Switching to ICD-10-CM and ICD revision in the USA. This presentation was made at AHIMA conference in 2011. Now ICD 11 is scheduled in 2017 and ICD-10-CM can be made as a National Linearization.
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AHIMA ICD-10 ICD-11 switch to ICD-10-CM in the USA;
1. To code
or
Not to Code….
Managing Health Information in the 21st Century
Dr. T. Bedirhan Üstün
Coordinator, Classifications, Terminologies, Standards.
World Health Organization
4. Plot: Health Information Management
Context in the 21st Century
• Health care is a very high information-intensive sector
– Multidimensional: deaths, diseases, disability, risk factors, treatments, costs…
– Complex: genes, patient care, population health …
– Accurate information for life-long continuity of care
Health information sources are fragmented: integration is needed
•
Health care information is of vital
importance
– Multipurpose: Patient Safety, Population health & well being
– Policy decisions: how to make invest money in health
•
Health care information is worth
a lot
– Most countries spend 5-15% of their GDP on their health care
– People value health care in political choices
• External demands
– IT sector, economics, governments, international regulations
• Multiple stakeholders are involved / a common language is needed
– Policymakers; Providers; Clients
Health Information Systems & Standards need to be built jointly
7. Health Information Management
in the 21st Century
•
The 21st century ≡ CHANGE
•
Change 2000 – 10
last 10years
> Change 1900 - 2000
last century
Countries
managers
professions are not ready for this change
8. Why was transition to
ICD-10 in the
Wonderland delayed?
“Ain’t it broke, don’t fix it!” +Y2K
+…
• WHO developed ICD-9 in
1975
• USA implemented ICD-9-CM in 1979
4 years
• WHO developed ICD-10 in 1990
• USA will implement ICD-10-CM in 2013
23 years
• WHO will develop ICD-11 in 2015
• USA will implement ICD-1(CM) in 20??
?? years
9. Everything is linked…
Encoding software, Case mix systems, Medical record abstracting, Billing systems,
Registration and scheduling systems, Accounting systems, Decision support systems,
Clinical systems, Utilization management, Quality management, Case management,
Clinical protocols, Test ordering systems, Clinical reminder systems, Performance
measurement systems, Medical necessity software, Disease management systems
Provider profiling systems…
13. Health Systems & Information Systems:
Analog to Digital
How do we
optimize
our health
services
14. Health Professionals
Coders
Bridge-Coding
Data Structures GEMS
Codes Coding Guidelines
Updates on Codes and Coding Guidelines
Health Information
Root Operations:
Coder Training Manual
Clinical Documentation Improvemen
Assessments
Computer Assisted Coding Summit
Data Mapping in Electronic Health Records (online training)
Turnkey Solutions for Enterprise-Wide ICD-10
Training
Academy for ICD-10-CM/PCS
seminars/webinars on ICD-10-CM/PCS
CDI in Preparation for ICD-10-CM/PCS (on-line course)
SNOMED-CT®
Mapping
Modeling
15. AHIMA assets
• Knowledge
• Association – Organization – Network
• Potential – Capacity
Coding Health Information Management Quality
Accuracy
Timeliness
Reproducable
Complete
Responsibility
16. I want to be a
Health Information Manager
Just like my Mom…
17.
18. Problems with ICD-10
1. Driven by mortality and billing use cases
2. Used in 117 out of 193 countries for official statistics
3. Limited web presence
4. Does not interoperate with electronic health
records
5. "Frozen historical accidents"
6. Is just "a laundry list " – no definitions
18
19.
20. Key points on
transitioning to ICD-10
1.
ICD-9-CM is obsolete and the new version is ready for
implementation
2.
ICD-10 is needed to improve the quality of health
information
3.
ICD-10 is needed to support interoperable EHRs and a
NHIN
4.
ICD-10 is more precise and improves coding accuracy
5.
The benefits of ICD-10 outweigh the costs.
21. Key points on
transitioning to ICD-11
1.
ICD-10-CM is obsolete and the new version is ready for
implementation
2.
ICD-11 is needed to improve the quality of health
information
3.
ICD-11 is needed to support interoperable EHRs and a
NHIN
4.
ICD-11 is more precise and improves coding accuracy
5.
The benefits of ICD-11 outweigh the costs.
22. Health Information Standards
• ICD
– 1948
ICD-6
– 1990
ICD -10
– 2014
ICD-11
International Nomenclature Regulations
All Member States agree to use WHO
Classifications by treaty (1967)
•
• ICD -11 is being produced
•
•
•
•
•
•
Joint Authoring
Review
Field testing
Multiple Languages
USE CASES
BUSINESS Applications
23. WHO Classifications in HIS
ICD
ICF
Knowledge
Representations
Mappings
e-Health Record
Systems
ICHI
Classifications
Terminologies
Population Health Clinical
•
•
•
•
•
Births
Deaths
Diseases
Disability
Risk factors
Administration Reporting
• Decision Support • Scheduling
• Integration of care • Resources
• Outcome
• Billing
• Cost
• Needs
• Outcome
26. Why work together?
– WHO & IHTSDO
–
–
–
–
–
Coverage & Adequacy
Quality – Reliability - Utility
MultiLingual Applicability
Interoperability
Sustainability
– Member States:
Enable health care delivery
and compile health
information
SNOMED & WHO Classifications
are synergistic and not antagonistic
27. Rewriting ICD Using SNOMED
example of Depressive Disorder F32.0
A.
Low mood
{41006004}
Loss of interest
{417523004 }
Low energy
{248274002}
Appetite
(decrease, increase) {64379006, 72405004}
2.
Body weight
(decrease, increase) {89362005, 8943002}
3.
Sleep
(decrease, increase) {59050008, 77692006}
4.
Psychomotor
(decrease, increase) {398991009, 47295007}
5.
Libido loss
{8357008}
6.
Low self esteem
{286647002, 162220005}
7.
Guilt, self blame
{7571003}
8.
Thoughts of death …
9.
Suicide Ideation
B. 1.
{102911000, 6471006}
28. Digital Models
New business models
e-bay
e-trade
New products
e-health
e-banking
Existing products
e-media (music/video)
Existing business models
29. Sharing Ontologies: Knowledge Representation
"One day I read a book and whole my life changed "
Common sense/intuition Disciplined definitions
Orhan Pamuk, Nobel Literature Laurate, 2006
SALT
LAKER
30. What is “NOntology” ?
Ontology (philosophy)
the Organization of Reality
!!!
Ontology (computer science)
– the explicit – operational description
of the conceptualization of a domain
• Entities
• Atributes
• Values
•
An ontology defines:
– a common vocabulary
– a shared understanding/exchange:
• among people
• among software agents
• between people and software
– to reuse data - information
– to introduce standards to allow
interoperability
31. Computers are S T U P I D
? They cannot ask
questions
¿ They may –if you
enable them - only
give you
answers.
Pablo Picasso
32. Definition of Disease
a set of dysfunction(s) in any of the body systems including:
• with a known pattern of signs, symptoms & findings
» symptomatology - manifestations
• probably with an underlying explanatory mechanism
» etiology
• a distinct pattern of development over time
» course and outcome
• a known pattern of response to interventions
» treatment response
• with linkage to underlying genetic factors
» genotypes, phenotypes and endophenotypes
• with linkage to interacting environmental factors
33. THE CONTENT MODEL
Any Category in ICD is represented by:
1.
ICD Concept Title
1.1. Fully Specified Name
2.
Classification Properties
2.1. Parents
2.2 Type
2.3. Use and Linearization(s)
3.
Terms
7.1.
7.2.
7.3.
7.4.
7.5.
8.
4.1. Base Index Terms
4.2. Inclusion Terms
4.3. Exclusions
5.
Body Structure Description
5.1. Body System(s)
5.2. Body Part(s) [Anatomical Site(s)]
5.3. Morphological Properties
6.
Manifestation Properties
6.1. Signs & Symptoms
6.2. Investigation findings
Causal Properties
Etiology Type
Causal Properties - Agents
Causal Properties - Causal Mechanisms
Genomic Linkages
Risk Factors
Temporal Properties
8.1. Age of Occurrence & Occurrence Frequency
8.2. Development Course/Stage
Textual Definition(s)
4.
7.
9.
Severity of Subtypes Properties
10. Functioning Properties
10.1. Impact on Activities and Participation
10.2. Contextual factors
10.3. Body functions
11. Specific Condition Properties
11.1 Biological Sex
11.2. Life-Cycle Properties
12. Treatment Properties
33
13. Diagnostic Criteria
34. ICD11 Components
Foundation: ICD
categories with
- Definitions, synonyms
- Clinical descriptions
- Diagnostic criteria
- Causal mechanism
- Functional Properties
Find Term
SNOMED-CT,
International Classification of Functioning,
Disability and Health (ICF)…
Primary Care
Linearizations
Morbidity
Mortality
34
35. The ICD Foundation Component
• is a collection of ALL
ICD entities like
diseases, disorders...
• It represents the whole
ICD universe.
•
•
•
•
In a simple way, the foundation component is similar to a
“store” of books or songs.
From these elements we build a selection as a
linearization.
This analogy may however be misleading because there
are many links between the ICD entities (like parent-child
relations and other).
The ICD entities in the Foundation Component:
• are not necessarily mutually exclusive
• allow multiple parenting ( i. e. an entity may be
in more than one branch, for example
tuberculosis meningitis is both an infection and
a brain disease)
36. The ICD Linearizations
• A linearization is a subset of
the foundation component,
that is:
• Fit for a particular purpose: reporting
mortality, morbidity, or other uses
• Jointly Exhaustive of ICD Universe
(Foundation Component)
• Composed of entities that are Mutually
Exclusive of each other
• Each entity is given a single parent
•
The linearization is similar to the classical print version of ICD
Tabular Lists (e.g. volume I of ICD-10 or other previous
editions). Various linearizations could be built at different
granularity, use case or other purposes such as for Primary Care,
Clinical Care or Research. The linkage from the foundation
component to a particular linearization will ensure consistent use of
the ICD.
•
The ICD Entities are represented in a content model which has 13
46. Construction of ICD-10:
Revision Process in 20th Century
• 8 Annual Revision Conferences (1982
- 89)
• 17 – 58 Countries participated
– 1- 5 person delegations
– mainly Health Statisticians
• Manual curation
– List exchange
– Index was done later
• "Decibel" ? Method of discussion
• Output: Paper Copy
• Work in English only
• Limited testing in the field
47. Construction of ICD-11:
Revision Process in the 21st Century
• Internet-based permanent platform
– All year round
– Open to all people in a structured way
– Content experts focus
• Digital curation
– Wiki enabled collaboration
– Ontology based
• Enhanced discussion & peer review
– TAGs serve as the editorial group
• Electronic copy print version
• Work in multiple languages
• Planned field tests
– Based on Use Cases
49. What difference does it make?
Coding cycling accident in ICD-10
• V12.24 Pedal cyclist
injured in collision
with two- or threewheeled motor
vehicle, unspecified
pedal cyclist, nontraffic accident, while
resting, sleeping,
eating or engaging in
other vital activities
50. The history of cycling codes
• 1972 ICD-9 (E826): 8 codes
• READ-2 (T30..): 81 codes
• READ-3: 87: 82 codes
• 1999 ICD-10: 587 codes
51. Defusing the exploding bicycle:
500 codes in pieces
•
10 things to hit…
– Pedestrian / cycle / motorbike / car / HGV / train / unpowered vehicle /
a tree / other
•
5 roles for the injured…
– Driving / passenger / cyclist / getting in / other
•
5 activities when injured…
– resting / at work / sporting / at leisure / other
•
2 contexts…
– In traffic / not in traffic
V12.24 Pedal cyclist injured in collision with two- or three-wheeled motor vehicle, unspecified pedal
cyclist, nontraffic accident, while resting, sleeping, eating or engaging in other vital activities
52. Conceptual Lego… it could be...
Goodbye to picking lists…
Structured Data Entry
File
Edit
Help
Cycling Accident
What you hit
Your Role
Activity
Location
59. Post Salt Lake City :
WHO AHIMA collaboration
• ICD Revision
• Joint Authoring
• Review
• Field testing
• Multiple Languages
• USE CASES
• BUSINESS Applications
• Coding clinical information
• Classification Linkages with SNOMED
• Get the EHR right
Editor's Notes
The titular hero of one of Shakespeare's most famous tragedies, Hamlet, has probably been discussed more than any other Shakespearean character, especially for his famous soliloquy "To be or not to be; that is the question".[89]Unlike the introverted Hamlet, whose fatal flaw is hesitation, the heroes of the tragedies that followed, Othello and King Lear, are undone by hasty errors of judgement.[90]
Implemented in 1979 in U.S.Expanded diagnosis codesDeveloped procedure coding systemICD-9-CM Diagnoses –used by all types of providersICD-9-CM Procedures –used only by inpatient hospitalsCurrent Procedural Terminology (CPT) –used for all ambulatory and physician procedure reportingReimbursement –Medicare Severity-Diagnosis Related Groups (MS-DRGs)Adjudicate coverage –diagnosis codes for all settings Compile statisticsAssess quality
ICD-9 codes are running out in many important categories including cardiac and orthopedic procedures. CMShas been placing these procedures in completely unrelated categories for procedures performed on ears and eyes.Finding these cardiac and orthopedic codes would be like trying to find your favorite fiction book in the stacks at the Library of Congress that someone haphazardly placed in the autobiography section.
ICD-9 codes are running out in many important categories including cardiac and orthopedic procedures. CMShas been placing these procedures in completely unrelated categories for procedures performed on ears and eyes.Finding these cardiac and orthopedic codes would be like trying to find your favorite fiction book in the stacks at the Library of Congress that someone haphazardly placed in the autobiography section.
Comprehensiveness:Coverage for all aspects of health careAdequacy:Is it fit or purpose – multiple purposes?Does it have a good information model and ontological basis?Multilingual applicabilitylanguage independent formal concept representationRepresentation in multiple languages – more than translationUtility:Is it beneficial for: Care providers : decision making, outcome evaluation Consumers : participation – ownership – evaluation – risk reductionPolicy/Decision Makers : informed decision making on costs, benefits, efficiencyReliability:does it give the same results in different usersValidity:Does it indicate the right things – and does the indication make senseInteroperabilityTechnical: Can information systems exchange information and use it? Semantic Can information systems interpret the data with the same meaning? SustainabilitySecured maintenance: commitment to stability with earlier versions Openness to address emerging technical issues
Search specific parameters
Linearizations can be browsed searched in a similar fashion.Easy to switch between Foundation Component and Linearizations
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