Stop the fear mongering over ICD-10: It's just another taxonomy

 

Connecting state and local government leaders

The complaints about the upgrade to ICD-10 health care codes illustrate common misconceptions about the organization and characteristics of big data sets.

A recent Weekly Standard article shrilly announced that an  Oct. 1, 2014, update of ICD medical codes would augur “a nightmare for doctors.” This was not the only source predicting doom and gloom for the forthcoming code switch from ICD-9 to ICD-10 -- so I decided to investigate. 

It turns out many of these critics are falling victim to common misunderstandings about taxonomies and the characteristics and purposes of large, structured data sets. Here’s how.

ICD, or the International Classification of Diseases, is a taxonomy for diseases. As a  classification scheme it is no different than any other hierarchical or drill-down scheme where data items or nodes flow from parent to child (and where the child is more specialized than its parent). Examples abound, including the Dewey Decimal System for libraries, Amazon’s product catalog, Netflix movie categories and iTunes music genres. 

ICD-10 originated as an international standard with 12 top-level nodes that drill down to about four or five levels. Specifically, the ICD-10 codes consist of two parts:  ICD-10-CM for diagnosis coding and the ICD-10-PCS for inpatient procedure coding.  Basically, one taxonomy is for diseases and one is for procedures to treat diseases.

The headline of the Weekly Standard article is “Code Chaos,” which is a significant misnomer because a taxonomic structure is a well-proven, simple and effective information organization structure, Instead of chaos, it actually follows best practices for a code organization scheme.

There are  three main areas of confusion about the great ICD code switch:

Misunderstanding of magnitude. The chief issue that naysayers harp on is the increase in the number of codes. The Weekly Standard describes this difference as “vast,” from 17,000 codes in ICD-9 to 155,000 in ICD-10. 

The misunderstanding involves an incorrect assumption about complexity. An increase in the number of codes cannot be directly correlated to an increase in complexity, especially when the additions are made to a taxonomy or tree structure. Adding a new level to a tree always represents an exponential increase in the total number of nodes, but it may also mean that only one or two more new levels have been added to the tree.

When only the total number of new codes is emphasized, the implicit assumption is that some kind of linear search process is under way. But that is not true with taxonomies.  The drill down is much more efficient than that. In fact, this sub-dividing of a tree structure is why trees are so prevalent as tools in computer science; they neatly execute a “divide and conquer” strategy for organizing information. 

The total number of codes in ICD-10 should not be feared because they are divided into bite-sized groups within the taxonomy structure.  In fact, the taxonomy structure drastically reduces the organization and learning complexity even when the number of total codes grows exponentially.

Misunderstanding of outliers.  Many commenters poke fun at the level of detail in ICD-10 by citing a rare disease or procedure that is represented in ICD-10 that was not in ICD-9. Examples include an injury when water skiing or a bite from a venomous frog. 

While some of these codes may need to be refined or possibly removed, the critics misunderstand the utility of such fine-grained detail. The assumption is that since several outlier codes may never be used, one can conclude that a large percentage of codes at this level of granularity will not be used. 

Tom Coburn, the senator from Oklahoma who is also a doctor, is quoted as saying that 80 percent of the new codes won’t be used. I respectfully disagree. A more reasonable analysis is that the codes within each branch would follow a normal bell curve in terms of the rarity of their occurrence in the population.  Again, linear assumptions based on outliers are not accurate for a hierarchical structure.

Misunderstanding of purpose. While some critics understand the inherent benefits of specificity, many others incorrectly assert that ICD-10 is mere bureaucratic overreach, which belies a misunderstanding of the correlation between this type of information and successful big data analytics. 

Every business in the country is clamoring for improved business analytics and better decision making. The way you get that insight is by adding fidelity to your data management practices and data collection. High fidelity, granular data collection is the base of the pyramid, and predictive analytics is the top – you don’t get one without the other. 

As they said in the movie Fame, “Fame costs, and right here is where you start paying.” Well, I’ll rephrase that and say, “Analytics costs, and fidelity is how you start paying.”

ICD-10 is a major change that will require resources and training to implement, and its structure and codes will be refined as it evolves. But it is also just a set of taxonomies to categorize diseases and procedures and should not be overblown. 

Implementing ICD-10 is achievable by organizations of all sizes and will greatly improve the analysis of healthcare in the United States. Taxonomies are a proven metadata technique that is a best practice in information organization and discovery. In the case of ICD-10, the benefits really do outweigh the costs.

Michael C. Daconta (mdaconta@incadencecorp.com or @mdaconta) is the Vice President of Advanced Technology at InCadence Strategic Solutions and the former Metadata Program Manager for the Homeland Security Department. His new book is entitled, The Great Cloud Migration: Your Roadmap to Cloud Computing, Big Data and Linked Data.

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.