While it is impossible to predict the actual future of coding, we can make some speculations based on the past and knowing what is likely to happen in the future in terms of technology development. Regardless of the evolution of classification of clinical data, it is clear, that the need for this data – and more of it – is likely to increase. We have become an information driven society. As such, the ability to turn diseases, symptoms, treatments (in the form of procedures), exposures and causes into data that can be analyzed in aggregate is attractive to many – including providers, the government, researchers, pharmaceutical companies, insurance companies, vendors to the health care industry, employers and consumers of health care. This list covers just about everyone.
Although the demand for the work product of a coder is likely to increase, the methodology used by the coder is likely to evolve into a more efficient process – one that is rich in technology as well as intellectual capital. After all, would the coder of 1960 have ever imagined that her beloved coding book would be replaced by a computerized encoder? Not likely. The important point to make here is that the coder as the manager of the process of coding did not disappear when the coding book gave way to the encoder. Rather, the coder needed to develop an entirely new set of skills focused on computer technology. In the future, it is likely that technology will play an ever increasing role in documentation and coding and classification systems. The savvy coder will begin today to develop the skills that will be needed for tomorrow. This is an exciting time for everyone involved in the Coding Profession – we have the ability not only to learn new cutting edge skills, but also to contribute to the future. The coder of the future will be classified as one of the many "knowledge workers" that will dominate the workforce in developed countries. In his recent book, Management Challenges for the 21st Century, Peter F. Drucker discusses six major factors that will affect the knowledge worker. They are:
- Knowledge worker productivity demands that we ask the question: "What's the task?"
- It demands that we impose the responsibility for their productivity on the individual knowledge workers themselves. Knowledge workers have to manage themselves. They have to have autonomy.
- Continuing innovation has to be part of the work, the task and the responsibility of knowledge workers.
- Knowledge work requires continuous learning on the part of the knowledge worker, but equally continuous teaching on the part of the knowledge worker.
- Productivity of the knowledge worker is not – at least not primarily – a matter of the quantity of output. Quality is at least as important.
- Finally, knowledge-worker productivity requires that the knowledge worker is both seen and treated as an "asset" rather than a "cost". It requires that knowledge workers want to work for the organization in preference to all other opportunities." Drucker, Peter F., Management Challenges for the 21st Century, Harper Business Publications, 1999.
If we look at the characteristics that will dominate the knowledge workers in the 21st century as detailed above by Peter Drucker, they all appear to apply, at least to some degree, to the profession of the coder. More importantly, if each of these characteristics were in place in the workplaces of coders today, their tasks would be much more efficient. Most importantly, coders need to be able to have autonomy and the ability to manage themselves. Continuous learning and continuous teaching is clearly part of the Coding Profession and will continue to be into the next century.
The future of coding will most likely require skills in the following areas:
- Standardized Nomenclature
- Internet
- Disease Process/Clinical Knowledge
- Data analysis
As noted under the history of coding section, there is a difference between classification systems and nomenclatures. There are many who believe that nomenclatures will play an increasingly important part in the classification of diseases in the future. One of the undeniable advantages to use of a standardized nomenclature system is that it will allow for a smoother conversion of the actual assignment of codes to diagnoses and procedures. This would result in physicians carrying a bigger responsibility for knowledge of the nomenclature so that their spoken or typed communications can be translated into coded format through technology. Given our current and historical issues with physician documentation, the "evolution" that would need to occur in physician compliance with the standardized nomenclature is monumental, at best. Assuming that the evolution does occur, the coding profession will evolve as well to one that will require increased physician communication, more intense analysis of physician documentation and the ability to appropriately re-categorize coded data assignments when they have been made in error. One of the most common systems currently being reviewed by many parties in the US as a candidate for the US Standardized Nomenclature System is the Systematized Nomenclature of Medicine (SNOMED). This system was originally published by the American College of Pathologists in 1977. It is the most comprehensive nomenclature in the health care field. The system has seven axes that look at topography, morphology, etiology and function of the disease as well as procedures performed and occupation of the patient. The intensity of this system allows for identification of the patient’s signs, symptoms, problems, and disease components as well as the ability to translate the final diagnosis into a disease classification for statistical reporting. For more information on SNOMED, visit the website at www.snomed.org.
The ability to be able to access data in a real time manner becomes increasingly important into the future. This is particularly true as advances are made in medicine and we can use the internet to access other providers as well as publicly accessible data bases. Coders should be able to access and link into this information to ensure that their data is high quality and benchmarked against national and peer norms.
It is likely that physicians will provide initially coded information based on the documentation they are providing in the computerized medical record. It is also likely that the information provided by the physician is likely to be wrought with the same kinds of issues we currently see in documentation. Physicians are unlikely to ever think in terms of standardized nomenclature – unless we gain the ability to pre-program their brains. As a result, the coder of the future will need to be able to truly understand the disease process and be able to apply it to the Standardized Nomenclature system they are using. And, as medicine becomes more complex and the number and types of diseases increases, coders will need to keep abreast of all of these concerns.
Because technology will increase the intensity of the coder’s work product, it is likely that coders will be responsible for some level of data analysis. With this said, coders should have knowledge of basic descriptive statistics, be able to manipulate data within and among data bases, and identify trends or aberrations from the norm.
