July 2, 2013

Clinical Integration/Clinical Integrity: What is the Risk for I-10 Transformation?

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We in the healthcare industry who are working to meet the requirements and demands of interoperability (especially MU 2), plus the need to ensure we are able to receive actionable data from other sources, understand the need for clinical integration and clinical integrity. We understand that healthcare data needs to follow the patient/consumer, especially as we move toward medical team healthcare, as there must be integrity in the clinical documentation that is integrated into the medical record.

The American Medical Association (AMA) describes clinical integration as the means to facilitate the coordination of patient treatment across conditions, providers, settings, and time in order to achieve care that is safe, timely, effective, efficient, equitable, and patient-focused. The goal is a seamless delivery across the continuum of care. Some key concepts to grasp include the following:

  • Transitioning to ICD-10 is about linking clinically accurate patient documentation to coded information. The coded Information is integrated into the patient record to support the clinical picture.
  • Clinical integration is a fundamental component of a reformed healthcare system.
  • Clinical integration has been described as the "centerpiece to adding value and promoting performance" within a system.

So, how do we ensure that ICD-10 codes provide and preserve clinical integrity as the industry strives to meet the implementation deadline, then goes on to adjust during the next 24 months? One of the big challenges is how each organization translates codes from ICD-9 to ICD-10.

We know it will take time to resolve misalignment of codes and to introduce new ICD-10 codes once the code freeze is lifted, which means that there will be a need to monitor and manage clinical integrity for at least 18 months post-compliance.

It is also important to consider how ICD-10 will impact the use of eponyms in clinical documentation, clinical integration and clinical integrity.

Medical eponyms still frequently are used by physicians and taught to medical students and residents seeking to document inpatient procedures. Medical eponyms have been a part of the English language for a long time, and there has been a global attempt at standardizing them in order to achieve global clinical integrity. Medical eponyms are defined as the name of a disease, structure, operation, or procedure, usually derived from the name of the person who discovered or described it first.

Some common examples used today include the Spurling test, Mueller’s maneuver, Parkinson’s disease, Down syndrome, Krebs cycle, Hodgkin’s lymphoma, the Heimlich maneuver, Kocher’s method, etc. It is important to understand that medical eponyms have largely been eliminated in the lexicon of ICD-10-PCS procedural coding.

What does this mean to clinical integration and clinical integrity? The idea is that providers will need to replace eponyms with more detailed clinical documentation, specifically describing actual procedures and conditions in formal terms to allow for improved translation of medical events to codes to reimbursement. In replacing a medical eponym, providers will need to write details using greater specificity to substitute for the traditional understanding of the eponym. The reality is that the debate on the use and standardizing of medical eponyms is taking place around the world. To demonstrate how embedded they are in certain systems, an iPhone and iPad application has even been developed.

We need to ask ourselves about the risk of eliminating eponyms from ICD-10-PCS. What impacts will this have on clinical integration and clinical integrity?

There are some collaborative efforts taking place across the country, being driven by large hospital systems and payers. We know that there is a revival of support for HIE as well. Much of this is intended to create alignment for testing, but will it also help providers meet the critical challenges for clinical integrity to provide accurate reporting, data analytics, and patient records?

In other words, how do we get the industry to work in harmony? One of my mantras during the many years we have been working toward ICD-10 compliance involves emphasizing the need to build trading partner communities. It is critical for testing, but beyond that, it will become an important component of medical care in the U.S.

We can expect that trading communities and the overarching governance structure will assist in building data models for clinical integration. The first step in collaborative sharing will be to identify the individual moving parts of the full trading community, also focusing on second-tier support to the community, a sector whose data and knowledge brings expanded value to these data models. The mapping of the data is critical, especially as the industry completes the transition to ICD-10. Data quality, which is paramount to ensure clinical integrity, plus finding coding conflicts and possible duplicate patients with disparate medical profiles, adds to the challenges of ICD-10, potentially impacting clinical integration and clinical integrity.

Knowledge management and document management across the various sectors of the healthcare industry demands an enhanced degree of stewardship, with a focus on the owners of the data and the consumers/patients.

Clinical integration will drive research and development, future reforms, the empowerment of consumers, the improvement of clinical outcomes, cost reductions, and support for a more transparent healthcare delivery model!

About the Author

Ellen VanBuskirk, senior principal in business consulting for Infosys Public Services, is a healthcare consultant focused on compliance strategies with a mission to work across the Healthcare value stream to meet regulatory challenges. VanBuskirk has conducted business development efforts in support of healthcare compliance and reform, as well as ICD-10 transformation by both provider & payer organizations. With more than 20 years of success in leading business teams and identifying emerging opportunities and challenges in the healthcare industry, VanBuskirk brings deep expertise in health plan regulatory and compliance initiatives, including healthcare reform, ICD-10 transformation, meaningful use, HITECH and HIE.

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The ICD-10-CM Transition Is Like Learning to Drive

Ellen VanBuskirk

Ellen VanBuskirk is the national director of healthcare practice with Slalom Consulting and has held executive positions in provider, payer, and managed care organizations. She started her career in clinical delivery with an expertise in emergency medicine. Ellen brings her expertise of working for many years on the U.K. National Health Service Modernization Program, as well as her experience of working on global and domestic healthcare program change for her clients.