Introduction:
World Health Organization (WHO) identified the novel coronavirus disease 2019 (COVID-19) as a pandemic in March 2020 1. The pandemic has impacted the world economy negatively, as well as social and personal health across the globe. A thorough analysis of the current state of the pandemic and the appropriate associated solutions such as allocation of resources to medical centres and launch of new field hospitals requires an accurate evaluation of the number of confirmed and suspected cases and their state of health. Moreover, a true assessment of disease symptoms and the ongoing therapeutic interventions and associated outcomes can facilitate future informed therapeutic decisions.
Medical record codes are considered to be one of the most important pieces of administrative data 2 . The International Statistical Classification of Diseases and Related Health Problems (ICD) is a medical classification list of codified standard diagnoses introduced by the WHO. This standard is updated regularly and has so far reached its 10th revision (ICD-10). Different countries have developed their native variations of these standards, tailored to meet their specific healthcare requirements. For instance, a variant of ICD-10 named ICD-10-CM has been developed and adopted in the United States 3.
These kinds of codes are useful for the processing of reimbursement claims, clinical and epidemiological studies, quality of care and also used for reporting disease surveillance and monitoring4. ICD-10 standards have preserved levels of coding for new types of disease (U codes). For the case of COVID-19 pandemic, there is a preserved ”U” character assigned for this disease.
Reports of surveillance and monitoring of the COVID-19 pandemic is directly linked to the accuracy of clinical coding in accordance with the WHO coding guidelines 5-7. However, due to the unprecedented and unknown nature of this novel disease, future modifications of the introduced codes might be needed, which, in turn, may require changes of the codes used for medical records. Moreover, changing diagnostic methods, e.g., computerized tomography (CT) reports have created some problems for the accurate coding of medical records. In particular, during the first month of the COVID-19 outbreak in many countries, coding practices were inconsistent. Patients were discharged before guidelines had been made available and different codes were also released in succession 8,9.
The process of notifying and training coders is an important step in maintaining the accuracy of data. Despite the heavy financial burden of the current pandemic on healthcare systems, careful attention should be paid to meet coding standards10. Documented guidelines alone do not seem to be adequate to address the questions and problems raised by coders.
More recently, social networks have attracted a lot of attention for online consultations. There are systematic reviews that highlight the value of social media for healthcare communication and interventions11-13. Some studies emphasise the effectiveness of social media in different areas of healthcare consultation such as plastic surgery 1, emergencies 14, orthopaedics 15, and oral or maxillofacial surgery16. Also, over the course of COVID-19 pandemic, governmental organizations have attempted to use internet-based technologies and telehealth (defined as the use of telecommunication technologies to support long-distance clinical health care and patient data 17,18) to overcome problems arising from the pandemic through online monitoring and follow-up of patients with chronic disease and people with initial symptoms of COVID-1919-21. For example, in China, an online mental counselling application has been implemented in an attempt to overcome the psychological stress exerted by the COVID-19 situation22. Baptista Silva et al. mentioned that health managers need to use remote consultations to improve services and provide care from a human rights perspective 23. Sabrir et al investigated the effects of WhatsApp video consultation on patient admission and dis­charge times in comparison to bedside consul­tation during the pandemic. Consultation via WhatsApp reduced both contact time with patients with COVID-19 and the number of medical staff contacting the patients, which contributes greatly to reducing the risk of COVID-19 transmission 24. Xu et al. evaluate a telemedicine model that was developed to address the challenges of treating patients with progressive COVID-19 based on a popular social media smartphone app called WeChat. The telemedicine system was useful for medical staff to identify disease progression and, hence, make appropriate and timely treatment decisions25. Abbas et al. mentioned positive effects of educating people through social media platforms to reduce the mental health consequences of the COVID-19 26.
The ability of smartphones to transmit voice, text, images, videos and other multimedia messages has made them an effective and popular messaging tool. Today, smartphones are ubiquitous and almost everybody, including health professionals, in different countries make use of them27.
In this study, we assessed the efficiency of using tele-consultations between clinical coders based on the social network to solve COVID-19 clinical coding problems and reduce coding time. Consultations were gathered over a 10-month period since the onset of the pandemic in Iran. Also, we evaluated the expediency of code setting and use by investigating the categories of consultations in coding groups.