Happy new year to one and all. I have had the honor to take an incredible journey over the past 15 years. You are about to begin an incredible journey as well; a journey the likes of which the acupuncture profession has never participated in, but which I feel will prove just as rewarding, if not more so, as my journey has been for me. It all began back in 2005, when I attended my first World Health Organization (WHO) meeting in Seoul, South Korea.
Standardization: Points & Terminology
The goal of the first technical advisory group established at that 2005 meeting was to reach a consensus decision on 361 acupuncture points. This was the beginning of standardization for the traditional medicine profession. There was much discussion that ultimately culminated in the publication of WHO Standard Acupuncture Point Locations in the Western Pacific Region in 2008. By standardizing point location, we took a giant step forward for our ancient medicine.
Shortly thereafter, a second advisory group produced a vocabulary list of 4,000 terms, with agreed-upon definitions supplied by China, Korea, Japan and others in the Pacific Rim, as well as the U.S. This book also was published in 2008.
TM Diagnostic Codes
The progress of these two technical advisory groups slowed in 2009, but in 2010 I was invited to Hong Kong by the leader of the international classifications to begin work on a set of diagnostic codes. The United States was asked to donate $300,000 to this process. With the help of the Council of Colleges of Acupuncture and Oriental Medicine, the National Certification Commission for Acupuncture and Oriental Medicine, the National Federation of Traditional Chinese Medicine Organizations, the American Acupuncture Council and numerous individual donors, we reached the goal in 2013 and gave the money to Stanford University. This helps build the technology platforms for traditional medicine's set of diagnostic codes.
Technology, whether in the clinic (electronic health records) or health care worldwide (data sharing, research, etc.), is essential to prove our medicine works the way we have always said it does. Private insurance, Medicare and integrative care opportunities will all rely on data.
After numerous meetings involving discussion of many different ideas, the traditional medicine ICD-11 diagnostic classification was completed and voted on by the WHO General Assembly in 2017. Countries around the world were excited about the inclusion of acupuncture in the International Classification of Disease codes. There are 408 traditional medicine codes in the ICD-11, which will be released in February 2021 for use / training in advance of the 2022 implementation date.
Using the Codes: A New Way of Thinking
Acupuncturists will be double coding. This means you will be coding both a Western ICD code and an Eastern traditional medicine code. Depending on how you currently evaluate and treat a patient, this may require you to change your clinical process to include all of the following:
This is an important opportunity to develop more communication with the patient and/or the patient's family by creating a goal. You should dedicate and schedule a separate time, after you've completed your assessment and gathered all your "data," to explain the diagnosis including pattern identification; and how you plan on treating it. The expected time frame to resolve the condition and number of visits required should also be noted.
Welcome to the Future
This is also an important opportunity to adopt technology. This is the first time the code sets have been formulated and structured with technology – another reason why it was so important for acupuncture / traditional medicine to be included.
Practitioners, both Eastern and Western, will be able to take training classes on how to use the new codes, including correct usage and interfacing of Western and Eastern codes. Upon completion of the training, practitioners will receive a certificate documenting completion. Classes will potentially be online, as well as a few in-person (subject to COVID guidelines / restrictions, of course).
Charting, documentation and/or SOAP notes will be vital for traditional medicine providers. Out of this process, the WHO and health care systems worldwide will be able to gather data and use it to help better serve patients and advance public health .. and in so doing, create endless opportunities for our profession on a global stage.
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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