Overcoming the documentation challenges of ICD-10


Healthcare system managers know that the hardest part of moving to ICD-10 will be training physicians to document their work in ways that facilitate appropriate coding. Physicians are not necessarily motivated to change their workflow to justify more granular codes. And, with only a year-and-a-half to go before the October 2013 deadline, healthcare organizations have to begin engaging doctors now to spur more complete documentation before the number of diagnosis codes explodes.

The reluctance of doctors to change their documentation habits is a major reason why the American Medical Association recently asked Congress and the U.S. Department of Health & Human Services to stop implementation of ICD-10. While the Medical Group Management Association has not gone that far, MGMA continues to cite a study showing how much ICD-10 will cost practices in terms of lost productivity.

Meanwhile, physicians are facing other challenges, including electronic health record implementation, Meaningful Use, and healthcare reform. But EHRs and other forms of health IT can actually make it easier to deal with ICD-10.

Let's start with computer assisted coding (CAC). Already being used in ambulatory care and hospital outpatient departments such as radiology and pathology, CAC is starting to make inroads in inpatient care, as well. The basic idea of CAC is to apply natural language processing to digitized text--such as transcribed dictation and scanned reports--to help coders identify the basic elements of documentation they need to code a visit, test or procedure. CAC has been shown to increase coding productivity, and some hospitals believe it can help maintain productivity during the ICD-10 transition.

But that's only the beginning. As EHRs are upgraded to reflect the requirements of ICD-10, physicians must learn how to enter more discrete data than ever before. There's a big enough learning curve involved in entering basic information during a patient encounter; the need to input even data more threatens to slow physician work to a crawl. And as we all know, doctors will not abide by that.

Alternative approaches are clearly called for, and experts have suggested some ideas of how to grapple with this problem. Heather Haugen, corporate vice president for the Breakaway Group, a health IT consulting firm owned by Xerox, told FierceHealthIT that she favors the use of clinical decision support tools to prompt doctors to enter certain data.

Similarly, Victor Freeman, MD, MPP, speaking at HIMSS' Virtual Conference and Expo last summer, said EHRs are vital to ICD-10 documentation. He proposed that EHRs have doctors select diagnoses and then prompt them to enter the information that coders need to pick the right ICD-10 codes.

Another approach that may help some organizations is the use of "semantic interoperability," which includes the mapping of clinical terms to ICD-10 codes. By connecting the terminology underlying an EHR database to the new code set, a healthcare provider could greatly simplify the work of coding from documentation. Terms can be extracted from both structured and unstructured EHR data and mapped to a standardized clinical language.

Sharp Healthcare in San Diego is already working on mapping ICD-10 to the SNOMED clinical terminology, Haugen said. Of course, most organizations don't have the resources to do that. But there are firms that have already done the mapping and can customize it to a particular organization's information systems.

One such company is Health Language Inc. (HLI), which recently launched a new version of its "provider friendly terminology" that includes more than 100,000 attributes of the ICD-10-CM coding set.

According to HLI's announcement, "The version simplifies complexities that are associated with coding in ICD-10 by enabling providers to input familiar terminology into their electronic health record [EHR] and prompting clinicians or coders to add newly required data that may be missing. As a result, hospitals and health systems can enhance clinical workflow and minimize lost revenue from inaccurate or incomplete clinical documentation." - Ken

Editor's Note: FierceHealthIT is hosting a breakfast panel discussion on ICD-10 preparedness from 7 to 8:30 a.m. on Wednesday, Feb. 22 at the HIMSS conference in Las Vegas. Executives from leading healthcare organizations will share what they're doing now to ensure a smooth--and even profitable--transition to ICD-10. For more information and to register, visit the ICD-10 Readiness for Hospital IT Leaders: Lessons Learned from the Trenches website.

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