King Charles, Struck by Orca, and the ICD

King_Charles_II_(Lely) Many, many thanks to FB friend Caroline Meikle, an alert SLIS grad and veteran of my Health Information Systems class, for sharing the news about Struck by Orca with me. It’s a volume of artworks illustrating the International Classification of Diseases, v. 10 – ICD-10 for short. How can a classification system have illustrations, you ask? Read on.

You have all encountered the ICD system if you live in a country that is part of the World Health Organization, or WHO, and have gone anywhere near a health-related process which needed to be counted by someone – whether or not the service cost you any money. Because the ICD is a product of the World Health Organization, it is not a commercial product and requires no licensing. For this reason, health information systems vendors used to brag that they built it into your system for free. To this, informed medical informatics professionals responded: “Big whoop.”

On your doctor or hospital bill in the US, if you are unfortunate enough to be admitted to the hospital with the plague, your ICD-10 code probably looks like this:

A20.9 Plague unspecified

“Unspecified”, which was “NOS” in ICD-9, is an all-purpose means of denoting “a concept for which a code does not yet exist.” In the example given above, this code would be used for a case of plague that was recognized as a more specific type –the specific types recognized by the system have codes:

A20.0 Bubonic plague
A20.2 Pneumonic plague

All classification systems must have a “park it here for now until we have something better” space. Why? Because knowledge is constantly evolving faster than shared language can express. However, these spaces must be raided regularly to develop new codes, or else the classification system will become encased in concrete and will be unusable. Hence the paradox of controlled vocabularies: Always a bit behind reality; constantly under revision.

For some years, my informal method of assessing classification codes in health information systems was to do a search for Astrocytoma. This is a specific type of brain neoplasm (=cancer). Until ICD version 10, the closest available term for this diagnosis was Miscellaneous Brain Neoplasm: NOS. Not very helpful if you are looking for astrocytomas! The cheaper systems vendors didn’t bother to build in other vocabularies, and stopped at ICD-9, because it was free; so the absence of an astrocytoma code was a negative sign for the health of the information system.

WHO nations use the ICD to produce disease statistics. This has been going on for centuries [See here for a good pocket history; initially, because the country’s leaders needed to be informed about the health (or not) of the nation. (The origin of “statistics”, of course, is “the state.”) John Graunt, an English haberdasher (1620-1674) is important to epidemiology and public health because he is the father of the mortality table: he tried to create a system showing deaths from the Bubonic Plague. For this work, King Charles II made him a member of the Royal Society, although according to Wikipedia this did not prevent him from dying in poverty because he chose to convert to Catholicism at the wrong historical moment. You can see excerpts from John Graunt’s work here; it must be an authoritative source because the site maintainer labels it “the official John Graunt Site of the 1996 Olympic Games.”

Later on, nations began to compare themselves to each other by using statistics. This effort was systematized by French statistician Jacques Bertillon (whose younger brother Alphonse invented the criminological use of fingerprints – what interesting conversations they must have had over dinner). Over time, through and despite world wars, these statistics assumed standard formats and grew into the ICD we know today and its family of context-aware modifications — such as the ICD-CM, used for billing in places like physician’s offices, which knows about diagnoses as well as causes of death. ICD-10 was finished in 1992. It is considerably more complex in the ~25 WHO countries that use it for reimbursement purposes; 110 WHO countries use it for purely statistical purposes. For this reason, the United States of America has been moving at an absolutely glacial pace (ICD-10 launched here in October 2013) while in parts of Europe ICD 11 is in beta.

Because the causes of human disaster are infinitely varied, there are some really, really odd codes. Among them:

• R46.1. Bizarre personal appearance
• Z62.891. Sibling rivalry
• X52. Prolonged stay in weightless environment
• V96.00XS. Unspecified balloon accident injuring occupant, sequela

And my personal favorite:

Y92.253. Opera house as the place of occurrence of the external cause

According to the publisher’s website, Struck By Orca is a book of “more than 60 pages, illustrating dozens of artists’ visual interpretations of their favorite ICD-10 codes. Artists include healthcare professionals, entrepreneurs, and professional artists.” I always like it when the artists include artists—this gives me a feeling of confidence. But it is much more important that the artists include healthcare professionals, who really understand the subject matter almost as well as their patients do. Look at the unhealthy art yourself at:

Portrait credit: Peter Lely [Public domain], via Wikimedia Commons.

Author: cat

Associate professor at the University of Wisconsin-Madison

3 thoughts on “King Charles, Struck by Orca, and the ICD”

  1. I love this post. I’d marry it if I weren’t already engaged to Travalon. These bizarre codes are the best! The artists’ bios are worth reading too; one of them “Lives, paints, and eats doughnuts in Brooklyn.”

  2. It’s a shame you don’t have a donate button! I’d definitely donate to this brilliant blog!
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