Brief History of Health Data Collection and Classification
Brief History of Health Data Collection and Classification
Although to us the collection of healthcare data may seem a new phenomenon, it has been with us since Hippocrates.(1) In the late third and fourth centuries BC he performed experiments and collected data to show that disease was a natural process which freed medicine from magic, superstition, and the supernatural. Using this data he systematically classified diseases based on similarity and contrast. This classification of disease put diagnosis and treatment on a much more scientific basis.
The next recorded instance of healthcare data occurred in the early 16th century when John Gaunt, using church records of burials created the London Bills of Mortality.(2) They were used to warn of bubonic plague. When burials reached a given level it was regarded as a warning that another Bubonic Plague epidemic was present. Gradually other items were added, for example baptisms from church records in 1570 and causes of death in 1629.
With the last addition, the London government became responsible for collecting the data.(2) However, due to a lack of standardized terminology and a situation in which the clerks doing the recording had no medical training, many peculiar or vague causes of death were recorded, among them Horsehoehead, Stoppage in the Stomach, Twisting of the Guts, Eaten by Lice, and Rising of the Lights. Other more tersely described causes include Overjoy, Purples, and Teeth. The data were published weekly and provided in London and other regions in England. In the 1700s the age at death was added to the London bills. (For those interested in seeing a London bill of mortality, high resolution images are freely available from the Wellcome Society in London at http://wellcomeimages.org/.)
In the 1700s, De Lacroix made the first recorded attempt to classify diseases systematically. Under the title Nosologia methodica he published a comprehensive treatise on the topic. (3) Another contemporary, Linnaeus published a treatise titled Genera morborum. In the begging of the 1800s the classification most in use was one by Cullen, which was published in 1785 under the title Synopsis nosologiae methodicae. Fortunately for the progress of preventative medicine, in 1837 William Farr, regarded as the first medical statistician, realized that the Cullen system, which treated all diseases “… as a manifestation of nervous reaction.” (4) was not satisfactory and advocated the adoption of a uniform classification system. (3)
The first International Statistical Congress in 1853, recognized the importance of such a system. At the second Congress two years later, William Farr and Marc d'Espine, of Geneva were tasked with preparing an internationally applicable, uniform classification of causes of death, which were presented at the Third International Statistical Congress in 1855. (2) William Farr created a list arranged under five groups: “epidemic diseases, constitutional (general) diseases, local diseases arranged according to anatomical site, developmental diseases, and diseases that are the direct result of violence.” (7th paragraph under Early History.) Marc d'Espine’s list classified diseases according to their nature, that is where they were gouty, herpetic (a viral disease that causes small, blister like vesicles on the skin or mucous membranes) , or haematic (relating to blood) etc. The Congress selected a compromise list of 139 entities. Revisions followed in 1874, 1880, and 1886. These lists gradually evolved into the International Classification of Death, presented by Bertillon at the International Statistical Institute in 1899 Included in this was the recommendations of the American Public Health Association for decennial revisions.
In 1900 at the First International Conference to revise the Bertillon Classification of Causes of Death in Paris in 1900, a parallel classification of diseases for use in statistics of sickness was adopted which became the International Classification of Disease (ICD-1). Interestingly, as early as 1855 William Farr had recognized this need and included in his report a general list of diseases that affect health as well as those that are fatal. Florence Nightingale, who was present at the Fourth International Statistical Congress held in London in 1860, urged the adoption of this disease classification in a paper titled Proposals for a uniform plan of hospital statistics. (3)
The ICD lists have been revised approximately every 10 years as new knowledge became available. Most of the world is now using ICD-10. ICD-10 was the first of these lists to include nursing concerns. The United States (US) is still using ICD-9. Changing to ICD-10 involves adding the ability for an extra digit in coding. The deadline in the US for adopting ICD-10 was supposed to be October 1, 2014, but on April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, which prohibited the Secretary from requiring adoption of ICD-10 prior to October 1, 2015. (5) Currently work is underway on ICD-11. The creators of these standards are mostly volunteers, hence work is slow.
For a very thorough history of the development of the ICD go to www.who.int/classifications/icd/en/HistoryOfICD.pdf . This interesting Web page helps one to realize the complexity creating standardized terminologies and gain an appreciation of the time that creating standardization and terminology involves. Given that medicine has been working on this problem since the 1500s, we should be proud of nursing who in a little over 40 years have created several different terminologies to classify nursing situations.
The ICDs since their inception have been focused on statistics. As such they are not in competition with SNOMED which is designed to capture clinically relevant data for patient care. 6
References
1. Greek Medicine. Hippocrates: father of medicine. 2007; http://www.greekmedicine.net/whos_who/Hippocrates.html . Accessed April 13, 2014.
2. Royal Society of Medicine. Bills of Mortality 2007; https://www.rsm.ac.uk/welcom/feature-billsofmortality.php . Accessed April 8, 2014.
3. World Health Organization. History of the development of the ICD. N.D.; www.who.int/classifications/icd/en/HistoryOfICD.pdf . Accessed April 8, 2014.
4. Wilson JL. Chapter V. Elias Samuel Cooper and 19th Century Medicine Medical Systems. Stanford University School of Medicine and the Predecessor Schools: An Historical Perspective 1998.
5. Centers for Medicare and Medicaid Services. ICD-10. 2014; http://cms.gov/Medicare/Coding/ICD10/index.html . Accessed July 1, 2014, 2014.
6. Bowman S. SNOMED, ICD-11 Not Feasible Alternatives to ICD-10-CM/PCS Implementation. 2014; http://journal.ahima.org/2014/06/12/snomed-icd-11-not-feasible-alternatives-to-icd-10-cmpcs-implementation/ . Accessed October 21, 2014.
Created October 21, 2014
