It happened. The switch flipped and on Oct. 1, our healthcare system went from around 14,000 diagnostic codes to 68,000 codes with the final implementation of ICD-10. No “Y2K”-style catastrophe. No computer system meltdowns.
We will now be watching for the long-term effects of this change. Will the processing of payments for healthcare services in the United States be adversely affected by this transition? We won't know the answer to this for some time.
As the EHR guru for my private practice, I have been responsible for the transition on the local level. This means making sure that our software is up to date and ready, and our various billing documents and their associated procedures are ready to communicate ICD- 10 information to our billers.
Additionally, as an EHR "superuser" on the medical staff of my community hospital, I watched transition issues and steps very closely in preparation for the transition. I have to say that I have been pleasantly surprised with both the administration of the hospital, as well as with the IT folks and on-site EHR vendor staff, in making this transition as painless as possible.
I have written before about how, in this phase of EHR development, the EHR has focused on the needs of the system (i.e. meaningful use, billing, etc.) and not the needs of the providers in making the process of documenting our care as smooth and easy as possible. In the most recent major upgrade to the industrial strength EHR system, significant strides forward were achieved in making the providers’ lives easier.
The first was to make customizable specialty view landing pages that facilitated EHR use to document patient encounters in a very linear and intuitive process. I have been documenting patient care with the EHR for more than three years now, and this one change was a huge step forward in using my time efficiently on rounding in the hospital.
The second major change in the hospital's EHR was simplifying the coding tool. From within the landing page, you just click on diagnosis, and start with a simple search term like "breast neoplasm." This immediately presents you with vertical lists in columns, from left to right. As you make choices in the columns (e.g., disease specifics, anatomical location, laterality, etc.) the choices rapidly narrow, and the coder lets you know through visual clues when there is sufficient information for a complete ICD-10 code. Whoever designed this deserves a medal.
I have worked with physicians and showed them how to use the landing page, as well as the diagnosis tool, and early and late adopters have both been able to adjust their way around the software quickly - indicating a sign of intelligent, user-friendly design.
I have been told by the vendor support staff that the new focus on supporting the needs of the providers will bring tablets and tools to the floor of the hospital, which will make the end user experience much better, time efficient, and useful. This has not happened just yet – one step at a time - but I remain bullish on the promise of the EHR.
I'm hopeful that the world of the EHR is moving to a new phase; a phase that focuses more on making the processes of documenting patient care easier, faster and more intuitive. Good data flows uphill, and makes the other outputs of the EHR more cohesive. The coming weeks, months, and years will ultimately tell the tale of this transition to ICD- 10, but I’m hopeful that it will ultimately give us the information and data we need to make a difference in the healthcare system and in the lives of our patients.