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Books, Journals, New Media
November 22/29, 2000

Medical Records: The Endangered Medical Record: Ensuring Its Integrity in the Age of Informatics

Author Affiliations

Harriet S.MeyerMD, Contributing EditorDavid H.MorseMS, Journal Review EditorRobertHoganMD, adviser for new media


Not Available

JAMA. 2000;284(20):2652. doi:10.1001/jama.284.20.2652-JBK1122-5-1

In The Endangered Medical Record the authors propose a solution to a significant problem facing health care: current coding systems such as the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), Medicare's diagnosis-related groups, and the Health Care Financing Administration's Common Procedure Coding System are a blight on the health care system in the United States.

The authors provide significant evidence that such coding systems fail on several levels. First, the systems were often not designed for the purposes to which they are being put. The ICD-9's primary purpose is the collection and reporting of international causes of morbidity and mortality. It does not even do that well, so it is no surprise that it is wholly inadequate for use in electronic medical records, clinical research, epidemiological research, and administrative tasks such as billing, reimbursement, and single-hospital statistics and trends. Second, these coding systems are really classifications, putting patient cases into broad categories. Once a code is assigned, significant clinical detail is lost and cannot be recovered without a return to the original, paper-based patient record—an expensive and time-consuming task. Third, these coding systems encourage distortion and hiding of the truth because of the manner in which they are used. Certain codes are "forbidden" by third party payers, thus they are avoided even if they would accurately describe what was wrong with the patient or what services were really provided to patients. Fourth, the rules are so complicated that even coding professionals do not consistently code patient cases. Both intracoder and intercoder variability is high.