Ooi Erwyn Chin Wei, Isa Zaleha Md, Manaf Mohd Rizal Abdul, Fuad Ahmad Soufi Ahmad, Sidek Hammad Fahli, Ahmad Azman, Mustapa Mimi Nurakmal, Kharie Mohamad Fadli, Shith Shahidah Adilah, Marzuki Nuraidah Mohd
Department of Public Health Medicine, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia.
Health Informatics Centre, Planning Division, Ministry of Health Malaysia, Putrajaya, Malaysia.
BMC Med Inform Decis Mak. 2025 Aug 21;25(1):314. doi: 10.1186/s12911-025-03157-7.
The eleventh version of ICD (ICD-11) is the latest version of ICD adopted by the 72nd World Health Assembly in 2019. Worldwide, countries are piloting the ICD-11 and conducting relevant feasibility studies. ICD-11 implementation was not a straightforward initiative, requiring the involvement of various stakeholders. The challenges and facilitators beyond the pilot implementation settings were less well understood. There is a need to understand the perspective of implementers who have experienced ICD-11 implementation involving heterogeneous systems.
We used primary data gathered between April and May 2024 via semi-structured interviews with the implementers (n = 15) who were members of Malaysia's national-level ICD-11 implementation committee. We collected and analyzed the qualitative data using the Consolidated Framework for Implementation Research (CFIR) 2022 to understand how the key informants implemented ICD-11. Permission was obtained to record the interviews, which were transcribed and coded using NVivo 12. We used conventional qualitative content analysis to identify key facilitators and challenges to ICD-11 implementation.
By applying CFIR 2022, we determined the relevant factors influencing the implementation of ICD-11 in Malaysia. Defining the facilitators and challenges provided direction on areas of focus and improvement in the ICD-11 implementation context. The facilitators included the lead organizations' reputation, fulfilment of existing use case, extensive content with terminology service, trialability, lower cost, collaboration with external agencies, improvement of existing laws, clear roles within the organization, effective communication, emerging needs, suitability with existing workflow, easy access to knowledge, motivated team, availability of existing frameworks, and engaging team. The challenges were ICD-11's complexity, customization, support by top management, vendor's steep learning curve, inadequate documentation, outdated infrastructure, data duplication and validity, workforce, impact on work processes, funding, and technical expertise.
This study identified key facilitators and challenges in nationwide ICD-11 adoption, providing critical insights for implementation across heterogeneous systems. Successful adoption requires addressing coding, technical and policy aspects. Future research should evaluate user perspectives and the adaptability of implementation strategies in diverse settings.
Not applicable.
国际疾病分类（ICD）的第11版是2019年第72届世界卫生大会通过的ICD最新版本。在全球范围内，各国正在对ICD-11进行试点并开展相关可行性研究。ICD-11的实施并非一项简单的举措，需要各类利益相关者的参与。对于试点实施环境之外的挑战和促进因素，人们了解得较少。有必要了解那些经历过涉及异构系统的ICD-11实施过程的实施者的观点。
我们使用了2024年4月至5月期间通过对马来西亚国家级ICD-11实施委员会成员（n = 15）进行半结构化访谈收集的原始数据。我们使用2022年实施研究综合框架（CFIR）收集和分析定性数据，以了解关键信息提供者是如何实施ICD-11的。获得了录制访谈的许可，访谈内容被转录并使用NVivo 12进行编码。我们使用常规定性内容分析来确定ICD-11实施的关键促进因素和挑战。
通过应用2022年CFIR，我们确定了影响马来西亚ICD-11实施的相关因素。明确促进因素和挑战为ICD-11实施背景下的重点关注领域和改进方向提供了指引。促进因素包括牵头组织的声誉、现有用例的实现、带有术语服务的丰富内容、可试验性、低成本、与外部机构的合作、现有法律的改进、组织内明确的角色、有效的沟通、新出现的需求、与现有工作流程的适用性、知识的易获取性、积极的团队、现有框架的可用性以及参与度高的团队。挑战包括ICD-11的复杂性、定制化、高层管理人员的支持、供应商的陡峭学习曲线、文档不足、基础设施过时、数据重复和有效性、劳动力、对工作流程的影响、资金以及技术专长。
本研究确定了全国范围内采用ICD-11的关键促进因素和挑战，为跨异构系统的实施提供了关键见解。成功采用需要解决编码、技术和政策方面的问题。未来的研究应评估用户观点以及实施策略在不同环境中的适应性。
不适用。
