Sue Walker: 30 Years With WHO-FIC

In early 1994, I was working in Queensland Health when I received a phone call from a colleague who told me about a position which had become vacant that she thought I might be interested in. The position was Director of the National Reference Centre for Classification in Health (NRCCH), which was a centre located at QUT but funded by the AIHW to support its work as the Australian WHO Collaborating Centre for the Classification of Diseases. The role was to work with WHO on morbidity and mortality coding issues. I was interviewed and got the job, commencing work on 11 July 1994. The NRCCH had been in existence for several years but its terms of reference were a bit unfocussed and, as the previous incumbent had already left to move to Sydney and I was the only staff member in Brisbane, my first task was to work out what the job entailed! Working with Dr John Donovan, the principal medical advisor at the AIHW, we started work to support classification and coding activities in Australia and overseas. AIHW had no mortality coding experience so one of my first jobs was contacting the Australian Bureau of Statistics and understanding how mortality coding worked because to that point, I had only ever coded in hospitals. At the time, Australian hospitals were using ICD-9-CM for morbidity purposes and the ABS was coding with ICD-9.

My first exposure to the WHO-FIC Network was in October of 1994 when I attended my first annual ‘heads of centres’ meeting held in Caracas, Venezuela. What a revelation! It was attended by about 25 people – we could all sit around one single boardroom table! It was the first time I had attended an international meeting and I not only meet HIMs from other countries, but others who worked in Ministries of Health and statistical agencies on coding issues. I was so new to the role that much of the discussions went completely over my head. However, there were early deliberations about replacing ICD-9 with a more contemporary classification, to be the 10th revision of the ICD, and development tasks were distributed. These included creation of the index and tabular list. Subsequent work was completed and shared by post – incredible to think what was achieved when electronic communications were not possible!

Since that first meeting, I have attended 90% of the annual October meetings. Each meeting is hosted by one of the Collaborating Centres and have been in Australia twice – Canberra (1995) and Brisbane (2002), Tokyo (three times), Copenhagen, Cardiff, Rio, Cologne, Reykjavik, Tunis, Trieste, Seoul (twice), Toronto, Cape Town, Brasilia, Beijing, Barcelona, Manchester, Mexico City and Banff. I missed meetings in Washington, New Delhi and Bonn but attended online during the COVID years in 2020-2022. The early meetings were single sessions that ran over a week (with a weekend in the middle). From discussing ICD-9 and the International Classification for Procedures in Medicine, we moved to development and implementation of ICD-10 and in more recently, progress on ICD-11.

In 1999, the concept of a ‘family’ of international classifications was initiated, consisting of three reference classifications – the International Classification of Diseases (ICD), the International Classification of Functioning, Disability and Health (ICF) and the International Classification of Health Interventions (ICHI) – and a series of derived and related classifications that capture information about different aspects of health. To manage the workplan for the development, translation and use of these classifications, WHO has supported the establishment of what are now 32 Collaborating Centres throughout the world, creating the WHO-FIC Network. As ICD-11 work has progressed, new collaborating centres have joined the family: WHO Collaborating Centres for Classifications, Terminologies, and Standards (WHO CTS CC), for Classifications Scientific Support (WHO CSS CC) and for Verbal Autopsy (WHO VA CC). The Network supports WHO in the development, maintenance, and use of a cohesive set of reference health classifications and related products that standardise the production and use of health information internationally. Participant numbers at the annual meetings have grown exponentially with several hundred classification experts now attending.

The work of the Network is carried out through committees which all meet at least once face to face annually in October but more regularly via electronic means:

Classification and Statistics Advisory Committee (CSAC)
Education and Implementation Committee (EIC)
Family Development Committee (FDC)
Informatics and Terminology Committee (ITC)
Medical and Scientific Advisory Committee (MSAC)

There are also five reference groups which provide advice in the specialised uses of the classifications:

Mortality Reference Group (MRG)
Morbidity Reference Group (MbRG)
Functioning and Disability Reference Group (FDRG)
Traditional Medicine Reference Group (TMRG)
Verbal Autopsy Reference Group (VARG)

I have been co-Chair and member of the Education and Implementation Committee and a long serving member of the Mortality Reference Group. I have made many friends around the world through my involvement.

My work over the years has primarily been in education. Since the first course I ran in early 1996, I have conducted 62 training courses, both in Australia and overseas. Supported by WHO, AusAID, other aid agencies and governments of various countries, these courses have focussed on morbidity and mortality coding with ICD-9, ICD-10, ICD-10-AM and ACHI; medical terminology; death certification and basic medical record practices.

Author:

Sue Walker Life member HIMAA, FHIMAA, CHIM

Senior lecturer, Bachelor of Health Information Management

Queensland University of Technology