Iris Institute

Iris is an automatic system for coding multiple causes of death and for the selection of the underlying cause of death. It can be used in batch or interactively. The aim of Iris is twofold:

1. To provide a system in which the language-dependent aspects are separated from the software itself. Moreover, the language-dependent parts are stored in database tables and can easily be modified.
2. To improve international comparability. Iris is based on the international death certificate form provided by WHO in Volume 2 of ICD-10 and the causes of death are coded according to the ICD-10 rules. Updates to ICD-10 are included according to the WHO-timelines.

Through version 4 the Iris software uses components of the Mortality Medical Data System (MMDS) of the U.S. National Center for Health Statistics (NCHS).

Since version 5 the Iris software uses the Multicausal and Unicausal Selection Engine (MUSE). MUSE operates based on internationally agreed decision tables which are based on the most recent version of ICD-10.

Iris can be used in two modes. In the code entry mode, the user enters ICD-10 codes corresponding to the conditions reported on the death certificates. Iris then selects the underlying cause. In this mode Iris is ready for use as soon as it is installed. In the text entry mode, the user enters the causes of death in free text, as they are reported on the death certificate. For text entry coding, you need a dictionary that translates text into ICD-10 codes. The advantage of including a dictionary is that once a decision has been made on which ICD-10 code to use for a specific diagnostic expression, the expression will be coded in the same way each time it occurs on a death certificate. Iris also provides means for language standardisation, which very much reduces the size of the dictionary. Note that an example of dictionary in English is provided with the international Iris version.

France, Germany, Hungary, Italy, USA, England and Wales collaborate as the Core Group in the development of Iris. Sweden was involved in for more than twenty years in the development of Iris and was part of the Core Group until the end of 2016. Statistics Netherlands (Netherlands) intend to join the Core Group and hold a candidate membership since 2017.

Please note: Iris uses ICD-10 codes and titles of WHO. It is not allowed to extract the ICD-10 codes and titles from Iris and duplicate and distribute them separately. All rights of the ICD-10 are at the WHO. If you would like to use the ICD-10 separately from Iris please contact the WHO for the conclusion of a license agreement. An online form is available at

The use of Iris has started in many countries. Countries that have acquired some knowledge in the use of Iris can help other countries to start their implementation process as well. Therefore we ask the users of Iris to share some information on their status of implementation. In the table you will find information about the Iris users that these have shared with us. This table doesn't have any claim of completeness and up-to-dateness.

You will find a questionnaire as a pdf file at the link below. We would like to ask you to fill in this form and would like to know if you agree to the publication of the information on your Country in the table above. If there are any updates in the future, please forward them to the Iris Institute. Thank you for your assistance.

Iris is maintained by the Iris Core Group in the realm of the Iris Institute. The maintenance supported by the member countries of the Iris Core Group can only be limited and restricted to the basic updates necessary and will not cover the implementation in other countries.

In order to give users the opportunity to contribute to the maintenance and update of the Iris system and thereby guarantee the long term availability of the Iris software a support model was put in place. Contributing to the Iris development by agreeing to support Iris will give you two advantages:

• Support Iris: You will help to guarantee availability and up-to-date software that is adapted to ICD updates and software evolvements.
• Receive support: Additional benefits for your country as listed below will help you to implement Iris in your country.

All financial support received by the Iris Institute will be used to maintain, update and further evolve the Iris software.

Are you interested in supporting Iris? There are two levels of support:

For more information about the support model and application for support, please contact the Iris Institute.