From coding to the core of the profession

There's been a running dialogue on the Listserv of the Association of Medical Directors of Information Systems of Information Systems since last week when CMS acting Administrator Marilyn Tavenner disclosed that the federal government was getting cold feet about its Oct. 1, 2013 deadline for the federally mandated nationwide implementation of ICD-10.

Part of the discussion among the physician informaticists centered on whether the move to what is formally called the International Classification of Diseases 10th Revision family of diagnostic and procedural code should be scrapped entirely. One school of physician thought is to wait until ICD-11 is released in 2015 or so and be among the first adopters of that rather than the last in the world to implement ICD-10. Meanwhile, physicians and other providers could adopt the Systematized Nomenclature of Medicine-Clinical Terms, or SNOMED-CT, code system to provide more granular data descriptions than possible with the ICD-9 codes in current use.

Dr. William Bria, a pulmonologist, chief medical information office for the Tampa, Fla.,-based Shriners Hospitals for Children, and board chairman of AMDIS, posted what I thought was an insightful response in the thread. With Dr. Bria's permission, I thought I'd share it with you.

“I'm not sure a taxonomy (ICD-10—SNOMED—whatever) is our problem in American healthcare,” Bria wrote. “It's that there has been a fundamental loss of focus at the core of our profession, care of our fellow man.

“That loss of focus has a million excuses: 1. Out of control cost of care. 2. Superspecialization and loss of the core physician-patient relationship. 3. Over-enthusiastic application of technologies (and I'm not just talking about the EHR here). And last but not least: 4. The overshadowing of medicine by the business of medicine.

“That last one is why ICD-anything is a `bridge too far' for so many these days. Our strength, mission and profession always came from the same place, our fellow man. If Medicine (big M), doesn't wake up soon and reconnect, we will reap the whirlwind. Everyone on this listserv knows what we stand for looks like when it's working the right way. We have to make sure we stay engaged in the national discussion lest our patients AND our profession…suffer.”

Watch Bria discuss meaningful use and other hot topics in a video interview with Modern Healthcare in Las Vegas at the Healthcare Information and Management Systems Society's annual conference.