ICD-10-CM and Windows ME: A Switching Analogy

Much of the lack of resistance to the switch to ICD-10-CM is based on the presumption that since it is the next "version", it simply must be better. Proponents deride the arguments against the switch as being analogous to the question "MS-DOS works fine, why Windows?"

However, a better operating-system analogy would be "Windows 98 works fine, why Windows ME?"

As those who upgraded to Windows ME can attest, the upgrade was a complete disaster. PC World rated Windows ME as the fourth worst tech product of all time.

Analogously, ICD-10-CM is the last upgrade for the archaic, "statistical classification" architecture of terminologies. ICD-11 will use modern approaches to terminology.

In this sense ICD-10-CM is very much like Windows ME, in that Windows ME was the last MS-DOS based Microsoft OS before Microsoft converted its home OS to the newer, Windows NT architecture.

How ironic.

As naysayers against ICD-10-CM, we are saying that we should skip ICD-10-CM, which is the Windows ME of disease classification. It is the proponents of ICD-10-CM who are arguing for the perpetuation of ancient technology, not the naysayers.

ICD-10-CM and Word Processing

We noted in one of our first posts that the National Center for Health Statistics releases ICD-10-CM as a 23 MB portable document format document (click here to view it). And we noted that ICD-10-CM therefore fails to meet a fundamental requirement for a modern diagnosis coding system, namely that we can use it in our computer systems directly (which would require at the very least some machine-processable text file such as comma-separated value or tab-delimited text, instead of a file format meant for humans to read or print).

We have learned that in fact, the NCHS uses a word processor to create and maintain ICD-10-CM. The following quote is from a presentation that Dr. Chris Chute gave as part of a seminar series of the National Center for Biomedical Ontology:

...the American 10 clinical modification will migrate to the tools that we're using to build ICD-11, benefiting from a better environment. They're using a word processor now...kind of pathetic actually...

We agree, that is pathetic. To hear it yourself, go to a point approximately 32 minutes into the presentation and listen from there.

So, if modern tools exist now for creation and ongoing maintenance of the next version of ICD, why is NCHS still using a word processor?

Dr. Chute does go on to say that NCHS will migrate to these tools and ICD-10-CM will "evolve to become identical to ICD-11". But not until after 2015, when ICD-11 is finalized.

So, for the next 7 years at least, NCHS will continue to maintain ICD-10-CM with a word processor, and release it as a giant text blob from which one cannot automatically and reliably extract the set of codes it contains for use in a database or spreadsheet.

Thus, we have additional evidence that ICD-10-CM is based on archaic practices and technology. And $11 billion or more to upgrade to something archaic is a waste of money.