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ICD-10 and EHR Fuel Clinical Documentation Improvements

Scott Mace, for HealthLeaders Media, March 18, 2014

"When a group of terms is completed, we determine what would be useful as a problem list subset and then donate that problem list subset to IHTSDO and the National Library of Medicine," Lee says. IHTSDO, the International Health Terminology Standards Development Organisation, is the Denmark-based not-for-profit association that owns and maintains SNOMED CT.

The subsets donated to date include the Clinician Display Names, as well as associated Patient Display Names, ICD-9-CM mapping, ICD-10-CM mapping, and existing or new SNOMED concepts modeled by Kaiser Permanente.

"As we enter 2014, we have made significant progress in this work and are well-positioned to complete the transition activities ahead of the October 1 implementation date," Lee says. The progress made to date, she says, is in part due to a strong level of collaboration with the Kaiser Permanente terminology working group, which consists of physician users from seven Kaiser Permanente regions who review the clinical terms created by CMT for end-user usability.

The extent to which Kaiser Permanente has had to blaze trails in CDI points out the tremendous cost that can be incurred—cost often incurred by vendors, but also providers themselves if they develop their own EHR software.

Beth Israel Deaconess Medical Center is one such provider. At the November 13, 2013, meeting of HHS' Health IT Standards Committee, John Halamka, MD, who is CIO and senior vice president of information systems for the Boston-based 649-bed teaching hospital, revealed that the cost of its clinical documentation improvement project has skyrocketed.

"The regulation originally assessing the impact of ICD-10 suggested that Beth Israel Deaconess should spend $600,000 and would achieve everything that was necessary," Halamka said. "I'm now $10 million into the project and we're not quite done yet. It's not the retrofitting of the financial and the clinical systems to hold an alphanumeric code that's seven characters long; it's reengineering the clinical documentation processes to effectively support the code that you have to specify. That's hard work.

"We'd hoped that SNOMED could inform the ICD-10 selection so that you would link the problem list, the documentation, and the billing into one workflow. And we have yet to see products that really do that."

Reprint HLR0314-5


This article appears in the March 2014 issue of HealthLeaders magazine.


Scott Mace is senior technology editor at HealthLeaders Media.
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