By now, everyone’s heard the jokes about the new International Classification of Diseases, the disease and health problem taxonomy standard managed by the World Health Organization. ICD is the latest in a series of efforts to classify diseases, starting in the 1850s. Originally called the International List of Causes of Death, the WHO assumed responsibility for the ICD when the organization was created in 1948. ICD version 10 (or ICD-10) is the newest code set. October 1 is the date on which ICD-10 compliance is required by the Centers for Medicare and Medicaid Services.
With 68,000 discrete diagnosis codes (as opposed to the previous 14,000), we are now able to define diagnoses at a very precise level of detail. Very, very, precise — such as “V97.33XD: Sucked into jet engine, subsequent encounter” or "Y92.146: Swimming-pool of prison as the place of occurrence of the external cause.” Yes, these are actual codes.
But, jokes aside, precise classification has its merits. It strengthens the storage and retrieval of diagnostic information for clinical, epidemiological and quality purposes. ICD descriptors also provide the basis for the compilation of national mortality and morbidity statistics. Kaiser Permanente has actively joined other health care providers in this massive project.
However, Kaiser health care practitioners during World War II were also trying to use precise descriptions to improve health, in a slightly different way.
In May, 1944, the 627-page dense tome Physical Demands and Capacities Analysis was published as a joint project of the Kaiser Foundation Hospitals and the Occupational Analysis and Manning Tables division of Region XII War Manpower Commission. The physician in charge of the study was Clifford Kuh, MD.
One of the primary goals of the Analysis was to make sure that individuals were assigned to jobs which they could perform without risk to their health. The study detailed 617 distinct job titles in the shipyards, from “Asbestos Worker, Cutter” to “Window Cleaner.” Although the Richmond shipyards did have the opportunity to use pre-placement physical examinations prior to hiring, the study provided the basis for accurate review of work-related health problems and suggestions for reassignment. During a short three-month survey period, only three workers had to leave their assigned job due to physical failure. During the four war years Kaiser’s yards employed almost 200,000 people.
An article in the Call Bulletin touted the survey, quoting William K. Hopkins, regional director of the United States War Manpower Commission:
“While the study has in mind the placement of all workers, the technique on which it is based will be invaluable in the post-war period — when tens of thousands of returning service men and women will have to be fitted into new jobs. I am particularly impressed with the study’s positive approach in emphasizing what a worker has the physical capacities to do, rather than the handicaps, often minor, which tend to prejudice his employment.”
Kaiser Permanente, building and using precise medical data for social benefit since 1944.