Hey Herman, you ever think about how much invisible infrastructure is supporting us every time we interact with a modern system? I mean, we talk about the internet or the power grid, but there is this whole other layer of data that basically translates our physical reality into something a computer can understand. It is like we are living in a world of objects, but the machines are living in a world of labels.
Oh, absolutely. Herman Poppleberry here, and I have to say, that is a rabbit hole I have spent far too many late nights exploring. It is one of those things where the more you look at it, the more you realize that the world is essentially held together by spreadsheets and classification systems that most people never even hear about. We like to think of medicine as this very human, hands-on art, but behind every stethoscope is a database waiting to be fed.
Well, today’s prompt from Daniel is right in that wheelhouse. He wants to dig into medical coding. Specifically, he is curious about how standardized these systems really are. If you show up at a hospital in Sao Paulo with an asthma attack, and then a year later you are in an emergency room here in Jerusalem for the same thing, is there a universal language that describes what happened to you?
That is a fantastic question because it touches on the tension between the global nature of science and the very local, fragmented nature of healthcare systems. And the answer is a classic "yes and no" situation. On one hand, we have some of the most sophisticated international standards in existence. On the other hand, the way those standards are actually used can vary wildly depending on who is paying the bill and what country you are in. It is February of twenty twenty-six, and while we have made massive strides in the last five years, the "Tower of Babel" problem in medical data is still very much a reality.
Let’s start with the big one. If I have asthma, there has to be a code for that, right? I have heard of the I-C-D codes. Is that the gold standard?
It really is. The International Classification of Diseases, or I-C-D, is the backbone of global health data. It is managed by the World Health Organization, or W-H-O. As of right now, in early twenty twenty-six, we are largely through the massive global transition from I-C-D ten to I-C-D eleven. But to answer Daniel’s question directly, yes, if you have an acute asthma exacerbation, there is a specific code for that in the I-C-D system. In the older I-C-D ten, you were looking at the J-forty-five category. In I-C-D eleven, which is the current international standard, it has been refined even further.
So J-forty-five would be recognized in Brazil and in Israel?
Exactly. The core of the I-C-D is designed to be a universal language for mortality and morbidity. It started way back in the late nineteenth century, believe it or not. It was originally called the International List of Causes of Death, often attributed to Jacques Bertillon. The idea was that if we want to understand how people are dying around the world, we need to make sure we are all calling a heart attack a heart attack. If Brazil calls it "cardiac failure" and Israel calls it "myocardial infarction," the global statistics are useless.
That makes sense for tracking pandemics or global health trends. If the W-H-O wants to know if asthma rates are rising globally, they need everyone to use the same label. But Daniel also asked about how this fits into the broader picture of electronic medical records and whether it is truly interconnected. If the code is the same, does the data actually move?
That is where the friction starts. You see, the I-C-D was designed for statistics and epidemiology. It was not originally designed for the day-to-day clinical management of a patient or for the incredibly complex world of insurance billing. So, while the "what" of your diagnosis might be standardized, the "how" of your treatment is where things get messy. In Sao Paulo, you might be treated under the S-U-S, the Sistema Unico de Saude, which is Brazil's massive unified health system. They use I-C-D codes for reporting, but their internal billing and resource allocation might look very different from a private hospital in Jerusalem or one of the Israeli health maintenance organizations like Clalit or Maccabi.
Right, because a hospital in Sao Paulo might use the I-C-D code for asthma, but they might have a completely different way of coding the actual nebulizer treatment they gave you, or the specific type of steroid shot you received.
Precisely. And this is where we have to talk about "Clinical Modifications." In the United States, for example, they have their own special version called I-C-D-ten-C-M. It is basically the international code on steroids. They took the base codes and added tens of thousands of sub-categories to satisfy the demands of the American insurance industry. So, while a doctor in Jerusalem might just see "asthma," an American coder might be looking for a code that specifies if it is exercise-induced, or if it is a chronic obstructive pulmonary disease overlap, and whether it was an initial encounter or a follow-up. We are talking about a jump from about fourteen thousand codes in the base I-C-D to over seventy thousand in the U-S version.
It is like everyone is speaking the same root language, but some people are using a very technical dialect that includes details about the color of the patient's shoes.
That is actually a pretty good way to put it. And it creates this massive burden for medical coders. This is a huge profession that people don't often think about. These are professionals who spend their entire day reading through a doctor's notes and translating those human sentences into these alphanumeric codes. If the doctor writes "patient was wheezing and unresponsive to inhaler," the coder has to decide which specific code in the ten-thousand-plus options best represents that clinical reality. By twenty twenty-six, a lot of this is being assisted by A-I, but the complexity remains.
I imagine that is where a lot of the errors creep in. If it is that complex, how can we ever expect two different systems to talk to each other perfectly?
Well, that brings us to the second part of Daniel’s prompt about drugs and active ingredients. He pointed out that while trade names like Ventolin might change, the active ingredient, like Salbutamol or Albuterol, is the same. You would think that would be the easy part to standardize, right? Chemistry doesn't care about borders.
You would think so. A molecule is a molecule whether you are in the Amazon or the Galilee.
You would be surprised. There is a system called the Anatomical Therapeutic Chemical Classification System, or A-T-C. It is also managed by a W-H-O collaborating center in Oslo. It classifies drugs based on the organ or system they act on and their chemical, pharmacological, and therapeutic properties. It is a beautiful, five-level hierarchical system. For example, Salbutamol has the A-T-C code R-zero-three-A-C-zero-two. The "R" stands for Respiratory system, "zero-three" for drugs for obstructive airway diseases, and so on.
So if the A-T-C code is universal, why is there still a problem?
Because of "identifiers." Think of it like a bar code. Every country has its own regulatory agency that assigns specific identification numbers to the drugs sold in that country. In the United States, you have the National Drug Code, or N-D-C. In Brazil, you have the A-N-V-I-S-A registration numbers. In Israel, the Ministry of Health has its own registry. So, even if the "A-T-C" code for the active ingredient is the same, the actual digital "object" representing that box of medicine in the hospital's computer is often local.
So if the computer in Sao Paulo is looking for a specific Brazilian drug I-D, and the record arrives from Jerusalem with an Israeli drug I-D, the computer might just throw up its hands and say, "I don't know what this is."
Exactly. It is like trying to use a European power plug in an American outlet without an adapter. The electricity is the same, but the interface doesn't match. This is the big challenge for electronic medical records, or E-M-Rs. We have these massive silos of data. This is why a new international standard called I-D-M-P, or Identification of Medicinal Products, is so important. It is a set of five I-S-O standards that are finally being implemented globally to create a truly unique, global identifier for every drug product. But we are still in the middle of that rollout.
So, is there an "adapter" being built? I have heard about things like S-N-O-M-E-D. Does that help?
Now you are talking my language. S-N-O-M-E-D C-T, which stands for Systematized Nomenclature of Medicine Clinical Terms, is basically the most comprehensive, multilingual clinical terminology in the world. If I-C-D is the table of contents for a book of diseases, S-N-O-M-E-D is the entire dictionary of every medical concept imaginable. It covers everything from symptoms to anatomy to social context. It has over three hundred and fifty thousand active concepts.
That sounds like it would solve the problem. Why isn't that just the universal standard everyone uses for everything?
Because it is incredibly dense and complex. S-N-O-M-E-D is a "polyhierarchy," meaning one concept can have multiple "parents." For example, "Pneumonia" is a type of "Infectious disease" but also a type of "Lung disease." Implementing it is a massive technical and financial undertaking. Most hospitals are still struggling to get their basic systems to talk to each other, let alone implementing a system that is as complex as a human brain. However, many countries, including Israel and Brazil, have adopted S-N-O-M-E-D as their national standard for clinical terminology, even if the billing still happens in I-C-D.
It seems like we are in this weird middle ground where the science is global, but the administration is intensely local. It reminds me of the early days of the internet when different networks couldn't talk to each other before T-C-P-I-P became the standard.
That is a perfect analogy, Corn. We are currently in the "post-standardization but pre-interoperability" era. There is a new standard that has really taken over in the last few years called F-H-I-R, which stands for Fast Healthcare Interoperability Resources. It is pronounced like "fire." It is designed to be the modern "web-like" way for health systems to exchange data. Instead of sending a giant, messy P-D-F of your medical history, it breaks the data down into small, standardized "resources" like "Patient," "Observation," and "Medication."
So, if F-H-I-R becomes the norm, the system in Jerusalem could just "request" the "Medication" resource from the system in Sao Paulo, and they would both know exactly what language they are speaking?
That is the goal. In fact, by twenty twenty-six, many international health exchanges are using F-H-I-R to power what we call the International Patient Summary, or I-P-S. The I-P-S is a standardized set of health data—allergies, medications, problems—that is designed to be shared across borders. If you have an I-P-S compatible app on your phone, that doctor in Jerusalem can scan a code and instantly see your asthma history from Sao Paulo, translated into the local terminology.
That feels like a huge win for the patient. But Daniel also asked about whether these systems vary based on specific populations. Are there codes that only exist in certain parts of the world?
Oh, definitely. This is one of the most interesting parts of I-C-D eleven. They significantly expanded the sections for "traditional medicine." This was a big move to include traditional Chinese medicine, for example, into the global statistical framework. It allows researchers to track the use and outcomes of these treatments alongside Western medicine. There are also codes for specific conditions that are endemic to certain regions. A clinic in the Amazon is going to be using a lot of codes for tropical parasitic diseases that a clinic in rural Norway might never touch.
It sounds like the "medical coder" is almost like a translator or a diplomat between the messy reality of a human body and the rigid logic of a database.
I love that. A diplomat for data. And it is a high-stakes job. If a coder gets the code wrong, the hospital doesn't get paid, or worse, the patient's record becomes a mess of misinformation. There is actually a famous list of "weird" I-C-D ten codes that people like to laugh at, which were designed to capture every possible injury for safety statistics. Things like "V-ninety-one point zero-seven-X-A," which is "Burn due to water-skis on fire, initial encounter."
Wait, that is a real code?
It is a real code. There is also "W-sixty-one point six-two-X-A," which is "Struck by a duck, initial encounter." And my personal favorite, "Z-sixty-three point one," which is "Problems in relationship with in-laws."
I mean, I guess if it happens, you need a code for it. But it does feel a bit like they are trying to account for every possible permutation of human misfortune.
They are. Because if you want to do high-level safety research, you need to know exactly how people are getting hurt. If a thousand people are getting struck by ducks every year, maybe we need a public awareness campaign about aggressive waterfowl. You can't know that if everyone just codes it as "animal encounter." The granularity is what allows for the insight.
But back to Daniel’s example. If I am the patient, and I am sitting in that E-R in Jerusalem, and I tell the doctor I was treated for asthma in Sao Paulo, what is the best-case scenario for my data right now in twenty twenty-six?
Right now, the best-case scenario is that you are using an International Patient Summary-compatible digital health wallet. Most modern smartphones now have this built-in. When you were treated in Sao Paulo, that hospital—if it is part of the global interoperability network—would have pushed a "summary" to your device. That summary contains the A-T-C codes for your meds and the S-N-O-M-E-D codes for your diagnosis. When you get to Jerusalem, you authorize the E-R to "pull" that summary. The doctor’s screen then populates with your history, already translated into Hebrew or English.
That feels like the future we were promised. But how common is that actually?
We are at about forty to fifty percent global adoption for that level of seamlessness in major urban centers. If you are in a rural area or a country with less digital infrastructure, you are still back to the "old ways"—carrying a paper printout or trying to remember the name of the inhaler you used. This is why we always talk about personal preparedness. You cannot rely on the "system" to be perfectly interconnected yet.
That brings us to the practical takeaways. If I am a listener and I want to be prepared, like we talked about in our triage and preparedness episodes, what should I be doing? If I can't rely on the "standardized, globalized, international system" to work perfectly, how do I bridge that gap?
This is where you become your own data diplomat. First, always know your "active ingredients." Don't just say you take "Ventolin." Say you take "Salbutamol." That is the universal language. If you have a chronic condition, keep a list of the I-C-D codes for your primary diagnoses. You can usually find these on your discharge papers or billing statements. If you show a doctor "J-forty-five point nine," they will know exactly what you mean, regardless of what language they speak.
That is a great tip. It is like having a medical passport. Instead of trying to describe your symptoms in a foreign language, you just point to the universal code.
Exactly. And the same goes for lab results. There is another standard called L-O-I-N-C, which stands for Logical Observation Identifiers Names and Codes. It is the universal language for lab tests. If you have your blood sugar or cholesterol results, they will have a L-O-I-N-C code. For example, a common glucose test is L-O-I-N-C code twenty-three-thirty-nine-dash-zero. If you have that, any doctor in the world can interpret the results without worrying about whether the units or the naming conventions are different.
It’s interesting that we have all these amazing tools—I-C-D, S-N-O-M-E-D, A-T-C, L-O-I-N-C—but the missing piece is the "glue" that holds them all together and makes them accessible to the patient and the provider in real-time.
The glue is what we are building right now with F-H-I-R and the push for "Open A-P-Is" in healthcare. In the United States, the twenty-first Century Cures Act really kicked this off, and other countries have followed suit. It basically mandates that hospitals must give patients access to their own data in a machine-readable format. This is huge. It means you can use an app of your choice to pull your data from the hospital's "silo" and carry it with you.
That feels like the real "aha moment." The standardization isn't just for the bureaucrats and the insurance companies; it is the key to patient empowerment. If the data is standardized, it becomes portable. And if it is portable, it becomes much more useful.
Exactly. Imagine a world where you land in Sao Paulo, you get a notification on your phone that says, "Hey, we see you are near a hospital and we have your emergency medical profile ready to share if you need it." The phone could translate your Israeli records into the local Brazilian standards on the fly because the underlying codes are the same. We are very close to this being the standard of care globally.
We are getting there, but it sounds like we are still in that messy transition phase. It makes me think about the role of artificial intelligence in all of this. Surely A-I is the ultimate "medical coder" now?
Oh, by twenty twenty-six, A-I has completely transformed the back office of medicine. We have "Ambient Scribing" now, where an A-I listens to the conversation between the doctor and the patient and automatically generates the notes and the codes. It is much faster than a human, and it can cross-reference those seventy thousand sub-categories in milliseconds. But—and this is a big but—it still needs a human in the loop for the "weird" stuff.
I can't imagine an A-I trying to figure out if someone was "Struck by a duck" versus "Struck by a goose" without some context.
You hit the nail on the head. The nuance of human experience is hard to code. If a patient says they feel "heavy-hearted," does that mean they are depressed, or are they literally feeling chest pressure from a cardiac event? An A-I might struggle with that metaphor, but a human doctor and a skilled coder understand the context. We are seeing a new role emerge: the "Clinical Data Auditor," who oversees the A-I to make sure the "translation" from human life to computer code is accurate.
This really brings us back to the idea that medical coding is this bridge between the subjective experience of being a patient and the objective need for data. It is a fascinating, hidden world.
It really is. And to Daniel’s point about drugs, the I-D-M-P standard I mentioned is the final frontier. It is a massive project involving regulators from the U-S, the E-U, Japan, and beyond. They are trying to create a single, global I-D for every single drug product on earth. It is a Herculean effort because of the sheer number of generic manufacturers and different formulations. But the payoff is huge. If we had a global drug I-D, we could track drug shortages in real-time. We could identify counterfeit medications much more easily. And most importantly, we could prevent those "lost in translation" errors in the emergency room.
It’s like we are building a digital version of the Library of Alexandria for human health. Every disease, every treatment, every drug, all cataloged and cross-referenced.
That is a beautiful image, Corn. And just like the original library, the challenge is making sure everyone has access to it and can understand it. We have the alphabet—those are the standards like I-C-D—but we are still writing the grammar rules for how the whole system talks to itself. The good news is that the grammar is getting better every day.
It makes me wonder about the future of this podcast, too. We are using these prompts to explore the world. In a way, we are doing our own kind of "coding"—taking these big, complex ideas and trying to categorize them and make them understandable for our listeners.
Guilty as charged. We are the coders of "My Weird Prompts." And speaking of the show, I think we have covered a lot of ground today. We went from the nineteenth-century list of deaths to the future of A-I-driven interoperability and the International Patient Summary.
We did. And I think the big takeaway for me is that while the system isn't perfectly "interconnected" yet, the "standardization" is much further along than I realized. The language exists; we just need the "glue" of better apps and international agreements to make it work for the person sitting in the E-R.
Exactly. The foundation is there. Now we just need to build the house. And for the individual, the message is clear: own your data. Don't just be a passenger in the healthcare system; be the keeper of your own codes.
Well, I think that is a good place to wrap this one up. It has been a fascinating look into the "invisible ink" of the medical world.
It really has. I am going to go double-check my own I-C-D codes now, just in case I have any "problems with in-laws" that need documenting.
Good idea. And hey, to our listeners, if you have found this deep dive into the guts of healthcare data interesting, we would really appreciate it if you could leave us a review on your favorite podcast app. Whether it is Spotify, Apple Podcasts, or wherever you are listening, those reviews really do help other curious minds find the show.
They really do. It is the best way to help us grow and keep answering these fantastic prompts from people like Daniel.
And remember, you can find all our past episodes, including those ones on triage and preparedness we mentioned, at my-weird-prompts-dot-com. We have an R-S-S feed there for subscribers and a contact form if you want to send us your own thoughts or questions. You can also reach us directly at show-at-my-weird-prompts-dot-com.
We love hearing from you. Truly. Every prompt is a new rabbit hole for us to explore.
This has been "My Weird Prompts." I'm Corn.
And I'm Herman Poppleberry.
Thanks for joining us in the library of data today. We will talk to you next time.
Goodbye, everyone! Stay safe and keep your codes handy!
