The Dreaded ICD10 Monster

The Phantom does not claim to be a computer wonk, but he was an early adapter and although he has eschewed the smart phone, he did develop his own version of an electronic medical record (EMR) before this became widely available and once he became a corporate employee, he learned the EMR and actually became almost fond of it, as you might become almost fond of the pit bull who your neighbor has chained to his porch, who growls at you every day and hungers for your vital organs as you walk past.

It is true the version he uses at work, called "Athena"-- improbably named after she who sprung fully formed from Zeus's brow and who kept the head god eternally  intimidated-- is something of a frustrating program. You can never accomplish a task with a single click on Athena.  Want to print? Yes. click. Want to print right now? Yes, click. Want to print on a printer? Yes, click. Want to print on paper? Yes, click. Want to print on white paper? Yes, click. Want to print on the paper sideways or vertically? Horizontally, thank you, click. So finally after about six clicks, it prints your note.

But now even Athena has been outdone by a new creature of uncertain provenance, a system for identifying diagnoses as you see your patients. Typically, for a medical doctor, the patient in front of him may have three or four, sometimes a dozen problems and now the powers that be, whoever they are, government, commercial insurers--it's not clear who has fathered the system called ICD 10--now they have taken diagnostic coding to heights of complexity beyond the merely absurd to the truly monumentally absurd.  

You have a diabetic, but that's not enough to say. Does he have neuropathy?  Does he have neuropathy in his feet? Which foot? Both feet? For how long? Is this recent neuropathy or chronic neuropathy? Does it cause pain or loss of sensation? Does it bother the patient or just his doctor? Does it keep him from sleeping? Does it require drug therapy? Which drug? How much? For how long? For how long do you anticipate this therapy will be necessary? Does his mother or wife object to the therapy or to the cost of therapy? Which one? Does the wife object in principle to all drug therapy?  Where does the patient store the bottle of pills? In his bathroom? In the cupboard over the sink? Which shelf? Is the cupboard painted or mirrored?

Doctors faced with this "coding" requirement have begun to ask: Who cares?  Does this come from the government or from commercial insurance companies?  To what use will all this specificity of information be put? Does an infection in the right ear get paid for differently than an infection in the left ear? 

It's actually entertaining, listening to the hired shills on the videos explaining these things with a straight face. Remember when Johnny Carson used to send the audience into howls of laughter by simply reading the income tax instructions slowly, carefully on air, from his desk, slowly going through each step?  ICD 10 has the IRS code outclassed by a light year.

I would love to see Stephen Colbert read the ICD 10 diagnostic coding instructions on air. 

When people complain about "regulation"  the Phantom immediately thinks they are just Tea Party Republicans. But maybe these complainers have a point.  

ICD 10 could make a Free Stater Let's-Live-Off-the-Grid out of any one.

Next time you visit your doctor and his eyes remained fastened on his computer screen rather than on your eyes or on your swollen, gouty, tophaceous toe, you'll know why: He's trying to get the wife of Zeus to tell the ICD10 monster which toe, whether it started hurting 1, 3, 6 or 12 hours ago, whether it has turned the toe red, blue, magenta or hot pink, and whether the nail over that toe has fungal disease, whether anyone in your family has ever had a similar toe experience, and whether you drank coffee before the toe started to hurt and whether the coffee was from Starbucks or Dunkin Donuts.   Once he has entered all that, he might be able to order some medication, if he's played the game right. But, under no circumstances will he have time to look you in the eye, or Heaven forbid, to look at your toe.