The International Classification of Diseases and Related Health Problems (ICD) was originally adopted in 1900. It has been implemented in Japan since that time and applied to various statistical studies, including mortality statistics. In Japan, the “Statistical classification of diseases, injuries and causes of death” is stipulated as a statistical standard under the Statistics Act and is applied to producing official statistics, including Vital Statistics and Patient Statistics, and is used in management of medical records in medical institutions.

With global aging, where Japan especially is entering a high-mortality society, it is important to prepare effectively by constructing a sustainable health and medical system. A foundation of statistics and information constitutes the basis of this and its maintenance and utilization will become even more required, while the newly ICD-11 and related international classifications are expected to fulfil its role to assist such a framework. From now on, we would like to verify the legal-system issues and the usage environment in cooperation with stakeholders and work toward smooth implementation in Japan.

The beta version of ICD-11, which was intended to integrate the updates of medical sciences, has been recently released. Since internal medicine accounted for a large portion of the whole disesase entities, most of the features of ICD-11 are well reflected in this field. In this paper, I would like to first make a very brief overview of the new characteristics of ICD-11. Then, picking up diabetes mellitus, which is a common chronic disease affecting multiple organs, as one of the prototype disorders of internal medicine, I would discuss the progress and future problems of ICD-11.

One of the main targets in the treatment of musculoskeletal diseases is maintaining or improving activities in daily life and social life, and previous versions of ICD were not well suited for musculoskeletal diseases. Orthopedists and rheumatologists established the musculoskeletal topic advisory group and proposed the drafts that fit for clinical diagnostic processes. In the revised ICD-11, the logical processes of diagnosis have been described, and the extension codes seem to be very useful to code complicated musculoskeletal conditions. Further efforts are necessary to utilize these data.

What sets psychiatry apart from the rest of medicine is that it is difficult to give a diagnosis based on biomarkers. In psychiatry, it is difficult to draw a clear line between pathology and normality to begin with, and objective facts to delineate diagnostic entities are lacking. In other words, in psychiatry, it is in a way arbitrarily determined how far one must go to be regarded as pathological or how one condition is differentiated from another. Since the threshold and diagnostic entities are determined as such, criteria used to conduct the act of diagnosis have to be operationalized. There are no self-evident diagnostic criteria, and instead, diagnostic criteria are set so that they are informed by knowledge and experiences and are most suitable at the given moment. Such a background explains why the significance and weigh that the diagnostic classification system and criteria in psychiatry carry differ compare to those in other areas of medicine. This paper discusses the difficulty, unique challenges, and significance inherent to the revision of the diagnostic classification system in psychiatry, considering ADHD, a condition recently well recognized; self-odor phobia, as it has been long recognized domestically; and gaming disorder, which has stirred heated debates in the media.

International Council of Ophthalmology (ICO) that formed ICD-11 Taskforce had taken part in the revision process of the International Classification of Diseases (ICD) in 2008 and created the Ophthalmology Chapter of the ICD-11 on the ICD-11 beta browser. The Ophthalmology Chapter, previously called Chapter 7 Diseases of Eye and Adnexa, is now Chapter 9 newly named Diseases of the Visual System, indicating that the Chapter was not only updated but also being organized according to the new concept. It is divided into two main parts- Disorders of the Visual Organ and those of vision and visual functioning, which is independently classified in addition to the conventional disease names. This review describes how it was produced and what are new in ICD-11.

After more than a decade in the revision process, the 11th edition of the International Classification of Diseases (ICD-11) has been released by the World Health Organization in June, 2018. Under the strong leadership of Professor Kentaro Sugano, the Japanese Society of Gastroenterology has made significant contribution to supporting the revision process of ICD-11 by forming an ICD-11 committee consisting of approximately 20 international and 30 domestic members, which was chaired by Professors Soichiro Miura, Hiroto Miwa (from 2015-), and Peter Malfertheiner (Germany) for the gastroenterology working group, and Professors Sumiko Nagoshi, Emmet B Keeffe (USA, -until 2011) and Geofferey C Farrell (Australia, from 2011-) for the hepatology and pancreaticobiliary working group. Our primary tasks were to advise on the development of the ICD-11 coding structure and to review and comment on proposals from other stakeholders and experts on the ICD-11 proposal platform.

The latest version of ICD-11 still needs to be refined, especially in areas overlapping with other disciplines (e.g. infectious diseases and neoplasms). The necessity of developing a specialty linearization for gastroenterology should be discussed in order to promote implementation of ICD-11 in Japan.

Purpose: To outline the background and development of Oriental medicine classification into ICD-11, and to explain its significance, tasks, and future prospects.

Development of traditional medical classification: The development of traditional medical classification at WHO was initiated as part of standardization headguarters projects of traditional medicine by the WHO Western Pacific Regional Office (WPRO). In 2009, WHO headquarters held a conference in Hong Kong, inviting representatives of traditional medicine from around the world. Subsequently WHO started the development of traditional medicine classification for ICD revision. In 2013 a beta version was completed and peer reviewed by 142 experts in 22 countries. After the field test, ICD-11 was released in June 2018, and traditional medicine classification was positioned as chapter 26 of ICD-11.

Significance of the traditional medical classification in ICD-11: In the history of ICD since 1900, this is the first time that traditional medicine has been incorporated. Former Director General Margaret Chan of WHO emphasized that this is a historical event in ICD history.

On the other hand, lagging behind Western medicine classification by 118 years, the diagnosis system of traditional medicine is internationalized. This does not mean that WHO endorsed the effectiveness or safety of traditional medicine. It is only an international tool for the future validation of effectiveness and the safety. Therefore, using this chapter on traditional medicine is required to take health informatics data from now.

Future prospects of traditional medicine classification: Development of the chapter on traditional medicine was accomplished by an international team. It will be shifted to the phase of maintenance and implementation. In addition, interventions such as acupuncture and moxibustion are planned to be within ICHI. The Traditional Medicine Reference Group (TMRG) was established in WHO-FIC in 2018. Oriental medicine is actively employed all over the world. In the future, health statistics, education, and clinical research using the ICD traditional medicine chapter are required to spread to all countries where oriental medicine is employed.

Conclusion: The traditional medicine classification chapter was incorporated in ICD for the first time in the history of ICD since 1900. The international foundation of traditional medicine statistics is ready, and by utilizing this, the implementation of health statistics, education and research are expected to be promoted.

The newly published ICD -11 includes an additional section on vital function assessment (V. Supplementary section for functioning assessment).

This is based on the International Classification of Functioning of Life (ICF: International Classification of Functioning, Disability and Health) adopted by the WHO General Assembly in May 2001, and it can be said that the importance of assessing vital functions in conjunction with diseases has been emphasized, as well as enhancing the linkage between the International Classification of Functioning of Life (WHO International Classification Family) prepared by WHO.

The supplementary section V of ICD -11 consists of three main categories that extract the key elements of ICF items from the WHO-DAS 2.0 (WHO-Disability Assessment Schedule 2.0) and MDS (Model Disability Survey) developed by WHO based on the concept of ICF and other ICF core set projects called the Common Functional Area of Life (Generic functioning domains). There are 61 evaluation items, Except for unknown details and others.

At present, studies using the ICF concept in Japan often summarize survey items, research content, and practices that make use of the concept. However, there have been some studies using the ICF core set and the WHO-DAS 2.0, that utilize the ICF items and evaluation rules as they are, and the development of evaluation tools that utilize the ICF items and evaluation rules.

In the future, WHO is planning to map various big data in the field of health care including medical care, nursing care and welfare to the WHO-FIC (ICD, ICF, ICHI, etc.), and to develop measures to promote the construction of the global health information system (HIS: Health Information System). In 2020 Japan, how to collect data utilizing the ICF items and how to link the collected data with other data is planned.

In Japan, diagnoses of diseases documented in hospital medical records are coded by the Health Information Manager (formerly known as the Medical Record Manager) by using the International Statistical Classification of Diseases and Related Health Problems (ICD). These data are utilized not only in hospitals but also in other environments.

ICD is used for Morbidity statistics in hospitals as well as for the DPC/PDPS (Diagnosis Procedure Combination/Per-Diem Payment System: Japan’s version of DRG), in which diagnoses of diseases for medical fee claims are coded by ICD. When ICD-11 is adopted, giving immediate education and proper guidance to Halth Information Managers is essential. That is a common challenge both in countries where ICD has been already implemented and in those where ICD is expected to be introduced. At the World Health Organization (WHO), the Education and Implementation Committee (EIC) of the WHO Family of International Classifications (WHO-FIC) is considering how we can address the challenge at the international level.

The ICD-11 version is an unprecedented major revision in terms of both its volume and contents. It has been achieved 28 years after the launch of ICD-10; adopts information technology for the first time in the 100-year history of the ICD; has 26 chapters, with four new chapters, including one part of the International Classification of Functioning, Disability and Health (ICF) as a chapter that had been treated as a different classification. There is a high possibility that other classifications, such as ICHI, will be digitized and integrated into ICD-11 in the future to be utilized. This article presents approaches and future challenges related to domestic implementation of ICD-11.

Objectives: WHO and the WHO-FIC Network have been developing the International Classification of Health Interventions (ICHI) since 2007. The aim is to meet a number of use cases including international comparisons, providing a classification for countries that lack one and to provide expanded content for countries that have a national classification focused on medical and surgical interventions. ICHI is under development and publishes ICHI Beta-2 2018 as a provisional version. The Japanese Health Insurance Federation for Surgery (JHIFS) has been developing STEM7 since 2008. This study clarified the trend of ICHI and compared the ICHI code with K code and STEM7. We examined the use of ICHI in Japan to determine if there are any problem.

Methods: K code used is the 2018 version, STEM7 used is version 9.1, ICHI code used is ICHI Beta-2 2018 version. While presenting concrete examples, this paper examines the differences in the basic structure of each code.

Result: STEM7 describes operative interventions using four axes: Operation target part, Basic procedure, Approach method and Auxiliary equipment. ICHI code describes health interventions using the three axes: Target, Action and Means, which is similar to STEM7. ICHI covers all medical Interventions, body functions and activities, the environment, and health-related behaviors. Users may choose to record a range of additional information using Extension codes.

Conclusion: By using the Extension code of ICHI, it is possible to refine the classification of medical interventions. It is a very useful code, but it is difficult to understand. In this paper, we presented examples of using Extension code. It is expected that this will deepen the understanding of ICHI. After ICHI is approved, it can be expected that ICHI’s domestic correspondence will be smooth.

The ICD-11 (11th revision of the International Classification of Diseases) field trial is positioned at the final stage of the ICD-11 revision process, and its purpose is to evaluate the applicability, reliability, and usefulness of ICD-11. WHO held the field trial in 2017 with a common protocol, in addition to the pilot test in 2016, in several countries and regions around the world, including Japan. Several field trials said that ICD-11 had finer classification granularity, and that it was possible to describe more detailed disease concepts than ICD-10. On the other hand, they showed the necessity of discussing an appropriate coding granularity, such as “To what level should we code.” In addition, the importance of education on post-coordination using extension codes that express parts, severity, time axis, and so on was pointed out. After releasing ICD-11 in 2019, discussions to clarify more specific issues and to establish guidelines for the smooth introduction of ICD-11 and operation based on the results of field trials will be active in several countries. Additional implementation of ICD-11 field trials will be desirable for the smooth introduction and operation of ICD-11 in Japan's own medical provision system and public statistics.

ICD-11 is designed as IT friendly system, and many new features with informatics are incorporated, such as contents model etc. It is not only as a coding system for diagnosed disease, but supporting system for diagnosis, which will result in standardization of medicine. This article will describe about the informatics characteristics of ICD-11, introducing informatics tools, and discuss about the future vision of its usage.

Objectives: This cross-sectional study aimed to determine the influence of selected background characteristics of community residents who participated in a long-term care-prevention workshop on the presence and severity of xerostomia symptoms.

Methods: Of 1893 participants across 12 care-prevention workshops, 1137 participants gave written consent to participate in the survey. A self-administered questionnaire was administered. The main survey items were background characteristics of the participants and the Xerostomia Inventory (XI).

Results: Factors found to affect oral dryness were age, medication use, sleep quality, constipation, and the use of dentures. Xerostomia was also found to significantly influence quality of life.

Conclusions: When organizing long-term care-prevention workshops aimed at improving oral function, the background characteristics of participants should be taken into consideration.

Purposes: The purposes of this study are (a) to clarify the state of preparation for public health activities in times of disaster in terms of organizational framework setting, preparation of manuals, and other areas to be pursued by each local government: (i) prefectural governments, (ii) cities in which public health centers (PHC-established cities) are located, and (iii) other municipalities (cities, towns and villages); (b) to make clear what is in the preparation for the local government related to the “implementation of training on public health activities in the event of a disaster”.

Method: In published literature, the activity areas of which everyday preparation efforts would help actual public health services operate effectively in the event of disaster were chosen. In order to collect information on the progress of preparation in the identified areas, the questionnaire survey was prepared, covering supervisory public health nurses stationed in each local government—prefectures, PHC-established cities, and general municipalities, as well as those working at PHCs. The questionnaire was mailed to be completed by the public health nurses on their own. For analysis, responses were classified into three types by response source: (i) prefectural governments and prefectural PHCs, (ii) PHC-established cities, and (iii) other general municipalities. After an adjustment based on the type of the local government, multiple logistic regression analysis was conducted using the dependent variable of “whether training is carried out for public health activities in preparation for disasters or not.”

Results: A total of 1,159 answers were received (response rate: 51.1%). The general local governments showed a lower implementation ratio than prefectures and PHC-established cities in terms of (i) sending health care section personnel to disaster response headquarters, (ii) preparation of relevant manuals, (iii) cooperation with other sections in the organization or medical associations, and (iv) implementation of education and training. The PHC-established cities and general municipalities are almost the same in terms of the preparation and management status of those in need of support for evacuation. It has also been found that the implementation of public health activity training in preparation for disasters is closely related to nine points, including (i) determination of the approximate timing of the termination of support from health and medical service teams, (ii) availability of opportunities for doctors' organizations and pharmacists' associations to discuss disaster relief measures, and (iii) dispatch of personnel to training sessions.

Conclusion: Preparedness in public health services for disasters is less progressed in other cities, towns, and villages than in other local entities. In the “implementation of training on public health activities in the event of a disaster”, preparations for disasters, such as “cooperation with related organizations”, “examination of the support system”, and “lectures” were related.