ICD-10 Delay: An Opportunity To Change Course

to use a different code set every so often. Or even to use a code set at all, if it's tied purely to illnesses and diagnoses, separate from several tied to procedures, and separate again from the ones tied to supplies. We can't immediately abandon fee-for-service medicine with its dependence on diagnosis code sets, but could we at least take some of that ICD-10 effort and repurpose it to better ends?

Many organizations have put off critical upgrades or new projects to make sure ICD-10 was survivable. Those organizations have a reprieve. If the IT strategic plan was crimped and crumpled to fit the ICD-10 timelines, consider straightening out some of the wrinkles. If one of the things that was put off was the IT strategic plan itself, now is an excellent time to create one. Either way, we all now have an excellent object lesson encouraging us to add risk management around last-minute regulatory changes.

Some of the ICD-10 effort, of course, is noble and reasonable in its own right. After all, better documentation, and in particular better communication, is a critical part of improving medicine. So let's look at the documentation-improvement efforts spawned by ICD-10, and abandon or de-emphasize the parts that are purely tied to coding. Focus on what's best for the patient and the physician, and supercharge those parts.

We know we don't get the right answers from our machines. Rather than hoping that a new coding system will miraculously solve this problem (spoiler alert: it won't), let's bring providers and IT together and do the hard work needed to ask questions that the database can answer, even as we improve the way we gather and refine data. We don't need ICD-10 for that. We already have a dozen terminologies, including SNOMED (which captures diseases and conditions, as well as a lot else), that we may want to use, but most of the problems we really need to solve soon have a lot more to do with answering simple questions than complicated code-based data mining.

Disease classifications are important in medicine. Diagnosis of disease is critical. But Osler said it best: "The good physician treats the disease. The great physician treats the patient who has the disease."

Whether we ultimately implement ICD-10 or any other diagnosis code set, we need to be sure that our best efforts are focused not at the disease, and certainly not at payment for the disease, but at the patient. To the extent that we can make ICD-10 a healthy part of that, it will be welcomed. But if ICD-10 is going to be just another ill-fitting part in a badly designed machine, we're better off without it.

Has meeting regulatory requirements gone from high priority to the only priority for healthcare IT? Read Health IT Priorities: No Breathing Room, an InformationWeek Healthcare digital issue.