Is ICD-10 Implementation on Track?

Is ICD-10 more difficult to use compared to ICD-9? Well, first and foremost there is no choice available; all stakeholders covered under HIPAA, e.g. Patients, Providers, Laboratories etc., are required to start using ICD-10 codes if they are to stand a chance of getting reimbursed for their claim after October 2014. Worker’s Compensation and Auto Liability claims are the only exceptions to the rule. The only similarity between these 2 approaches is the process of looking up for codes. The differences otherwise start right from the format. While ICD-9 codes uses are generally numeric with 3 to 5 digits, the ICD-10 codes are alphanumeric with 3 to 7 characters. Most important difference lies in the fact that ICD-10 will require additional documentation to be which in order to provide more information for the codes chosen. External circumstances and the location of injury or accidents need to be captured. Thus from a current number of 13000, when ICD-10 gets implemented the number of codes will go up to 68000.

All this is being done with the intention of capturing the exact details of the cause of ailments of patients. The higher the precision of diagnosis, the better the chances of administering the best possible treatment. Thus, rolling out an ICD-10 is not to be looked upon as an update to the ICD-9 code set. The lack of specificity in the former is what might have triggered of the need for the later but its implementation is a comprehensive process. A coder for example cannot necessarily handle the job in isolation unless all the relevant information is available in detail. In any case, the best person to program manage the roll-out of ICD-10 coding standards in a healthcare setup has to be either of the three – the physician, the practice administrator/office manager, or the billing manager. The concerned person has to have the confidence of all the staff and the required level of authority to ensure a smooth transition. Each of the stages – assessing, budgeting, planning, communicating, training, implementing, and monitoring requires good astute leadership to drive the implementation. Although there are mapping tools now available, they do not necessarily provide a definitive code for a situation because a one-to-one mapping is not always possible.

Surprisingly, inspite of its binding nature, the implementation of ICD-10 has not been at the pace at which it is expected to be. Practices have expressed their concerns, with the top three being:

• The high cost of implementation
• Need for changes in clinical documentation
• Loss of productivity

Some other concerns expressed include the difficulty of documenting patient encounter and the difficulty in choosing the right diagnosis code. One of the surveys conducted indicated that cost for a 10-physician healthcare setup to overhaul its practice management system and electronic health record software was approximately going to be more than $201,000. This can act as a huge deterrent, given the high amount of investment needed, for setups of similar or larger sizes. A few providers though are hopeful that their respective vendors for PMS and EHR would handle the cost of upgrading since they will not be left without a choice.

However, the starting point of all this – co-ordination among the stakeholders has unfortunately not at the level at which it is expected to be. ICD-10 implementation is not just changes to be made to software; it will require a lot of healthcare software testing and training on the part of providers. Unless enough time and effort goes into the last 2 areas , providers might have to deal with a shock when they take a look at their cash flow post Oct 2014.

One of the reasons why the implementation could be a tough one of achieve is because it is being planned simultaneously scheduled with the Stage 2 Meaningful Use of EHR and state Health insurances exchanges. Besides the financial angle, the sheer amount of time and energy that all such parallel implementation will require from all concerned people in healthcare setups is going to affect their ability to meet their primary responsibilities – that of providing good care to their patients. But inspite of all the uncertainties, physicians do not have a choice but to see that they themselves are aware of the coding fundamentals and are actively driving their teams towards a planned implementation. If not, a rude shock seems inevitable.

We provide healthcare software development services. If you would like to know more about our expert healthcare software developers, please get in touch with us at Mindfire Solutions.

What would Big data in Healthcare mean

True value from a healthcare ecosystem can be derived when there is a balance between the cost for care and the outcome from it i.e. Healthcare spend and Patient impact. What Information is expected to provide is better insight and feedback on what is most effective and is required to be done in the healthcare eco-system. For e.g. it should prompt patients to make healthy lifestyle changes by exercising on a regular basis and having healthy diet in addition to be more involved in their treatment in the event of their falling sick.

During care, information exchange should happen in a seamless manner across all the concerned stakeholders resulting in a coordinated approach and avoidance of duplication of efforts. The right type of provider should also be prompted given the nature of care needed. This will increase chances of better outcomes given that the skills of the selected provider would be ideally suited to the case in hand. In terms of provider better value, the care should be most cost effective without any compromise on quality. Finally information is expected to increase the pace of innovations resulting in newer and safer methods of handling care and finding path breaking solutions in areas which have proven to be impregnable. It is expected to lead to better R&D productivity is discovery and development. Thus inclusion of Big Data in the fold of healthcare is expected to bring all of the above mentioned changes in the existing setup and transform the way in which care is provided moving forward. The emphasis is clearly on providing better outcomes at minimum cost without compromising on quality in any capacity.

Implementation of the Medicare and Medicaid EHR incentive programs has led to widespread adoption of EHRs everywhere. With the prospect of adoption of Big Data in Healthcare Industry very likely , the impact on EHRs is going to be an important factor to consider. The ones in use are not actually built to store large clocks of data . Since they are primarily designed to facilitate day-to-day patient care they are also at this stage not capable of handling the capacity of data created by various medical tools. The obvious solution is to create more advanced EHRs moving forward. For the existing ones, a stop gap solutions being used by some stakeholders is that of using auxiliary systems for the storage of data. Another important thing to be noted here is that the potential benefits of Big Data is based on the assumption that that providers have readily available information and they make evidence-supported decisions using analytic tools.

Analytical tools are of no value if reality is far removed from this assumption. There is also this concern of ensuring privacy. With more real-time, personalized data from a range of sources available, having defined and proven methods of securing their safety, includes during transition as well, is of high priority. Some stakeholders have expressed that as much as they happy and upbeat about the potential opportunities, they cannot help but also be concerned about the scrutiny and potential law suits that are likely to happen related to data security issues . As a solution, defined steps will need to be identified , agreed upon and subsequently adhered to by all concerned stakeholders to ensure that likelihood of such risks are kept at a minimum. Also to be able to make optimum use of the opportunity Big data will throw up, strong expertise needs to be developed in the areas of Data Analysis, Data Management and Systems Management. This is bound to create a need for human talent, who are thoroughly trained, to take up important roles in the entire eco-system.

The early adopters who are keen on taking on the challenge of changing their mindset and embracing something which can redefine the future of this industry are going to benefit a lot from it. However back up from strong leadership is what will be the key in these organizations from a successful outcome. In addition, Healthcare software testing companies would play a major role as well in testing the solutions being rolled out. They will be required to be thoroughly involved in setting up goals, determining and closing the gaps, designing the approaches of rolling out initiatives and finally ensuring continuous improvement.

We provide healthcare software development services. If you would like to know more about our certified healthcare software developers, please get in touch with us at Mindfire