June 19, 2012

HIM, ICD-10 and Understanding Meaningful Use, Part II

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EDITOR’S NOTE: This is the second of a two-part article addressing the facts, adoption, implementation and the interconnectivity of ICD-10 and Meaningful Use.

The Stage 1 Meaningful Use program is being touted as a success by the Centers for Medicare and Medicaid Services (CMS).  “To date more than 43,000 providers have received $3.1 billion to help make the transition to electronic health records (EHRs); the number of hospitals using EHRs has more than doubled in the last two years from 16 to 35 percent between 2009 and 2011; and 85 percent of hospitals now report that by compliance date for stage one, 2015 they intend to take advantage of the incentive payments,” reports Marilyn Tavernner, Acting Administrator for the Centers for Medicaid and Medicare Services.

Since the CMS announcement to postpone the implementation date of ICD-10-CM/PCS, we are all waiting with baited breath to learn how long the possible postponement will be. The postponement raises questions in the healthcare industry surrounding EHRs and their interconnectivity to ICD-10, opportunities for improved continuity of care, quality of documentation, and reasonable reimbursement for the level of treatment a patient receives? In the last article, we explored the basics of Stage 1 Meaningful Use. In this installment, we will begin to show how each step in Stage 1 can be favorably impacted by ICD-10 classification integration before the deadline of either ICD-10 or Meaningful Use. In other words, both issues pose massive changes to the way healthcare does business, so why not plan the implementation of both so we can seize the opportunities that will be presented by each initiative both clinically and monetarily.

Let’s start by restating the goal of Meaningful Use:

“The ultimate vision of the EHR is that all patients have become fully engaged in their own healthcare and providers have real time access to all medical information and tools to ensure the quality and safety of care while also affording improved access and elimination of healthcare disparities.” CMS, June 1, 2009.

We should also review the Stage 1 core objectives, of which hospitals must complete; 14 of the core objectives, in addition to, 5 objectives from the Menu set, and report through the EHR 15 clinical quality measures.

Stage 1 Core Objectives:

  1. Use CPOE
  2. Implement drug to drug and drug allergy interaction checks
  3. E-Prescribing (EP only)
  4. Record demographics
  5. Maintain an up-to-date problem list
  6. Maintain active medication list
  7. Maintain active medication allergy list
  8. Record and chart changes in vital signs
  9. Record smoking status
  10. Implement one clinical decision support rule
  11. Report quality measures as specified by the Secretary
  12. Electronically exchange key clinical information
  13. Provide patients with an electronic copy of their health information
  14. Provide patients with an electronic copy of their discharge instructions (Eligible Hospital/CAH Only)
  15. Provide clinical summaries for patients for each office visit (EP Only)
  16. Protect electronic health information created or maintained by certified EHR

There are several steps of the Meaningful Use mandate that are interrelated. Computerized Physician’s Order Entry (CPOE) pharmaceutical orders top the mandated list. Many of the mandates naturally support each other, so it is better to look at them as a group. The support system that makes CPOE a real technology leap is the clinical decision support (CDS) system, which is also mandated in the top 15 core measures. Included in the support structures for CPOE are drug-to-drug and drug allergy interaction checks, computerized and updated patient problem lists, patient active medication lists and patient active medication allergy lists.

 


 

CPOE is an application that enables providers to enter medical orders into a computer system for inpatient or outpatient records. CPOE replaces the traditional methods of placing medication orders, including written (paper prescriptions), verbal (in person or via telephone), and fax. Most CPOE systems allow providers to electronically specify medication orders as well as laboratory, admission, radiology, referral, and procedure orders. The value of this application can be recognized immediately.  Written paper prescriptions are often illegible, and must be incorporated into the medical record, verbal and phone orders must be transcribed into the record, and faxed orders must also make into the medical record.  But the value is enhanced 10 fold if a CDS system is added as well.

CDS is technology that provides clinicians with instantaneous feed-back on clinical, diagnostic and treatment related data that can look for a variety of possible errors. Some examples include drug interactions, patient allergies to medication, medication contraindications, and renal and weight based dosing. This addition can potentially encompass 6 of the required core measures.

If we then take the new CPOE system one step further and include ICD-10-CM nomenclature, the hospital would begin to see a real change in data management. ICD-10-CM is a leap into the present in relation to disease specificity and granularity. The use of ICD-10 nomenclature will support the CDS technology in that diagnoses are much more descriptive of the depth and severity of the disease, and they will better support medical necessity and the use of other clinical support systems such as SNOMED-CT. ICD-10 also makes a concerted effort to standardize clinical language, which will aid the mission of an EHR and allow concise documentation of a patient’s medical history and all clinical encounters for utilization by all future healthcare providers on behalf of the patient. ICD-10-CM is a natural part of healthcare progression into value-based purchasing and the future of health delivery.

About the Author

Sandra Draper, RHIT, CCS, is director, education development, with Precyse. She is a certified ICD-10 CM/PCS trainer with more than 27 years experience in HIM and coding and has held the position of VP of HIM, conducted HIM department assessments, and is a published author and speaker.

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Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.