Will Weider, CIO, Ministry Health Care & Affinity Health System
I am all for standards. The more we define and codify the practice of medicine, the better and more interoperable our EHRs become. But a standard, for the sake of a standard, takes us backwards.
I believe the writers of the Final Rule that defined Meaningful Use of an EHR took us backwards when they specified two different standards for coding the problem list (SNOMED and ICD-9). Most organizations appear to be using ICD-9 to code the problem list. I believe that this is because SNOMED is way too complicated and there is no decent implementation reference.
But ICD-9 coding of problem lists does not make sense. Firstly, this country is in the process of migrating away from ICD-9 codes. Why make that process more laborious by creating one more conversion? Let’s skate to where the puck will be.
More importantly, ICD-9 codes do not describe problems in the hospital. ICD-9 codes are medical billing codes. Sure, they are based on a disease classification system, but problems are not always analgous with a disease or condition. For example, an important problem to note during a hospital stay is that the patient is “at risk for fall” based on a fall assessment. What is the ICD-9 code for this?
ICD-9 codes collected as part of creating the problem list will not provide any additional data beyond the ICD-9 codes that are already abstracted as part of the billing process. So, this pseudo-standard does not provide any new insights. Furthermore, I don’t believe this codification will do anything to improve the interoperability between providers and systems. In the end this is work for work’s sake. Busy work keeps us from implementing the rest of meaningful use that has true benefit to the patient and those that pay for care.
At least this is the way I see it. Am I missing something?
stratman65 says
Yes, first ICD-9-CM and soon ICD-10 are not billing codes. Yes they are used for DRG reimbursement and have been for a long time but if you know the history of ICD the purpose is not billing. It is a classification system really for the purpose of statistical analysis. SNOMED is for research. The flaw is with Meaningful Use and the the concept of problem lists. This is basically marketing for EHR’s. CMS wants the reason for admission and will be setting the bar higher for ICD10. ICD coding and Meaningful Use are separate topics and agendas. I’m afraid it will be a harsh lesson for most.