If we don't have ICD-10 coding, then the guinea fowl win

Last week I was working out John Halamka's observations about the impact of ICD-10 coding in a changing healthcare industry.

I approached it as a thought exercise not a debate.

I have a lot of admiration for Halamka's work and ideas. As proof of his thoughtful approach, I noted he doesn't make any flaming water ski jokes.

Then I find this quote in an interview with Halamka about the state of healthcare IT:

“Oh God. ICD-10. I need to come up with a new interface to allow you to code guinea fowl injury.”

Really? Guinea fowl?

I guess I should give him points for not using turtles. Enough points I'm not going to go into the merits of counting guinea fowl injuries. Actually, that would just make me look ridiculous.

And I understand the frustration behind that comment and the rest of his complaints. (It's called context, and we too often forget it exists.) Complying with federal mandates (HIPAA, ICD-10, Meaningful Use, ACA) can suck the time and energy out of an idealistic CIO.

And somewhere in the back of my mind, I seem to remember Halamka complaining that if the ICD-10 transition goes smoothly no one will notice. They will only notice if something goes wrong.

Yeah, that sucks.

But I have trouble imagining how ICD-9 coding will make it suck less. Of course he won't have to devote the resources to the transition. That would give him a certain amount of time to innovate and design personal health records that are uncorrupted by guinea fowl diagnoses.

Or maybe come up with a new interface to allow physicians to code youth sports injuries. Because there's an interesting question about how much concussion danger kids face while they play football. And soccer. Or is there a more dangerous youth sport? Maybe some external cause codes will help us figure that out.

I'm sure there are ways to do that without ICD-10 implementation. That's the benefit of working with antiquated systems. They make you figure out how to work around them to implement new ideas.

But then we end up cursing ICD-9 coding because we have to divert resources working around its limitations. And the guinea fowl rein of terror on suburbanites will go unnoticed because we won't have specific enough diagnoses in our electronic health records.