Cultural Transformation of the International Statistical Classification of Diseases and Related Health Problems' Guidelines Needed to Effectively Measure Well-Being

A cultural transformation is underway at the Veterans Health Administration and other health care systems to address the well-being of the whole person and not just their disease states. A part of this evolution is to develop a measurement paradigm because the existing ones are generally disease-specific; however, the International Statistical Classification of Diseases and Related Health Problems (ICD)-10th Revision-Clinical Modification does include codes for social determinants of health (SDOH). The ICD coding system is an internationally recognized system to identify and classify diseases, injuries, health encounters, and inpatient procedures. Medical and social service providers, researchers, health information managers, public health and health care system professionals, policymakers, and coders use these codes to conduct surveillance, such as on the existence of diseases and their outcomes, health care utilization, and health care-associated adverse events, and for billing and claims reimbursement. The ICD coding system has been the backbone of health care systems' clinical documentation and coding practices on an international level since 1909. Clinical documentation and coding have an immense influence on what can be measured in medical records. The current ICD guidance needs to undergo a cultural transformation to have parity between codes for medical and nonmedical conditions, such as supporting the standard use of SDOH as primary diagnoses for outpatient encounters, expanding its list of SDOH codes, and incorporating a wellness perspective. Developing a measurement paradigm that assesses the well-being of the whole person must involve in tandem revising the ICD coding system to include this same perspective.