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Commentary

ICD-10 Delay: Politics Trump Health Data Quality

With a fresh delay for ICD-10 compliance, US healthcare providers and patients remain trapped in debate. Is higher quality clinical data worth the cost of more detailed data collection?

The bottom line is that, after decades, here in the US we're still trapped in the same debate. Is higher quality clinical data worth the extra cost of the more detailed data collection required to obtain it? If ICD-10 is causing such a problem, what about SNOMED-CT, a far more complex system -- 370,000 codes and 1.3 million relationships among those codes -- that many advocate for the medical record notes of the future?

In a famous March 2011 blog post titled "The Rise and Fall of HL7," Barry Smith, Julian Park Distinguished Professor of Philosophy and professor of neurology and computer science at the University at Buffalo, and an experienced researcher in biomedical ontologies, said, "Complicated standards can be pushed for a while but ultimately markets reject them. Even governments will ultimately reject complicated standards, through a democratic correction process."

Is that what we're seeing now? Is ICD-10 too complicated to be accepted here in the US? That is a difficult argument to make because virtually every other major advanced country -- and many not so advanced -- is already using ICD-10 and it is now available in 42 languages. In fact, ICD-11 is now just around the corner in 2017! Some here are even arguing that we wait for ICD-11 before making the change, an argument I suspect is more of a delaying tactic than anything else.

A more accurate description of the problem is that our complex healthcare system continues, as it always has, to resist changes because the financial incentives of providers, payers, and increasingly patients are in conflict. Quality data costs more but offers substantial potential benefits. Our problem remains that the costs and the benefits aren't fairly apportioned. With the accountable care organization initiatives promoted under the Affordable Care Act, maybe that will start to change. Until it does, I fear we'll remain stuck in this quagmire.

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