Software for the finest computer – The Mind


Posted by Tim Bryce on December 9, 2013


– Poorly designed systems, as dictated by the federal government, are strangling physicians.

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In the past, you have heard me talk about system snafus in Doctor offices, both systems and their inordinate dependence on fax machines. Suffice it to say, doctor offices are perhaps the most barbaric from an administrative point of view, not because they want to run this way, but because the federal government is forcing them to. Now, it appears it is going to go from bad to worse, thereby stretching their patience to the breaking point.

As I’ve written earlier, the government is forcing doctors to prepare extensive electronic records on their patients. This means doctors and nurses are spending more time performing data entry and less time caring for people. I might understand if the data is assembled according to standards, thereby providing the means to easily transfer it from one system to another. Unfortunately, it doesn’t which explains why doctors are so dependent on fax machines to transfer patient data, a horribly primitive approach in this day and age.

According to my doctor friends, more trouble is brewing. On October 1, 2014, all medical diagnosis coding will convert from ICD 9 to ICD 10 codes. The number of codes will increase from 17,000 to 141,000. The codes are supposed to be very specific so that disease processes can be narrowly described with one code number. Here are some examples:

W59.22 Struck by turtle
W59.22XA … initial encounter
W59.22XD … subsequent encounter
W59.22XS … sequela
W59.29 Other contact with turtle
W59.29XA … initial encounter
W59.29XD … subsequent encounter
W59.29XS … sequela

V96.01 Balloon crash injuring occupant
V96.01XA … initial encounter
V96.01XD … subsequent encounter
V96.01XS … sequela
V96.02 Forced landing of balloon injuring occupant
V96.02XA … initial encounter
V96.02XD … subsequent encounter
V96.02XS … sequela
V96.03 Balloon collision injuring occupant
V96.03XA … initial encounter
V96.03XD … subsequent encounter
V96.03XS … sequela
V96.04 Balloon fire injuring occupant
V96.04XA … initial encounter
V96.04XD … subsequent encounter
V96.04XS … sequela
V96.05 Balloon explosion injuring occupant
V96.05XA … initial encounter
V96.05XD … subsequent encounter
V96.05XS … sequela

V91.05 Burn due to canoe or kayak on fire
V91.05XA … initial encounter
V91.05XD … subsequent encounter
V91.05XS … sequela
V91.06 Burn due to (nonpowered) inflatable craft on fire
V91.06XA … initial encounter
V91.06XD … subsequent encounter
V91.06XS … sequela
V91.07 Burn due to water-skis on fire
V91.07XA … initial encounter
V91.07XD … subsequent encounter
V91.07XS … sequela
V91.08 Burn due to other unpowered watercraft on fire
V91.08XA … initial encounter
V91.08XD … subsequent encounter
V91.08XS … sequela
V91.09 Burn due to unspecified watercraft on fire
V91.09XA … initial encounter
V91.09XD … subsequent encounter
V91.09XS … sequela

Seems kind of silly doesn’t it?

For each injury or symptom, the physician will be required to enter one of these codes into the electronic patient records, from a list of 141,000. Hopefully, there will be some on-line help to point doctors in the right direction, but more likely they will have to reference a paper manual in order to look-up the proper entry.

In systems parlance, the code itself is referred to as a “group” data element, meaning it is a concatenation of data elements. We can find examples of “group” data elements in such things as a telephone number (area code-exchange-number), credit card numbers (financial institution-branchID-account-number), check numbers, power company numbers, and many more. It is simply a way to uniquely assign numbers in order to prevent redundancy.

In the example above, the code is probably decomposed accordingly:
First character (alphabetic) – Type of condition
Positions 2+3, Accidents/Conditions by general category
Position 4 – a decimal (presumably to delineate categories from treatment of conditions)
Positions 5+6 – Specific accident/condition
Positions 7+8 – Treatment

In other words, it’s a taxonomy for specifying a specific medical action. The government’s solution though is to force medical personnel to memorize these codes or look them up in a voluminous document or on-line help. A simpler way would be to provide a series of simple prompts to guide people through the taxonomy and assign the proper code.

One doctor friend claims he was told the new coding system will be very difficult to implement, such that insurance claims submitted will not likely be processed because of “computer glitches” in accepting the claims. Errors in uploading and downloading the encrypted codes are likely. So much so, the government is encouraging physicians to secure a six month line of credit to ensure their practices can remain open while the claims fiasco is corrected. He claims this is described by the government and mentioned on Medicare websites in many states.

I have dealt with a lot of information systems over the years, but I’m beginning to think we no longer know how to build them. Obamacare is as glaring an example as I can think of, this is another.

Currently, physicians are spending as much as 2-3 hours each day on meaningless computer work to satisfy government regulations. Time which does not improve the care of patients. Unfortunately, as of next October 1st, it will get worse and we’ll likely see many experienced doctors finally throw in the towel.

Keep the Faith!

Note: All trademarks both marked and unmarked belong to their respective companies.

Tim Bryce is a writer and the Managing Director of M&JB Investment Company (M&JB) of Palm Harbor, Florida and has over 30 years of experience in the management consulting field. He can be reached at

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Copyright © 2013 by Tim Bryce. All rights reserved.

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  1. Tim Bryce said

    A W.A. of the Dominican Republic wrote…

    “This is why 4 out of the six doctors that were involved with my back operation (5 lumbars July of 2009) told me that if the Health Act passed, they would definitely retire or go to one of the islands to practice. It included 2 neurosurgeons, 1 cardiologist, and one oncologist. All in the early to mid 50s, in their prime with great reputations. 2 told me they had already contacted the government in the Dominican Republic and one was already involved in setting up and construction of a new hospital in Punta Cana. The people that don’t believe Obamacare is a bad law will definitely find out when it takes them 3-6 months to see a specialist. Hopefully, Tim, you will not be one of them.”


  2. Tim Bryce said

    A J.S. of Skidway Lake, Michigan wrote…

    “Education for medical coders is very thorough. It is tedious work, but provides necessary information. V codes are a nuisance, but they provide specific information. In the 70’s & 80’s, coding was done for quality purposes. Later, when the US government implemented Diagnosis Related Groups – DRG’s – it became essential to reimbursement. Phasing in one change has always been difficult and time consuming, but implementing a whole new system in a short time is just not feasible. Nobody asked the health systems managers or other health care experts. Why bother us when politicians can do it all?”


  3. said

    If doctors rebel, the whole mess will unravel very quickly. I don’t think my provider (VA) will be affected but, I could be wrong.




  5. Tim Bryce said

    An M.T. in Cincinnati, Ohio wrote…

    “Tim, this is why we need medical personnel with computer experience who are up to date and familiar with the older systems. Last week a young billing assistant called and said we owed on two co pays to one of my doctors. This week I called back and spoke with a more experienced computer tech in medical billing and accounts. I was patient and waited while she looked up my file. She saw the co pays had been paid through my husband’s online banking account. She moved some information to “CASH” and we are now paid in full. I agree all those codes are not only silly but ridiculous. I have a doctors who spend their time taking care of my medical needs. In Cincinnati, Ohio, the computers are great for storing information about patients. In this manner, hospitals and doctor’s offices can communicate more efficiently about the important facts, like insurance codes, medications now taken, past visits with the doctor, etc. This saves time and energy and money. I am glad we have not needed Obamacare but I pity those who have to deal with this stupidity. Thanks for a good article, Tim.”


  6. Nice post but there is more problems in doctor offices.


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