Facilitators and challenges to ICD-11 implementation: a qualitative study using the consolidated framework for...

Area of Science:

• Health Informatics
• Public Health
• Health Services Research

Background:

• The eleventh version of the International Classification of Diseases (ICD-11) was adopted in 2019, with countries worldwide piloting its implementation.
• Understanding the challenges and facilitators of ICD-11 implementation, especially in diverse systems, is crucial for successful adoption.
• Previous research has not fully explored the implementer's perspective in heterogeneous system environments.

Purpose of the Study:

• To identify key facilitators and challenges encountered during the nationwide implementation of ICD-11 in Malaysia.
• To understand the factors influencing ICD-11 adoption from the perspective of national-level implementers.
• To provide insights for improving future ICD-11 implementation strategies.

Main Methods:

• Qualitative data were collected through semi-structured interviews with 15 national-level ICD-11 implementers in Malaysia.
• The Consolidated Framework for Implementation Research (CFIR) 2022 was used to analyze the qualitative data.
• Conventional qualitative content analysis was employed to identify facilitators and challenges.

Main Results:

• Facilitators included strong leadership, existing use cases, comprehensive terminology services, trialability, cost-effectiveness, external collaboration, legal improvements, clear roles, effective communication, emerging needs, workflow suitability, knowledge access, team motivation, existing frameworks, and an engaged team.
• Challenges identified were ICD-11 complexity, customization needs, lack of top management support, steep vendor learning curves, inadequate documentation, outdated infrastructure, data duplication/validity issues, workforce limitations, impact on work processes, funding constraints, and technical expertise gaps.

Conclusions:

• Nationwide adoption of ICD-11 involves critical coding, technical, and policy aspects.
• Addressing identified facilitators and challenges is essential for successful implementation in diverse healthcare systems.
• Future research should focus on user perspectives and the adaptability of implementation strategies in varied settings.