Slashdot Mirror
Federally-Mandated Medical Coding Gums Up IT Ops
Lucas123 writes "The change over from a medical coding system in use since the 1970s to an updated version that adds more than 50,000 new 7-character codes is being compared to Y2K as an IT project that is nearly impossible to complete on time. ICD-10, which replaces ICD-9, adds far more granularity to medical diagnosis and treatment. For example, ICD-9 has one code for a finger amputation. In contrast, ICD-10 has a code for every finger and every section of every finger. An 'unfunded mandate,' the change over to ICD-10 codes is a multi-year project for hospitals, state Medicaid organizations, and insurance providers. The effort, which affects dozens of core systems, is taxing IT operational budgets at a time when shops are already under the gun to implement electronic health records."
Surely if the specification lists the data in a structured way, they don't need to be hard-coded. Can't you just stick them all in a database and do lookups? Can't the authority give that the requisite structure?
"But everyone should know everything." -markab
Medicare, like any insurer may change it's paperwork in an effort to make the process more accountable. As it's an international standard that has already progressed to ICD-10-CM, it's probably about time.
The force that blew the Big Bang continues to accelerate.
the people who dreamt up the new coding system didn't even try to make it backward-compatible with the old one, hence the headaches and waste of money.
If ICD-10 was a superset of ICD-9, in a way similar to how UTF-8 is a superset of ASCII, the transition would be perfectly seamless and painless...
"A door is what a dog is perpetually on the wrong side of" - Ogden Nash
An 'unfunded mandate,' the change over to ICD-10 codes is a multi-year project for hospitals, state Medicaid organizations, and insurance providers. The effort, which affects dozens of core systems, is taxing IT operational budgets at a time when shops are already under the gun to implement electronic health records."
This is good as well. Insurance company profits are ridiculous and hopefully this will force them to invest a lot of those profits in the American economy to do this work. Complaining about expense when replacing systems in a organization that is fraught with malpractice (misdiagnosis, amputating the wrong limb, dispensing the wrong medication) is ridiculous. This is akin to the government complaining about the cost of replacing infrastructure when the alternative is your car plunging in the river on your morning commute.
TFA makes no mention of meaningful use, which is really taxing things... while it was marketed as being a way for health systems to earn monetary incentives by upgrading to EMRs, in reality what's going to happen everywhere, to every health system in the coming years is that one size fits all criteria is being foisted upon them in the form of very costly IT projects.
While there is a monetary payment from the government for the first few years for being in compliance, the cost to obtain financial reward X is significantly greater than X, but you have to do it anyway because non-compliance will result in heavy fines eventually.
And all these expenses are being piled on in economic times when health systems are already being crushed financially due to the state of the economy (lower patient volumes in general), terrible medicare/medicaid payouts, and the weight of supporting the government-insured, under insured, and uninsured (in that order) in general.
I know it's no surprise that national-level HIT management by the federal government has turned out to be not so grate akshully, but it is worth pointing out that Meaningful Use in the health care reform legislation is much worse than ICD-10
I'd love to be apart of that product manager's commission :( so what if it's going to take 5-10 years...
It may be an "unfunded mandate", but it will probably help eliminate thousands of medical errors (mistaken amputations, incorrect medicine given to patients, etc.)
The effort, which affects dozens of core systems, is taxing IT operational budgets at a time when shops are already under the gun to implement electronic health records.
For the most part, this isn't my problem.
ICD-10 has been on the radar for a while now. At least a couple years. And it's Federally mandated. So we didn't have any problem adding the necessary funds to our budget this year.
Each of our HIS vendors has already got ICD-10 stuff ready to go. We'll have to pay them for their time, or a software release, or whatever... But, as far as my own labor is concerned, it'll basically involve giving them remote access or throwing a disc in the drive.
Most of the labor involved is in our coding department. They're going to have to send folks out to get (re)trained in the ICD-10 stuff. They are, understandably, a little stressed. But they've been working on this for a while, too.
"Work is the curse of the drinking classes." -Oscar Wilde
As the spouse of a Physician (hospitablist) and a System Admin for a medical practice, I can tell you first hand that is a cluster f&*%. The effect this crap is to slow down physicians with tasks that they really should not be doing, (read data entry). That is exactly what these regulations are doing. And to keep productivity up, some doctors are resorting to hiring scribes who follow them around, just increasing costs that will get absorbed somewhere. It all looks good on paper but the effect is reducing productivity of the people on the front lines.
Conservative, mod down for violating
being compared to Y2K as an IT project that is nearly impossible to complete on time.
That sounds like good copy to a lowly journalist, but as someone "who was there" during Y2K, what was "nearly impossible"? We knew it was coming, we planned, the bosses mostly used it as an excuse to semi-fraudulently ram upgrades thru and as a powerful weapon to grab more budget money. It was way, big time, trivial.
Besides, just think about it. The entire world's IT department, all those guys who can't close open relays, blah blah blah all somehow 100% successfully did the nearly impossible... yeah uh huh.
"Science flies us to the moon. Religion flies us into buildings." - Victor Stenger
While this is definitely a huge pain, I have little sympathy for those complaining about the timing of this when the standard was finalized in 1992.
ICD-10 has been out for nearly 20 years. There was a 5 year timeline to get ICD-10 implemented, and there was likely a few years of discussion with major Medi* billers before that to let them know this was coming along.
Much like the FCC and HDTV, health care companies must have ignored the mandates until it was too late, whined and cried about how they couldn't meet such a strict deadline and pretty please can we extend it for another 5 years. Repeat until our health care records system is completely unusable.
Though, wow, I would have thought VistA would have ICD-10, but it's being bolted on now. Strange.
If you really have a problem with extending a field by a few bytes, you're using the wrong language. By now, you should expect the world is going to change constantly. If it's a surprise to you at this point congress is going to re-invent healthcare ever two years to boost their ratings, please beat yourself with your keyboard.
Let me guess, the people complaining are using z/os hardware and wrote everything in cobol accessing a ADABAS database. Some idiot business manager said, "It ain't broke, lets not upgrade" and decided to continue using their billion dollar IBM dildo for the next 15 years.
maybe we can use this to pinpoint where you assholes waste so much cash
is that why you whine about it?
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
FYI, this really doesn't affect the diagnostics. 98%+ of it has to do with billing. Just because there was only one code for amputating a finger doesn't have anything to with the doctor doing his job. He does cuts it off describes what was done in the chart(or EMR) then after the person is discharged a person in a little room called a "coder" goes through the chart and enters the billing code(ICD-9 currently) in the bill that gets sent off to the insurance company.
.
"Work on ICD-10 began in 1983 and was completed in 1992"
The Feds needed to mandate this to get it done?
Stuff like this is like infrastructure, the private companies will wait until it is completely disintegrating then try to get someone else to pay for it instead of spending money that could better be used for bonuses on capital improvement projects. ICD-10 was finished in 1992. So we're not stuck in the 70s, we're stuck in the 90s.
It doesn't help that all the private insurance companies have hitched their trailer to Medicare and do "whatever Medicare does", whether it's with regards to pay (doctors tell me that almost all private insurers pay a set percentage of whatever Medicare pays, which is why they're scream so loud every time Medicare cuts come up) or whatnot. At this point it doesn't take a law for the feds to "mandate" anything, if Medicare does it, monkey see monkey do.
If I have been able to see further than others, it is because I bought a pair of binoculars.
As pretty much everyone else has already said, if you don't have a system that can quickly and easily update from ICD-9 to ICD-10, you're so far behind the IT implementation curve that you should be drug out into the street and shot.
It's 2011. They've had many, many years to upgrade, and now they're poised to paid by the government to do so. Hell, my employer stands to gain $50 million dollars over the next couple years from implementing key portions of the HITECH provisions in ARRA. For those reading, that's more than half of my (quite large and well-funded) health system's annual budget.
For our part, we just slapped down a couple hundred thousand for a product that hot-swaps our ICD-9 coding for ICD-10, and also tosses in a problem list that physicians can use that's tied to these coding schema, potentially improving efficiency and accuracy as well. The only excuse, and I mean ONLY excuse for ICD-10 being a problem is poor IT leadership within the health system/hospital--a failing which is incredibly, unbelievably common.
I'm lucky, I work in an IT shop that actually has its shit together.
What they are saying is that ICD-10 is implemented through ID-10-T managment?
US cars use metric fasteners?
So, you are recommending putting bad data into the database as a better option? GIGO....
. . . is that you don't need to change historical data. There is a hard, day forward switchover date in October 2013. The lookup problem is that there is not a one to one relationship between the old codes and the new ones. The lookup would need to contain a level of intelligence that just simply isn't contained anywhere within the context of the data set. This means that every level needs to comply to get the data. You don't just need the space for the correct number of digits, or add logic to append a "19" or "20" in front of your year. - The doctor needs to be retrained (NOT an easy task since many already "know" everything they will ever need to know) to record the information from the encounter with the patient. - Then the coder needs to select the right codes (assuming the system they use can even handle the new codes). - The billing system needs to be capable of transmitting the new codes (new EDI x-12 rules go into effect in Jan 2012 to support this) - The payer's claim system need to be able to store the new codes - The contract between payer and provider on what amount will be paid for what service needs to be completely rewritten - The payer's examiners / adjudication process must be able to interpret the codes vs. the treatment codes to decide whether to pay the claim at all (Diagnosis = stubbed toe: treatment = removed kidney. . . no pay)
Yep, they use metric for every 2.54cm of the car.
What is the ICD-10 code for being a dickless idiot. They could save time by automatically adding it to the record of all Federal employees. OK - maybe not the FBI - honestly I didn't mean you, I was just sayi.....
The ICD-10 codes for being a dickless idiot would be:
Q56.4 Indeterminate sex
F79.1 Unspecified mental retardation with significant impairment of behaviour requiring attention or treatment
It is easier to build strong children than to repair broken men. -Frederick Douglass
I thought the 2009 stimulus package had $30 Billion which was to be paid to hospitals to update their systems? The only backup I have for this is an I, Cringley article I read over the weekend but I'd feel he'd of all IT writers would be a reasonably reliable and impartial source. Definitely a far more reliable source than the average Slashdot submission.
"All great wisdom is contained in .signature files"
ICD-10 IS a dramatic improvement over ICD-9, and you want hospitals to invest the time to implement it. Why?
- The US is the only industrialized in the world that is not using it (this matters if you want your medical records to be accessible when you travel)
- ICD-9 cannot accurately characterize diseases with enough granularity for use besides billing (this matters if you want electronic health care records that are accurate, enable things like clinical support systems, and better medical research)
- With ICD-10 and more specific links between disease, we can better track the progression of disease through populations (this matters if you want get the bird flu and want proper treatment and response, which in ICD-9 is characterized as "pneumonia" because theres no code for it)
So I understand that theres a knee-jerk tendency to say "the man is foist all this on me!" But this time the men, and women, are making an improvement thats going to save lives and money in the long run.
We're waiting to leapfrog from ICD-9 to ICD-11. We're expecting to save a boatload of effort that way.
the preceding comment is my own and in no way reflects the opinion of the Joint Chiefs of Staff
N52.2, Drug-induced erectile dysfunction?
S38.01, Crushing injury of penis?
Planning to be moderated ± 1: Bad Pun.
What is the ICD-10 code for being a dickless idiot.
S38.2 Traumatic amputation of external genital organs
F73 Profound mental retardation
The fun part about ICD codes are you get 3 replies with 3 different codes for the same problem.
I'm a good cook. I'm a fantastic eater. - Steven Brust
This is overlooked time and again.
Hello,
I am a surgeon, and I can tell you a lot of the cost is from all the middle men (ins companies), and defensive medicine. It's not the doctors who are making the big bucks. One of my patients said to me.
"Yeah Doc, the bill was big, but your part of the bill was peanuts - I feel sorry for you."
Most MDs pay about 10% off the top of profits for a billing service because it's so complex.
Many additional x-rays, lab tests are also ordered because we worry about "missing" something, and being sued. There are articles published about MDs doing that - its a real phenomenon. That's probably another 10% as well.
Large malpractice insurance (average $30k to $200K per year!!)- guess who has to pay for that...
Insurance companies - they are a new middle man. A whole industry has popped up, and the patient care has to burden the cost. They also inundate doctors offices with paperwork (20 page disability forms)- making it a pain in the ass to collect money. Many groups hire Physician assisstants to fill out paperwork, because there is so much of it.
SO yeah - costs have gone up,
..........FULL STOP.
Here are some federal employees I would like to see you say that to there face:
http://www.marines.com/
The Kruger Dunning explains most post on
In every objective study, the government has kept costs down, overall.
What has changes since them is technology.
Now we have safer rooms, many gases delivers through an internal system, more equipment, higher trained professional, and a large population.
You anecdote is crap, an not normal anecdote crap, but emotional based ignorant anecdotal crap.
Also, in the 40's and 50s a lot more people died.
Today, he might not have even needed to stay on the hospital.
Seriously implying the health care was better back in the day is just stupid.
wait.. he was a 'poor farmer' but still managed to pay even though he couldn't work the farm? He was a poor farmer that could have afforded rent on top of his farm?
There is an old robot saying for this: "DOES NOT COMPUTE."
The Kruger Dunning explains most post on
Does software actually exist that uses an ICD-9 code directly as a key? LOL. Amateurs.
I've seen worse. Not in the medical records biz but elsewhere. (Where exactly, I probably shouldn't say. Or you'll never get on an airplane again.) There's a good change that some apps have done something like hard-code ICD-9 codes (or ranges).
I've seen systems where a code was used to indicate some position on a shop floor, or process. And then management negotiated a union contract based upon code values or ranges. And now, when the s/w folks try to fix it, everyone up through the legal department and labor relations up through the company president comes unglued.
Have gnu, will travel.
The ICD-9/ICD-10 change over is a ballbuster, but is far from the worst of the lot. Useless "meaningful use" requirements based on closed standards that aren't complete or even accurate, at best, and contradictory at worst and the clusterfuck of the new ASC X12 formatting are both bigger pains in the ass, though I guess I'm lucky that the software I work on was at least clueful enough to store the codes in a database...
I'm on my 6th week of overtime now thanks to this BS.
One of these days, this asshole's gonna have a hard drive crash and lose his precious list, consigning his life's work to oblivion. He'll probably kill himself.
Having gone through an entire long term consulting gig assessing EMRs (electronic medical record packages) and installing and helping to run and EMR for a largish medical practice, I've seen firsthand a bit of the mess that is IT in medical practice. IDC-9 and IDC-10 are just the tip of a very big iceberg. It is already (for all practical purposes) impossible to run a medical practice even with IDC-9 without an EMR and practice management interface. These electronic tools are very expensive initially, a total pain to maintain (and an ongoing expense to maintain), and more often than not terribly designed and clunky for the physicians, nurses, lab, and office staff to use. IDC-10 is the icing on the cake -- with it it is absolutely impossible to try to continue to operate "by hand". The government is armtwisting medical practices towards the use of electronic medical records and practice management in various other ways -- notably by promising a time (soon) where in order to be reimbursed for various services e.g. medicare a practice will have to file electronically.
As has been pointed out, although there are various (completely inadequate) standards for EMRs in play out there, "compatibility" is a low bar to clear and everybody adds their own bells and whistles, making any sort of switch between EMRs a major data port and conversion problem. Training and service, often as not, involves phone banks in India and opaque accents. Many/most of the EMRs have for all practical purposes no serious internal security -- no encryption of connections, trivial authentication, and rely on vpns and control of the internal network for security. Of course HIPAA provides no useful security guidelines in the first place, so the more you can make security someone else's problem, the more profitable your EMR is. In general, scaling of EMRs is poor (with a few large scale hospital-based exceptions) and they are, of course, enormously Windows-centric because that too makes a lot of things somebody else's problems. Such as security, installation, cost, scalability...
It's really quite sad. EMRs "should" make medical practice much more efficient and facilitate a large portion of the enormous burden of documenting everything in real time for physicians, in addition to facilitating billing and insurance claims and the overall practice financials and access to e.g. labs and other auxiliary services. Most do, to some extent, accomplish these goals. But they fall far, far, short of what they could accomplish, especially with a truly portable EMR interface that wasn't locked to any particular operating system and that had a "real" security layer in place. Having real standards and a federal cross-platform cross-application certification process would make things even better -- one could actually disconnect the user interface from the back end data and let users (e.g. physicians) choose the interface that suits them best across all vendors on any common database back end.
Too bad this will absolutely never happen...
rgb
Even when the experts all agree, they may well be mistaken. --- Bertrand Russell.
Amen, brother!
(I too did some of this, but not for a living, as a sideline. But you are dead on the money.)
rgb
Even when the experts all agree, they may well be mistaken. --- Bertrand Russell.
What I think TFA is trying to express is NOT limited to ICD. That's a "low hanging fruit" which doesn't include the other coding enhancements required for EHR conformance. ICD is a way of expressing complains and maladies via a coded system so that everyone can understand it if it appears as a part of your public medical record. In other words, everyone has to say code xxxx1 = "breast cancer" so that when you show up in an ER 6 months after a diagnosis, they can tell what's going on. The elephant in the room isn't the malady descriptions, its the coding of procedural treatment (SNOMED-CT), laboratory procedures (LOINC), RX allocations (RXNORM and the NDF), and how its billed back to insurance (CPT), and more importantly how they interconnect.
We make EMR systems targeted towards radiology, and I can say with conviction that the whole CCHIT process has thrown GE and Siemens (and their ilk) into absolute chaos. They are, today, faced with fixing their old systems to be modern/conformant, and then trying to keep them updated going forward on a MUCH more aggressive maintenance schedule than they are used to. Oh, and every month that they can't do it, their customers will see as lost revenue from govt. reimbursements. Unenviable is an understatement, it will be a financial disaster for GE if they start losing people en masse to Epic and other new players.
As someone who makes "meaningful use" based systems, I can tell you its no joke to implement. CCHIT certification alone encompasses 25k pages of standards that have to be followed to the letter and proven via testing for qualification.
In a way, it's a strange twist that the big players (GE/Siemens/Merge) lobbied to make the qualifications as hard as they currently are in order to limit new competition, and are now sinking into the pit they themselves dug. Sick, but hilarious simultaneously.
Imagination is the silver lining of Intelligence.
As a former IT Admin for a medical clinic I can tell you that the medical software out there is generally outdated and usually running on older OS's and architectures. The doctors and other medical professionals want to do their jobs and not get bogged down in the technology. "If it works - don't fix it" is usually what they want - Not upgrading machines, software or anything else. Most of the time they point to the learning curve to teach people how to do things with new equipment (yes, some of the proprietary software out there is running -- still running -- on Win 98 and NT machines) or new software. Mandating EMR's (EHR) and "new" codes are good for patients for the most part. Unfortunately, Doctors and Software companies that supply them are very change resistant for a number of reasons.
Or... Goatse who cares? Internet made me insensitive.