Clinical Coding
A Brief History
John Gaunt
In the PDF by the World Health organisation it states how the first statistical study of disease began in the 17th Century with the work of John Graunt on the London Bills of Mortality. The paper goes on to state that "The kind of classification envisaged by this pioneer is exemplified by his attempt to estimate the proportion of liveborn children who died before reaching the age of six years, no records of age at death being available. He took all deaths classed as thrush, convulsions, rickets, teeth and worms, abortives, chrysomes, infants, livergrown, and overlaid and added to them half the deaths classed as smallpox, swinepox, measles, and worms without convulsions. Despite the crudity of this classification his estimate of a 36 % mortality before the age of six years appears from later evidence to have been a good one. While three centuries have contributed something to the scientific accuracy of disease classification, there are many who doubt the usefulness of attempts to compile statistics of disease, or even causes of death, because of the difficulties of classification. "
Florence Nightingale
The first real Clinical Coding was performed by the great hero of Nursing World Wide Florence Nightingale. In the PDF by the World Health Organisation it states that "Clinical Coding was introduced by Florence Nightingale (1855) during the Crimea War (1853 – 1855) (Bull 1992). Although the Russians were defeated at the battle of the Alma River (20 September 1854), the Times newspaper criticized the British medical facilities. Sidney Herbert, the British Secretary for War asked Florence Nightingale a mathematician to become nursing administrator and oversee the introduction of nurses to military hospitals. Nightingale at the end of the war was able to show positive outcomes from quality of care. When Nightingale arrived at Scutari medical barracks in 1854 she was appalled by the unhygienic conditions and high mortality rates amongst injured and ill soldiers. Soldiers were seven times more likely to die from diseases such as typhus and cholera in the hospital than to die on the battlefield. Nightingale’s knowledge of mathematics and statistics were evident as she collected data enabling her to calculate mortality rates. By February 1855 mortality rates had dropped from 60% to 42.7% due to an improvement in hygiene. By spring that rate had dramatically decreased to 2.2% through the provision of fresh water, the purchase of fresh fruit, vegetables and standard hospital equipment."
