Tuesday, October 11, 2011

Latest call for ICD-10 switch repeats the myths

Dr. Wendy Wittington, Chief Medical Information Office for Dallas-based Anthelio Healthcare Solutions, repeats several ICD-10 myths in her advocacy for the ICD-10 switch:

Myth #1: "...the switch is truly necessary"

We don't have to switch to ICD-10-CM. As we previously discussed here, there is an alternative approach, that is superior to ICD-10-CM.

Myth #2: ICD-10 is more modern

ICD-10 is still based on the same, antiquated, classification architecture as ICD-9-CM (see here, here, here, here, and here). So although it may reflect how medicine has evolved, it does not reflect informatics best practices. ICD-10-CM's underlying information architecture remains in the 1970s with ICD-9-CM medical terminology. The government is developing ICD-10-CM using a word processor!

Myth #3: ICD-10-CM will accurately translate what physicians do to payers.

Doctors don't recognize 318 kinds of diabetes mellitus (see here and here). Doctors don't use the terms "not otherwise specified" and "not elsewhere classified". Doctors don't speak in classifications, they speak in medical terminology. Doctors don't combine multiple patient characteristics into new diagnoses.

Myth #4: ICD-10-CM is necessary for evidence based medicine and comparative-effectiveness research.

As long as it's a classification and not a nomenclature, it will not be sufficient.

Myth #5: Silly codes do not get in the way.

See here for what a "silly code" is. They increase the cost, difficulty, and complexity of switching. Only necessary codes should be present. They will also inflate the number of search results a physician must process in an electronic medical record when looking for codes. For example, a search for "diabetes mellitus" will return 318 results!

Myth #6: Other countries have switched, therefore we're an embarrasment

Following the pack is not always a wise strategy. For many reasons listed on this blog, switching to something other than ICD-10-CM would be leading, not following. And certainly not embarrassing.

Myth #7: "...a lot of hospitals and healthcare providers have ignored it or put it on the backburner because they are too busy with meaningful use requirements"

Whoops! That one's not a myth. Meeting meaningful use requirements is probably a better expenditure of resources, and hospitals and physicians know it and appear to be acting accordingly.

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