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ICD-10 and EHR Fuel Clinical Documentation Improvements

Scott Mace, for HealthLeaders Media, March 18, 2014

In effect, the technology required to achieve both ICD-10 compliance and meaningful use stage 2 attestation has arrived in time for both to occur in 2014, Plantes says.

"Being in approximately 70 different communities across two states, we need and absolutely require Internet-based clinical solution tools to be able to execute our strategies that are both required by things such as meaningful use as well as what we want to do with advancing our quality program," he says.

While providers such as Christus are able to rely upon the efforts of vendors such as athenahealth to supply CDI technology, other large providers have different strategies.

Kaiser Permanente had an existing set of clinical terms that were mapped to ICD-9 CM and SNOMED for use in diagnosis and problem list entry. In 2011, the Kaiser Permanente Convergent Medical Terminology team began an effort to transition this set of clinical terms to ICD-10-CM. The effort was referred to as a "graceful transition" based on the strategy to implement the changes in small increments over the course of several years, rather than making one significant change on October 1, 2014. This required that new clinical terms added to production be mapped to both ICD-9-CM and ICD-10-CM.

Initially, Kaiser's team performed a preliminary evaluation of ICD-10-CM to determine the areas with the most potential impact to end users, according to Moon Hee Lee, director of convergent medical terminology at Kaiser Permanente. The existing set of clinical terms was then divided into logical groups based on medical specialties, such as cardiology. "We began with groups of terms having the least impact to end users, which meant the terms in noninjury categories," Lee says. "We first mapped the existing terms to ICD-10-CM, and then compared them to the ICD-10-CM code ranges to identify any gaps."

When Kaiser's team uncovered gaps, a team of terminology modelers consisting of physicians and nurses reviewed each of the ICD-10-CM codes in the gap to determine what clinical concept was implied by those ICD-10-CM codes. They then created new clinical terms to add to the diagnosis and problem list term set, and mapped them to equivalent SNOMED concepts.

When equivalent SNOMED concepts were not available, the team would model new SNOMED concepts following the SNOMED editorial guidelines. These concepts were then mapped to both ICD-9-CM and ICD-10-CM by two independent coders, Lee says.

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