EDITOR’S NOTE: The following article by Mandy Willis, originally published in the June 17, 2014 edition of the ICD10monitor eNews, is reprinted as the U.S. ramps up its response to the Ebola crisis here and in West Africa.
Along with being a perpetual optimist, I’m also an information junkie, and love when I read an article that provides me an example of why information, especially health information, is so critical to our health, both individually and globally. So, as I read a recent article in Scientific American™ my heart leapt at the opportunity to connect it to ICD-10.
The article, “Antibiotic Resistance Is Now Rife Across the Globe” (Dina Fine Maron, Scientific American, a division of Nature America, Inc., April 30, 2014), led with the following passage:
“A first-ever World Health Organization assessment of the growing problem calls for rapid changes to avoid the misery and deaths of a potential ‘post-antibiotic era’.”
As a coder, and ICD-10 expert and advocate, my brain automatically began to try to understand this from a coding perspective. I immediately recalled the familiar position that ICD-10 codes are good for epidemiology, but won’t improve patient care or health. Surely, this has to be an example of how ICD-10 can provide crucial information for epidemiology studies and at the same time improve patient care and ultimately patient health.
The gist of the article is this: The World Health Organization, pulling information from 114 countries, has concluded in a first global report that antibiotic-resistant bacteria and other pathogens “have now emerged in every part of the world and threaten to roll back a century of medical advances.” The buzzwords to remember are “World Health Organization,” “information,” “114 countries,” “first global report,” and “antibiotic-resistant bacteria.”
Let’s first consider that the World Health Organization, or WHO, owns the International Classification of Diseases or ICD and currently supports and publishes the tenth revision or edition. Within the tenth revision, ICD-10, are diagnosis codes for bacteria and pathogens as well as antibiotic resistance. The conclusion, therefore, is that the WHO intended to gather information from those 114 countries on the prevalence of antibiotic-resistant bacteria for their first global report on an emerging trend and provides a vehicle for sharing that information for participating countries.
Now, let’s consider that we, the United States, a country that uses broad spectrum antibiotics to treat infection, are the last country still using the ninth revision of the International Classification of Diseases. Our diagnostic information is not in the same classification system as the other 113 countries the WHO is monitoring for antibiotic-resistant bacteria. From an information-sharing standpoint, we are out of sync with the rest of the world and have been for at least 10 years. For something as crucial as a dangerous emergence of antibiotic-resistant bacteria across the globe, we should at least be speaking the same language.
Some may stop the conversation here, and say that indeed it is important for epidemiology studies to transition to ICD-10 and there are no issues with this.
But here is the rub: The main vehicle for gathering diagnostic information within our system is with diagnosis codes through such processes as healthcare claims, public health reporting, or registries. In order to speak the same language as the rest of the world, we have to transition our entire system, and not just a piece of it. This translates into viewing the process of transitioning to ICD-10 as beneficial to patient care and, ultimately, patient health.
Can we see the correlations between identifying such issues as antibiotic resistance and patient care? Take, for example, that increased antibiotic resistance means less effective antibiotics available to treat common infections such as gonorrhea and Klebsiella pneumoniae. The WHO warns that infected patients will require more extensive care and longer hospital stays and will die in greater numbers.
The availability of this information provides us with a picture of where we are today and helps us determine what steps to take in the future to improve patient care and the overall health of the population. The information gathered by the WHO allows them to provide guidelines for identifying appropriate diagnostic testing and treatment protocols that reduce the risk of exacerbating the problem.
The fact is that the world is changing. Things that we once could hang our hats on, like ICD-9 or broad-spectrum antibiotics, are no longer efficient and have become a risk to our health and our healthcare system. Compartmentalizing the benefits of ICD-10 as something good for one area of the healthcare sector (i.e. epidemiology) without recognizing the benefits for the providers and users of healthcare is preventing the implementation and optimization of criteria, policies, and processes that will address issues like antibiotic resistance in the years to come. In the end, nothing in healthcare is static.
There is a continuous need to identify and respond to threats to population health. One of the best tools we have in our toolbox is information. Our information requires a significant upgrade to communicate on the world’s stage.
ICD-10 is that upgrade… for now.
About the Author
Mandy Willis is a Certified Coding Specialist and AHIMA Approved ICD-10 Trainer with 15 years of experience in the healthcare industry. She has worked in the small physician practice environment, commercial and public payers. She is also co-chair of the Workgroup for Electronic Data Interchange (WEDI) ICD-10 Coding and Translation Subworkgroup. Currently, her focus is on assisting all sectors of the healthcare industry in making the transition to ICD-10.
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