ICD 10: Challenges for Family Physicians, Specialists

Although a lot of the buzz has drifted away from ICD-10 (for now) due to it’s delay, I cannot help but think about the challenges many physicians will face once October 1, 2015 finally comes. I often observe physicians while they search ICD-9 codes in the EHR to add to a patient’s chart while documenting a visit. I’ve also spoken with a few about what they think about ICD-10 and it’s implications. From my experiences, it’s apparent that most doctors aren’t very excited for the switch to ICD-10.

I believe physician resistance to ICD-10 can be boiled down to two core reasons:

1. Physicians don’t have the time to spend searching for specific codes. (laterality, status, manifestation) They’re already over-burdened with documenting in their ambulatory EHRs by having to check off dozens of boxes to satisfy Meaningful Use stages 1 and 2, Clinical Quality Measures, etc. Many specialists have a dozen or so ICD-9 codes memorized so they can just type them in and move on with the visit – this will no longer be feasible with ICD-10’s alphanumeric mix and increased code length.

2. Physicians don’t seem to even care about ICD-10. From their perspective: It makes their job harder – so what if it’s for better health reporting, “streamlined” billing, or research purposes – the bottom line is, it will undoubtedly take them more time to diagnose a patient via ICD-10 than ICD-9 using traditional search tools.

So, how do we address these problems?

I’m interested in seeing how EHR vendors proactively tackle this problem. I haven’t seen all the tools available (vendor-created and 3rd party) to physicians for coding in ICD-10, but my best guess is that they aren’t going to be free, and they aren’t going to be all that helpful.

I would love to see Computer Assisted Coding (CAC) find its way into the EHRs for ICD-10. Given many of the items (laterality, status, manifestations) physicians already check off or free text into the EHR, there’s plenty of available data to extract and use as “search refiners” when they click “Search For Diagnosis”. That way, if the doctor has already typed in or checked off information regarding the patient’s condition/side/status/manifestation and goes to click “Search For Diagnosis” – the results that populate are pre-filtered with the information provided in their documentation. Giving the doctors an easy way to populate as short of a list as possible is key, in my opinion.

I have seen this first hand – you give a doctor too long of a list of diagnosis codes and they will pick whichever one is the most general that way they aren’t technically wrong, and they can slide it by the payer (more about this in a later post). Since the goal of ICD-10 is detail, we need to set the physicians up for success.

The Good News: There are companies out there working on CAC solutions for ICD-9 and ICD-10. A notable example is Nuance’s Clintegrity 360, among others.

The Bad News: CAC solutions aren’t a built-in feature of any ambulatory EHR (to my knowledge), and will be an expensive add-on that physicians or physician groups will have to purchase in order to improve coding productivity. Ideally, EHR vendors need find a way to make this technology a component of their application suite at no extra charge.

Final Thoughts: Don’t get me wrong, I’m all for ICD-10… but the healthcare industry is in a very delicate position right now. ICD-10 needs to be implemented in a way that impacts provider’s workflow in the smallest way possible so they can focus on achieving Meaningful Use incentives, and most importantly, caring for their patients.