I have heard of it. The problem in the isn’t an unwieldy kitchen-sink international coding standard, it’s no standard at all on the national or state or industry level. The inefficiencies caused by this situation alone in the health insurance industry have given rise to whole sector of middle-men, rent-seekers and opportunistic parasites, all of who are eager to tell us scare stories about “death panels” and proclaim self-fulfilling prophecies about government never being able to do anything right (never mind that they also starve the same government of funding).
What I think will happen is that one of the sane and wealthy states that hasn’t completely drunk the neoliberal Kool-Aid (probably California) will tell the for-profit insurers and private hospitals “look, if you want to do business in our state you have to all use the same coding standard.” What standard will be imposed by law I’m not sure. Maybe it’s the variant of ICD-10 used by Medicare and Medicaid or the one used by the VA, or maybe it’s a variant of a variant after all the stakeholders and implementers and other experts look into it, but once it’s put in place in a state like CA where the large insurers can’t just ragequit the market then other sane and wealthy states will follow, and then the entire nation.
As someone who developed a (much smaller) schema for a (much smaller) industry years ago and was able to get adaptation of variants from key companies, I understand it’s far from a smooth and easy process and it will be far from the perfect solution that Libertarians always seem to demand when the problem is one that benefits them, but it can be done with far less drama than, say, ACA. It just takes political will, and I suspect that the Dem leadership of CA and NY will start seeing this as an opportunity rather than a burden.
[* apologies to right-wingers for the use of profanity]
This is why the blockchain style solution for EMR shows promise, and why Estonia is using KSI to introduce resiliency and security and flexibility into their version of medical records (amongst others). In making the commitment they’ve also made the commitment to address some of the other issues you raise like connectivity, devices and power-points for non-battery-powered ones are ubiquitous. There’s also a concerted effort to make everyone computer-savvy enough to do the basics.
More importantly, as a government they’ve also made it a clear policy that the EMR records are owned by the patient, who has the final authority to allow his record or a portion thereof to be pushed or pulled or viewed by another party or grant permission for an agent to do it. That’s where the system wouldn’t work in the current broken U.S. one, because the sociopathic AIs that are in charge of the sector here (for-profit health insurance corporations) are obsessed with owning everything to benefit their shareholders.
ICD-10 is already used as a standard in the USA. National, State, and industry level. https://www.cms.gov/Medicare/Coding/ICD10
“The ICD-10 transition is a mandate that applies to all parties covered by HIPAA, not just providers who bill Medicare or Medicaid.”
Blockchain also has nothing to do with any of this. Blockchain is for verifying data integrity for a growing set of records. It is only needed when independent verification is needed back to the very first record to insure the records have not been tampered with. It works on top of a records system. You need an agreed records system to apply it to.
And finally, it’s not the insurance companies that own the records in the USA. It’s the doctors and hospitals. But HIPAA mandates that patients must be provided copies on request.
There are problems with our system. But it would help if you understood how it actually works before proclaiming the source of the problems.
As a diagnostic code for the practitioner, not a billing code (those would be CPT or HCPCS, also mandated). I should have been clearer that the coding standard to which I was referring (since we’re discussing health insurance and not health care) is the billing one. Additionally, I should have been clear that my preference is a system where ICD-10 is fully harmonised with HCPCS (the Medicare/Medicaid standard) into one code so that diagnostic and clinical outcomes can properly take precedence over financial ones.
In the case of any of those standards, though, the HIPAA mandate only dictates how data (e.g. a claim) is transmitted securely and privately and not its format or contents. This leaves private insurers with a lot of wiggle room and leaves the various middle-men and rent-seekers in business.
It does in that it addresses some of the underlying security and reliability and accountability infrastructure issues @ringsundereyes brought up, along with the issue of access permissions related to data ownership. Looked at one way it’s a technological tool for implementing some of the privacy goals of programmes like HIPAA. Estonia doesn’t use the KSI blockchain tech with its EMR records just for kicks; from the article linked above:
Popular anxiety tends to focus on data security—who can see my information?—but bits of personal information are rarely truly compromising. The larger threat is data integrity: whether what looks secure has been changed. (It doesn’t really matter who knows what your blood type is, but if someone switches it in a confidential record your next trip to the emergency room could be lethal.)
I didn’t know that the insurance companies didn’t store or keep track of the billing aspect of medical records in their own databases (including claim codes for the procedures). Or perhaps you meant that medical billing records are not part of a patient’s medical record. Either way, fascinating.
My point above stands, which is that the entire medical record should belong to the patient first and foremost. When that doesn’t happen, you get unfortunate situations like the one described by @LurkingGrue above and information asymmetries and delays that lead to a lot of destructive outcomes.
That’s the understatement of the year when it comes to the only system in the civilised world that still doesn’t have a foundation of single-payer universal coverage and which still priorities corporate profits over health outcomes. Mandated standards and supporting technology aren’t a panacea, but as I described above they’re an effective wedge that helps open the door to a single-payer system.
Thanks for the response. I dont think we’re that far apart on much. Except for the following:
I think it’s the other way around and will take a single payer to force a coherent records system. I suspect that if such a records system were already in place, it would further delay changing to single payer by reducing the benefit.
