Why you need to do more than convert ICD-10 codes

Carl Natale
by Carl Natale

The coming ICD-10 transition is about more than converting ICD-9 codes to ICD-10 codes. In many cases, this means changing workflow.

John Halamka, Chief Information Officer of Beth Israel Deaconess Medical Center, outlines how he wants to change how clinical documentation is captured at the hospital. And it involves more than capturing more detail.

What's interesting is that Halamka outlines a problem with clinical documentation that has nothing to do with medical codes. It's a problem based upon legibility and collaboration. The solution isn't just an electronic health record (EHR). He wants a "daily note" that's created and shared on a Facebook-like app. All the data on a patient is collected and locked into  a daily record by a physician. To make this happen, Halamaka breaks down the solution into five pieces:

  1. "Disease specific templates"
  2. "Technology to capture free text and populate the templates i.e. my Wikipedia/Facebook concept describe above."
  3. "Natural language processing to codify SNOMED-CT concepts"
  4. "Mapping of SNOMED-CT concepts to ICD10 codes"
  5. "Rules to ensure documentation is complete enough to justify the ICD10 codes"

My opinion, the technological pieces should be pretty easy. We have the software and devices to make it happen. The tricky part is changing the workflow. It's going to be hard persuading clinicians to do something different. There's a reason why the broken system that Halamaka describes exists. It's the way everyone is taught to do it, and it works for them.

The hard work will be persuading staff that this will be better for them and patients.

But ICD-10 implementation probably will be blamed as the reason for overhauling clinical documentation. And maybe the staff will embrace Halamaka's vision despite onerous bureaucratic hurdles.

Three final notes

First, this clinical documentation system doesn't exist because no one has thought to ask for it yet. If you has a hospital or medical practice what technology is needed, the health information managers will ask for upgrades to the current technology. Halamaka is part of a rare breed who is focused on solving problems not upgrading tools.

Second, while Halamaka's fifth module exists to justify compliance with the ICD-10-CM/PCS code sets, the data captured could have uses as quality metrics. As healthcare moves toward accountable care models, this data will be required more.

Third, when healthcare organizations need to transition to the ICD-11 code sets, only two modules will need upgrading. The input devices probably will change between now and then. But the module approach will mean any piece can change without having to overhaul  the whole system. This should make future upgrades and changes more manageable and affordable.

Life as a Healthcare CIO: Brainstorming About the Future of Clinical Documentation.