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Creating a “Business as Usual” ICD-10 Transition

by Brian Anderson, MD, Senior Manager, Clinical Effectiveness

If you read the health care IT trade publications as much as I do, and pay attention to the relevant ICD-10 tweets and social media mentions, you may be pretty confused as to what exactly will happen come the October 1st deadline. And those of you who choose to skip the media and go straight for the published reports are probably confused, too; one much-touted study on Canada’s ICD-10 transition, (which occurred between 2001 and 2005) found little impact in providers’ coding practices, while a HIMSS and WEDI report predicts a “perfect storm” is upon us.

What can we all expect, then? Will we all experience an “ICD-10 Armageddon” only to catch our breath after the transition and find that not much has changed? And exactly how will providers be affected day to day? Perfect storm or business as usual?

Of course, I can’t answer that question for the industry as a whole. I can, at least, say that athenahealth will be ready for our clients, and we’re guaranteeing their results. We’re helping our physicians to experience business as usual through our intelligently designed clinical content – which works in both an ICD-9 and ICD-10 environment – surfacing relevant ICD-10 codes based on what caregivers document. To accomplish this, we’ve created “Best Practice Configurations” (BPCs); they’re essentially guides that athenahealth uses to ensure that your EMR is configured not only with appropriate clinical content based on your specialty (e.g. HPI, PE, ROS, templates), but also with content that matches your clinical workflow.

Inside these guides are starter sets of content that are ready to rock in an ICD-10 world. Here’s how the templates we set up for this content will work: If you identify an issue as acute (or chronic) while documenting in your History of Present Illness (HPI) section, or interpreting a test in our Test Interpretation section, we’ll surface the relevant ICD-10 codes directly in the assessment and plan (A&P) section. If you’re not satisfied with the defaulted ICD-10 code chosen based on your SNOMED diagnosis (remember, we use SNOMED in our A&P as a bridge, see my prior blog post on this), the ICD-10 codes you can sift through will only be relevant to your documentation, thanks to logic that we’ve built into our platform.

So how exactly does this benefit you, the caregiver? If you’re an obstetrician seeing a pregnant patient in their third trimester for an evaluation of hypertension, and you’ve documented (using our BPC templates) their pregnancy and their trimester already, our EMR is smart enough to bring that corresponding ICD-10 code to the top – this saves any provider from having to sift through a list of 50-100 ICD-10s about hypertension. We do the work behind the scenes, using an analytical model of mappings and attributes, filtering the list of ICD-10s through both the SNOMED set (that’s the provider-friendly diagnosis terminology set), and having the smarts to see what you’ve already documented.

All this translates into provider workflows that will have minimal impact on caregiver activity in the ICD-10 world. Or a “business as usual” experience on October 1, 2014.

Physicians shouldn’t have to worry about administrative minutia. We get our system as smart as possible to ease (or eliminate) that end of practicing medicine, and ensure that you can focus your attention on the patient. And, as a clinician who used to practice family medicine, it’s exciting to know there is technology that’s nimble enough to learn from what you’ve chosen, intelligent enough to adjust based on what you’ve documented, and easy enough to use so that you, the provider, won’t be needlessly clicking through ICD-10 choices to arrive at a billable code.

Need to learn more about ICD-10? Two athenahealth webinars can answer some of your questions, and they’re now available on demand: “ICD-10: Addressing Physicians’ Top Concerns ” and “Beyond Basics: A Closer Look at the ICD-10 Transition.”

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