“To change at this point, given that we are a year and a few months away from the magical transition date, would be, I submit, vastly more disruptive than just staying the course at this point,” Chute explains, hastening to add that he is not a proponent of ICD-10, but that “ICD-11 is not ready for prime time.”

Not yet, but 2015 is where the forthcoming new ICD-10 compliance deadline and ICD-11 might just intersect.

Should the U.S. delay the ICD-10 compliance deadline just one year, until 2014, then the WHO will have a beta of ICD-11 ready. And if Sisko’s gut is correct, and the new ICD-10 deadline flows into 2015, well, then a final version of ICD-11 will be fast-approaching.

When it arrives, currently slated for 2015 (but Chute said it could be 2016), the underlying structure of ICD-11 will be profoundly different than any anterior ICD.

[See also: ICD-10's Ten-year reign of fear.]

“ICD-11 will be significantly more sophisticated, both from a computer science perspective and from a medical content and description perspective,” Chute explains. “Each rubric in ICD-11 will have a fairly rich information space and metadata around it. It will have an English language definition, it will have logical linkages with attributes to SNOMED, it will have applicable genomic information and underpinnings linked to HUGO, human genome standard representations.”

ICD-10, as a point of contrast, provides a title, a string, a number, inclusion terms and an index. No definitions. No linkages because it was created before the Internet, let alone the semantic web. No rich information space.

Has anyone even considered ICD-11?
Perhaps the most problematic reality the nascent ICD-11 faces today is that because the U.S. government mandated ICD-10 before anything was known about ICD-11, it ostensibly appears that the people thinking about ICD-11 are limited to the WHO’s ICD-11 Revision Steering Committee.

As Blue and Co.’s Grider tells it, most of her hospital clients are trying to kickstart the ICD-10 implementation and not even looking ahead to subsequent coding changes.

And who can blame them? Even the AMA, in all its vehement opposition to ICD-10, would not touch the subject of ICD-11 when asked. “AMA policy does not address ICD-11,” a spokesperson says. “The AMA would not be in a position to comment on ICD-11 until we work with others on a required assessment.”

The AMA, just like all payers, providers, vendors, everyone else in healthcare today, has more than ICD-10 to contend with.

“I guess my question is: Has HHS looked at ICD-11?” Grider wonders. “I am just guessing but I would say no. With healthcare reform, meaningful use and now ICD-10 everybody is spread very thin. And I can see that when I go into the hospitals, into the medical practices to help them with the ICD-10 transition and see their condition. Everybody is trying to continue business as usual while doing this and that’s been a real challenge. And I know the government is spread thin with all the regulations and everything they’re trying to do, so I wonder if they’re even thinking about it.”

Perhaps all are but no one has publicly championed ICD-11 as an ICD-10 alternative. Not even Chute of the WHO ICD-11 Revision Steering Committee. But this week’s announcement that ICD-10 will be pushed back again holds at least a nugget of potential that the horizon is broadening to include two ICD options, if not simultaneously, than certainly in rapid succession.

Now that the industry has more time for ICD-10, perhaps it would be wisely-used considering the more modern, more useful ICD-11, either instead of ICD-10 or at the very least to plan two steps ahead.

Because that old saying about the dictionary – that its essentially obsolete by the time it gets printed – just might apply to ICD-10 as well.