with Mexico’s National Institute of Statistics and Geography, and support from PAHO–WHO and organizations such as Vital Strategies and the United States Centers for Disease Control and Prevention Foundation (CDC Foundation). Similar to Argentina, Mexico also lacks a dedicated task force to oversee transition to the ICD-11.

In 2019, the Mexican Center for Classification of Diseases conducted a comparative study of the selection and coding of the underlying cause of death between ICD-10 and ICD-11. The study used a representative sample of 1 252 deaths recorded within the Epidemiological and Statistical Subsystem of Deaths (SEED) in 2018. The results showed a 54.6% agreement rate between the two classifications.

The Ministry of Health postponed implementation of the ICD-11, initially set for 2021, due to the coronavirus disease 2019 pandemic. The transition plan has five phases (Figure 1) (18) and is being implemented in parallel with the development of electronic death certificates, with no set date for nationwide ICD-11 adoption.

The first phase of the transition plan involved an awareness campaign targeted at technical personnel and decision-makers involved in information systems to promote the benefits of adopting the ICD-11. The technical team of the Mexican Center for Classification of Diseases tested the ICD-11 coding tool using raw medical terms obtained from the National Health Information System (entered as free text by physicians) to identify terms not included in the tool.

In the second phase in 2021, the Mexican Center for Classification of Diseases conducted a virtual basic training on ICD-11, followed by training in 2022 on selecting the underlying cause of death and using APIs in electronic records. During this phase, participants who showed potential to become instructors were identified (19). The Directorate of Health Information Systems introduced the use of APIs in mortality databases and tested the DORIS beta version for automated underlying cause of death selection (20, 21).

Subsequent phases focus on assessing the effect of transition, implementing adjustments in national health information subsystems, and designing electronic formats (18).

Key challenges and lessons learnt

We explored the lessons learnt from the meeting with key actors who shared experiences in planning for ICD11 implementation in six pre-defined categories (Table 2): groundwork; partnerships; financial health; technology and architecture; operations; and monitoring and evaluation.

TABLE 2. Key considerations for successful preparation for transition to ICD-11: lessons learnt from the Argentina and Mexico.

Category	Key considerations	Argentina	Mexico
Groundwork	Assess current mortality information systems and capacities.	Need to understand regional differences and varying technical capabilities.	Electricity and internet connectivity are limited in some regions.
	Standardize approach to ICD-11 adoption across different systems.	A national electronic health records system exists while provinces have autonomy to adopt it or develop their own systems.
Partnerships	Foster intersectoral coordination.	Bridging communication gaps between national and regional levels is challenging.	High fragmentation complicates coordination; the health ministry is proactively promoting technological development for ICD-11 integration.
	Engage information technology and digital health professionals in planning phase.
	Develop regional alliances and make use of international support.		Collaboration with PAHO and Vital Strategies has been developed for technology adaptation.
Financial health	Plan financial strategy and long-term funding.	External support was received from international organizations.	External support was received from international organizations.
	Secure financial commitments and foster partnerships.	Alliances were formed with non-health sectors such as social security institutions and banks.	Some health care institutions have independent funding, which helps when national financing is insufficient; health ministry is advocating for a regional consortium for political and financial support.
	Allocate funds specifically for ICD-11 transition and promote digital adoption.		Incentives are needed to reduce paper use and promote digital adoption.
Technology and architecture	Address fragmentation in health care systems and transition to electronic health information systems.	Existing standards (e.g. SNOMED CT) can affect ICD-11 transition integration.	Fragmentation exists within health care system; capacities for health information management vary between service providers.
	Raise awareness about ICD-11 among stakeholders.
Operations	Develop effective and continuous training programs.	Delays exist in availability of training materials in Spanish.
	Tailor training for personnel across health care centers.
Monitoring and evaluation	Establish comprehensive plan for long-term financial sustainability and monitoring mechanisms.	Some monitoring of coder training occurred.	Comprehensive plan for monitoring has not been developed.
	Track progress, identify challenges, and ensure accountability.

ICD, International Classification of Diseases; PAHO, Pan American Health Organization; SNOMED CT, Systematized nomenclature of medicine clinical terms.

Source: Prepared by authors from the findings of their review and consultations.

Groundwork. Participants highlighted the importance of assessing current mortality information systems and human resources capacity for a successful transition. In Argentina, understanding subnational differences, and varying technical capabilities and infrastructure at different locations were emphasized. For instance, a national electronic health records system exists but provinces have the autonomy to adopt it or develop their own systems, which results in technological disparities. This issue underscores the need for a standardized approach to adopting the ICD-11. In Mexico, limited electricity and internet connectivity in some regions hinders effective electronic health care management.

Partnerships. Effective intersectoral coordination emerged as a recurring challenge. Communication needs to extend beyond the health sector to include civil registration, national statistical institutes, IT services, and other sectors such as digital health, education, and research. However, bridging communication gaps between national and regional levels and engaging key institutions in the initial stages of the ICD-11 transition have proven difficult. Despite the central role of technology, IT professionals and digital health sectors were not involved in either country.

In Mexico, a highly fragmented health care system complicates coordination among the many public and private service providers needed for ICD-11 adoption. To address this, the Ministry of Health is promoting technological development for integration of ICD-11 and encouraging gradual adoption. This includes internal coordination and collaboration with the National Institute of Statistics and Geography.

Participants emphasized the need for regional alliances and support from international organizations to share experiences and best practices. For instance, Mexico’s Directorate of Health Information Systems, in partnership with PAHO and Vital Strategies, developed new technologies to integrate the coding tool into existing systems.

Financial health. The ICD-11 preparatory process highlighted the need for a clear financial strategy with a long-term plan. The cost of implementing ICD-11 in Argentina and Mexico has not been estimated, and neither country has a financial strategy in place. Both countries received external support to start the preparatory and piloting phases, with international organizations such as Bloomberg Philanthropies, PAHO, WHO, and the CDC Foundation contributing to these efforts.

While both the provincial and national governments regularly allocate funds to improve health information systems, it was suggested that the ICD-11 transition should be explicitly included. In Mexico, federal resources may be limited, but some health care institutions have independent funding sources. Aligning incentives within these institutions to reduce paper use and prioritize ICD-11 integration was identified as a key strategy.

The importance of multisectoral partnerships, already mentioned, was specifically highlighted in terms of financial support. In Argentina, for instance, alliances with social security institutions and banks were effectively developed to secure some funding for the transition.

Participants from both countries also stressed the need for political continuity, as changes in government could affect financial support for ICD-11 implementation. For instance, Mexico’s Ministry of Health’s Undersecretariat for Prevention and Health Promotion is advocating for a regional consortium to raise the political profile of ICD-11 adoption and ensure continued financial support even in the event of government changes.

Technology and architecture. As mentioned, fragmentation is a challenge in Mexico. The health care system has multiple service providers, such as the Mexican Social Security Institute, the Institute of Health Services for State Workers, Mexican Petroleum Company, and private entities. Each of these providers has different capacity for health information management, leading to differences in the adoption of electronic systems across the country. For instance, some regions or facilities are expected to experience a prolonged transition from paper-based processes to digital platforms.

The need to adapt or create new electronic health information systems was a recurring theme. Participants acknowledged the importance of transitioning to electronic formats from paper-based systems, especially for death certificates. In this context, Mexican participants noted that countries already using the WHO 2016 medical certificate of cause of death, regardless of format, would experience a smoother transition due to the consistency between ICD-10 and ICD-11 mortality coding.

In contrast, the adoption of SNOMED clinical terms for clinical data processing in Argentina has affected the ICD-11 transition efforts. Some developers and health care providers using SNOMED CT view ICD-11 solely as a classification tool, which delays integration efforts. Raising awareness among stakeholders about the full scope of ICD-11 beyond its use as a classification system (i.e., its use in clinical documentation, decision support, and morbidity and mortality reporting, and its digital applications with enhanced interoperability that supports global data exchange) was suggested to support smoother implementation.

Operations. Effective and continuous training was recognized as essential to ensure a smooth transition to ICD-11. Both countries called for concise manuals, instructor guides, and tailored programs for personnel across health care centers, but both reported a shortage of specialists to deliver them.

Participants also noted that successful national implementation is closely tied to the timely release of guidelines and training tools by WHO and other partners. English materials are often released before Spanish versions, leading to delays that have already affected implementation in Argentina.

Monitoring and evaluation. While some monitoring of coder training was reported in Argentina, neither country had developed a comprehensive monitoring system. Participants therefore urged the establishment of robust mechanisms to track progress, identify challenges, and ensure accountability during ICD-11 implementation. They emphasized that such efforts were essential to demonstrate commitment and secure support for the transition.

DISCUSSION

This study explored the lessons learnt from early stages of the ICD-11 transition for mortality coding in Argentina and Mexico. Our findings highlight key considerations including the importance of system-level assessments, robust partnerships, financial planning, technological readiness, targeted training, and monitoring and evaluation mechanisms to navigate the complexities and ensure success.

The lack of intersectoral coordination among key partners was a recurring theme in both countries. Given the multisectoral nature of this effort, it is important to establish a structured mechanism for intersectoral coordination (22). This requires establishing a multiministerial or interagency task force with an overarching mandate across organizations to navigate potential bureaucratic hurdles (23). Empowered with authority, this task force should bring together representatives from relevant ministries, health care institutions, professional associations, and other relevant entities (24). By facilitating communication, collaboration, and alignment of efforts, the task force can drive progress toward ICD-11 adoption (23).

Transition to ICD-11, which is predominantly electronic, represents an opportunity to improve the integration, interoperability, and digitization of health information systems. However, we observed limited involvement of IT professionals in the early stages. Digital health and health informatics teams can lead implementation, ensuring integration of technological adaptations and alignment with existing terminologies. This facilitates interoperability within the health information ecosystem to meet the diverse needs and capacities of health care providers (25).

Our findings from Argentina and Mexico confirm that capacity-building is essential for this transformation. Comprehensive training programs are necessary for all end-users, including IT staff, coders, and health care professionals (26). In Kuwait, early-stage ICD-11 implementation included training physicians using innovative methods, such as social media platforms, for improved access to training materials (27). In Argentina, training programs were successful, tailored to the needs identified in the preliminary assessment, and supported by highly motivated coders. However, concerns exist about the timely provision of training materials and other tools in various languages (26, 28). Despite Spanish being the first language into which ICD-11 was translated, other supporting resources, such as the DORIS tool and the API integration package, are not yet translated, resulting in language barriers that hinder implementation efforts.

The lack of essential tools and related technologies may further complicate the integration of ICD-11 into the existing systems (29). A specific challenge was observed in Argentina, where SNOMED-CT is used as the standard terminology for clinical data processing. The lack of SNOMED-CT to ICD-11 mapping at the global level directly affects the transition efforts. This problem is likely to affect all countries using SNOMED-CT (30, 31). On the other hand, the technical team of the Mexican Center for Classification of Diseases proactively tested the ICD-11 coding tool using raw medical terms to identify those not yet included. These collaborative efforts not only enhanced the tool’s accuracy but also highlighted the value of adapting global standards to local contexts.

Our research underscores the fragmentation of the health information system in both countries, with management capabilities ranging from paper-based systems to a variety of electronic systems. Conducting a comprehensive system-level assessment to identify potential opportunities and challenges is a key component in the preparatory stages of ICD-11 transition (30, 31). This assessment goes beyond updating electronic health information systems or adopting open APIs. It requires: understanding the existing technological infrastructure; assessing applications and vendors; ensuring readiness; making necessary system and interface modifications; and re-engineering business processes. However, at the time of this study, no comprehensive assessments had been conducted in Argentina or Mexico.

In Argentina, despite a national framework for electronic health records, provincial autonomy in selection of systems has caused technological disparities. This challenge may be shared by other federal states where health care administration is primarily a provincial responsibility (32). Nonetheless, decentralization also presents opportunities through mobilizing local resources (33), as seen in Mexico, where the decentralized funding structure enables health care organizations to use internal financial resources.

Neither country has a well planned financial strategy for ICD-11 implementation. ICD-11 should be integrated into national strategies such as digital transformation reforms and digital health strategies funded by the national budget. In Argentina, the use of resources from multiple sectors broadened the financial support base, demonstrating the effectiveness of cross-sector collaboration. A multisectoral approach to financial planning increases sustainability and resilience, thus facilitating broader societal engagement and commitment. However, challenges arise because non-health sectors may not fully recognize the co-benefits of interventions aimed at improving population health, which can result in underfunding and fragmented resource allocation. To address this problem, cross-sectoral co-financing has been proposed to ensure holistic benefits of interventions are recognized and adequately supported in a coordinated manner (34).

Our results also highlight the important role of international partners. The need for continued external support will diminish as countries develop the capacity to manage the implementation process independently (35). However, international and regional support, such as through the WHO-FIC network of collaborating centers, is still crucial for countries in the early stages of ICD-11 implementation.

Finally, our assessment showed that Argentina and Mexico lacked a structured monitoring plan to track progress and address early implementation challenges. Developing a robust monitoring and evaluation plan for digital health helps identify challenges, facilitates necessary corrections, and optimizes the scale-up process (36).

Limitations

While our study provides valuable insights into the early stages of ICD-11 implementation, it has some limitations. Focusing on countries in the ICD-11 familiarized stage (implementation level 1) provides preliminary lessons, but it underscores the need for studies on more advanced stages. Our research exclusively examined mortality coding, and there is a need for separate investigations into readiness. for morbidity-coding. Moreover, the implementation approach in both countries lacked broad stakeholder engagement, as reflected in the workshop participants’ profiles. Finally, the involvement of PAHO in data collection could introduce response bias, given the donor-driven nature of the study.

Conclusions

Preparations for the transition to ICD-11 in Argentina and Mexico underscore the importance of tailoring strategies to each country’s unique context. Improving collaboration across sectors, including digital health and health informatic professionals, establishing a national task force and clear monitoring and evaluation frameworks are essential for smoother transitions in future implementations. ICD-11 cannot exist as a stand-alone project; it is part of a larger endeavor and must be integrated into national health information systems and data architecture for sustainability and improved interoperability of morbidity and mortality data in the different information systems. Overcoming challenges of ICD-11 implementation requires increased support, accelerated development efforts to make tools and resources more accessible, and the establishment of expert networks and training programs. Guided by digital health and health informatics experts, countries can navigate technical challenges and ensure alignment with broader health care objectives, ultimately improving global health outcomes.

Funding Statement

Vital Strategies (Award number 552009-0001). The funder did not influence the design, data collection, analysis or writing of this study, or the decision to publish the results.

Disclaimer.

The authors hold sole responsibility for the views expressed in the manuscript, which may not necessarily reflect the opinion or policy of the Revista Panamericana de Salud Pública / Pan American Journal of Public Health and/or those of the Pan American Health Organization and the World Health Organization.