Nov

30

EMRs and ICD-10

Filed Under EMR Software, Medical Software

We all know the advantages of  the electronic medical record – improving access to critical information, eliminating errors, automating tasks, improved accuracy and legibility of documentation and improving coding for better billing and reporting. The government is offering financial incentives to physicians that implement EMR software soon.

There are over 330 electronic medical record software systems for physicians to choose from today.  To complicate the decision process further, in order for physicians to qualify for the financial incentives promised by the HITECH act, “meaningful use” of such a system, (to be defined by the end of 2009,) must be achieved by 2011 for the incentives to be realized to their fullest.  In addition, there is the threat that penalties will be levied  against practices if a compliant system is not implemented by January 2011.

The latest Health IT Policy Council Recommendations to National Coordinator for Defining Meaningful Use Final  
( http://health.state.mn.us/e-health/standards/mufinalrecs102609.pdf ) stipulates that EMRs must maintain problem lists in either ICD-9 or SNOMED.  As of today, the meaningful use definition does not include compliance with the two final rules to continue the transformation of the US healthcare delivery system to an electronic environment through adoption of the next generation of diagnosis and procedure codes and updated standards for electronic exchange of healthcare data announced January 15, 2009 by the U.S. Department of Health and Human Services (HHS).

The first rule adopts the ICD-10 medical data code sets standard for use in exchanging diagnoses and inpatient hospital procedures information replacing and greatly expanding the ICD-9-CM code sets, developed nearly 30 years ago effective 10/1/2013.

The second rule replaces the 4010A1 standards for electronic health care transactions with Version 5010 on 1/1/2012.

The American Medical Informatics Association (AMIA), American Health Information Management Association (AHIMA), and AdvaMed, have issued a summary of their joint position on the adoption of the International Classification of Diseases, tenth revision (ICD-10) which includes the following points:

  1. The ICD-9 CM (International Classification of Diseases, ninth revision, clinical modification – a U.S. version of ICD-9 developed by the World Health Organization) is obsolete. Its continued use will adversely impact the value of healthcare data as well as hinder medical decisions based on imprecise data. Further delay adds to the cost of modification and the investment in electronic medical records (EMRs).
  2. CD-10 is needed to improve the quality of health information. It is designed to provide better data to meet the needs of today’s electronic healthcare environment and of an increasingly global healthcare system. ICD-10 will enable more accurate and improved information to be captured. ICD-10 will provide better data to support improved public health and bio-terrorism monitoring, more accurate reimbursement rates, patient safety improvement, medical error reduction, quality measurement, and pay-for-performance initiatives.
  3. ICD-10 is needed to support interoperable EMRs and a National Health Information Network (NHIN). EMRs and NHIN networks require a modern classification system in order to accurately summarize and report healthcare data. EMR system benefits cannot be achieved fully by utilizing the 30-year-old ICD-9 classification system. ICD-10 must be incorporated into medical software systems with SNOMED-CT in order to realize the benefits of a NHIN and interoperability. SNOMED-CT and ICD-10 will allow data to be shared between EMR systems in their common medical language.

ICD-10 increases the sheer number of diagnostic codes ten fold.  There is not a one-to-one mapping between ICD-9 and ICD-10.  Adding choices and complexity can only help achieve improved health and more accurate payment if the systems and people are capable of codifying data properly.

Doesn’t it make sense to look for an EMR vendor who has a rock solid plan to remediate their EMR solution to utilize ICD-10 codes? To achieve real interoperability and, therefore, meaningful use, you must have a plan in place to train your physicians and staff responsible for coding in the use of ICD-10.  Make ICD-10 part of your criteria for vendor selection and meaningful use.

- Sandra Schafer
President, Turning Point Advisors

About the Author
Sandra Schafer has over twenty five years experience in healthcare IT.  Prior to forming Turning Point Advisors, a healthcare IT vendor consulting firm specializing in product commercialization and strategic marketing, she was Senior Vice President of Marketing and Product Direction at CareMedic, Vice President of Marketing and Product Marketing at NDCHealth, Vice President of Strategic Business Development at Healthcare.com.  Sandra began her career at HBOC, now McKesson where she spent 17 years in various management positions.  Ms. Schafer holds a B.A. degree in Business Administration and a Masters in Healthcare Administration from the University of Iowa.

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