If the collaborative wiki process works for compiling an encyclopedia, couldn't the same approach work for classifying all the diseases and injuries that afflict humankind? The World Health Organization thinks it can.

It is embarking on one of its periodic updates of a system of medical coding called the International Classification of Diseases, or ICD, and it wants the world's help doing it.

While work on previous versions has been the domain of hand-picked experts, this time the Geneva-based global health agency is throwing open its portal to anyone who wants to weigh in on the revision.

"When I think of the ICD … it's been largely controlled by a very small group of people," said Dean Giustini, biomedical branch librarian at the University of British Columbia.

"The updates have not always been responsive to changes within the practice of medicine. So I think: What better way to make it responsive than to put some of the technology to good use and make people at the grassroots able to go in and make changes?"

Giustini is an associate editor of Canada's newly launched online open-access medical journal, Open Medicine. He's also a proponent of the democratization of the internet, the Web 2.0 movement that the Wikipedia embodies.

So he's supportive of the WHO decision to open up the ICD revision process to all comers willing to register, back their suggestions with evidence from medical literature and participate in online debate over proposed changes.

Specific codes

If you are not a health-care professional, hospital administrator, health insurance executive or medical researcher, you've probably never heard of the ICD, even though the classification system has been around in one form or another since the 19th century.

The current version is ICD-10; this process will produce ICD-11.

Every disease, ailment and health-related mishap has a code. And those codes are highly specific, with 27 possible codes for frostbite depending on what part of the body is affected and how badly, for example.

While it all may seem like so much medical minutiae, the fact that these codes are universally used allows everyone, everywhere who is involved in the delivery, funding, planning or research of health care to count the same things more or less the same way.

"The International Classification of Diseases puts diseases in categories, in small drawers, to be able to group them and count them and then to use this information to, for example, make decisions in public health like vaccination programs," explained Dr. Robert Jakob, the WHO medical officer responsible for the ICD.

Changes in medical care and in the scientific understanding of different diseases demand that the ICD be tweaked from time to time. So does the emergence of new diseases; after the spring of 2003, a code for SARS — U04 — had to be added.

But occasionally there is a need for a major overhaul, like this one. It's typically a process that takes between four and eight years, with many consultations and multiple drafts by experts representing different medical specialities who met in person. 

Blog for proposed changes

The new, more open approach to updating the disease classifications won't be entirely wiki-esque. That process, with its anyone-can-edit approach, builds a degree of vulnerability into the end product, with some contributors deliberately planting false information for the fun of it.

With the ICD, people can propose changes and argue for them on a WHO-sponsored blog. But groups of subject matter experts will weigh and synthesize the suggestions, Jakob said.

Giustini suspects the ICD rewrite won't be a major draw for internet pranksters.

The WHO is running its platform in English, but partners may host the program in official UN languages and other tongues to facilitate greater participation.

The steering group is aiming to have an initial draft ready for field testing by the end of 2008. Jakob said the final version should be ready by 2010 or 2011.