Comment:

The challenge for effective use of coded information is to not lose the nuances that inform a concept-balancing a code for computability with the narrative that may inform it is critical for human use-the tyranny of overusing narrative is that (like IDC 10) the information is so granular that it cannot be rendered useful for research and communication about disease instances or trends in a population-in this section it seems that extensibility that is anchored with a required code would allow for a standard with some variance rather than a variance with some standardization-happy to elaborate if this is unclear and if it helps to inform further thinking in this area-Keith Salzman