| Electronic Health Records and ICD-10 |
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The value of the information housed in each and every patient’s Electronic Health Record (EHR) in every health organization is at risk. A national health information infrastructure and a standard EHR both require the use of uniform health information standards and a common medical language in order to link data within an EHR system or share health information between systems. This common medical language consists of clinical terminologies and classifications, with maps to link them. These standard clinical terminologies must be incorporated into EHR systems in order to effectively achieve system interoperability and the benefits of a national health information infrastructure. Classification systems, like ICD-9 and ICD-10 are not designed for the primary documentation of clinical care. They are the most common source of clinical data today, however, although they are inadequate in a reference terminology role because they fail to define individual clinical concepts and their relationships. But SNOMED-CT reference technology codifies the clinical information captured in an EHR. It is designed for use only in EHRs, because of the number of terms and level of detail it contains, which cannot be managed effectively without automation. Considering that ICD-10 was released in 1994 by the World Health Organization (WHO) but it still hasn’t been adopted by the U.S., it is long overdue. ICD-10 is supposedly coming eventually as part of HIPAA legislation, but no one knows for sure when it will happen. The health information contained in an EHR system will only be fully maximized if both systems involved in the map (SNOMED and ICD) are up to date and accurate. Mapping is the process of linking content to a classification or linking one terminology to another. Mapping is not specific to a particular patient encounter, unlike coding. SNOMED-CT was adopted as the Consolidated Health Informatics initiative and license agreement between the National Library of Medicine and SNOMED International as the clinical language of medicine in the U.S. The eventual use of SNOMED will not eliminate the need for the classification systems that we use now. Even with fully employed terminology systems, says Kloss, health information professionals do see an ongoing need for classifications to permit collection of clinical data for administrative purposes, including health policy decisions, reimbursement, and statistical and epidemiological analyses. “It makes no sense to map a robust terminology such as SNOMED-CT to an outdated classification system such as ICD-9-CM . . . The anticipated benefits of an EHR cannot be achieved if the reference terminology employed in the EHR, such as SNOMED-CT, is aggregated into a 30-year-old classification system, such as ICD-9-CM, for administrative use and indexing,” explains Sue Bowman, RHIA, CCS (“Coordinating SNOMED-CT and ICD-10,” Perspectives in HIM, AHIMA, 2005, www.ahima.org/perspectives). Bowman states that the longer that the implementation of ICD-10 is delayed, the more expensive it will be and the longer it will take to achieve a fully functioning EHR with the interoperability necessary to share healthcare data. ICD-9 is a 30 year old system and no longer can accurately describe the practice of medicine. Using this system jeopardizes the ability to “effectively collect and use accurate, detailed healthcare data and information for the betterment of domestic and global healthcare,” according to Linda Kloss, author of “The Promise of ICD-10-CM,” Health Management Technology, July, 2005. “By failing to upgrade, we could find ourselves building an infrastructure that does not provide the information necessary to meet the healthcare demands of the 21st century . . . ICD-9-CM also cannot address the increasing pressure for more specific codes, especially codes that represent new technology. Outdated codes provide inaccurate or limited data and insufficient detail related to health diagnoses, procedures, and technologies . . . Many new healthcare diseases and services can no longer be described accurately using ICD-9-CM.” The U.S. is the only developed country that has not adopted ICD-10. Of course, cost is a factor for the adoption delay, but waiting will only increase future implementation costs. But reduced healthcare costs will result once a more specific coding system like ICD-10 is adopted. Kloss points out that not only will ICD-10 leverage our investment in EHR, but it will also give the U.S. healthcare system the following:
She also notes that the U.S. is making it more difficult to share disease and mortality data now, a time when global sharing is essential for public health issues. ICD-10-CM would have, for example, better documented SARS and West Nile Virus for better tracking and earlier detection. ICD-10 is seriously long overdue in order for the U.S. to catch up in matters of public health and safety and to effectively utilize EHRs. The full benefits of EHRs cannot be realized if we don’t improve the quality of data that they are designed to manage. We may be striving to get ahead in health care by employing more complex technology, such as EHRs, e-prescriptions, electronic medical billing, etc., but we are still falling behind compared to the rest of the world in terms of ICD-10, and that’s hurting us. The following steps are essential, according to AHIMA, in order to maximize the power of healthcare data and build a better healthcare system:
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