Somebody had to say it, and leave it to our outspoken colleague, Dr. Art Epstein, to note in his editorial this week what a bureaucratic nightmare the ICD-10 is going to be. Here’s what Art has to say:
“ICD-10 is a little more than a month away. I hope the powers that be will forgive me, but I can’t muster any excitement about it. To the contrary, I am dreading it. Dreading ICD-10, not just for me, but for you and for our patients. Now, don’t paint me a “techno anarchist conspiracy theorist contrarian-geek.” I do get it. I understand greater specificity and more detail can facilitate inter-professional interaction and has the power to improve care. However, I am enough of a realist to understand that won’t happen.
I made the mistake of actually looking at ICD-10. In some areas, it seems to have been based upon reasonable clinical input and reflects current medical thinking; in other areas it seems outdated by at least a decade. Dry eye, for example, is a disaster area. Whoever drafted that section appears to have been locked in a room without access to the Internet nor seen a patient since the Mets last won the World Series.
I know ICD-10 will find its greatest use, at least at first, for rejecting insurance claims and making charting painful. It’s not as if our love affair with EHR hasn’t been rocky enough already, this will add yet another layer of meaningless and unnecessary complexity. It will force us to turn our backs to our patients even more, typing away, praying for drop-down lists that actually list helpful things. Sadly, it will waste the precious moments of patient face time that once defined quality healthcare. In its place, meaningful use—yet another bureaucratic cluster—will steal more time, add more meaningless complexity, fuel greater doctor/patient distrust and, in the end, accomplish little to help anyone.
As doctors we are bound by the tenet of first, do no harm. What a shame that the bureaucrats and administrators, the insurance companies and the other middlemen who have managed to wedge their way in between the doctor and their patient aren’t bound by the same principle. ICD-10. My diagnosis? More pain.”