Re: ICD10 delay
First it is excellent that it is going to being delayed. I am a critical care physician and have used many EMR
I have been involved when I was DOD healthcare implementing EMR and telemedicine
ICD 10 is generally a good product for its specificity and granularity. I am familar with the people who worked on SNOMED. In reality Snomed has been close to 20 years and althoug it has great specificity and exactly more in line with physicians thinking , it is cumbersome for physician to use and it is great for an healthcare dictionary for coding.
1. To make this right, this needs to be field tested by physicians in many organizations and study completed to see if it has any significant improvement in outcomes, qulaity of care, and improves productivity and efficiency.Goal is not to make physicians a documentation puppet but to give care to patient. Looking at the ICD 10 compared to ICD 9, ICD 10 is certainly will cause more physicians to be less productive. The reality is even with present EMR including EPIC and Cerner (has better coding database) most physicians do not use the EMR codes. Problems and diagnoses are not necessary updated. In reality most physicians free test codes. I suspect the of ICD 10 will be to free text more codes in their progress notes rather than wasting time with granularity that govt, healthcare informatics zealots, and the lobbyist who want this system. The bottom line if it impacts productivity do not expect that physicians will use this. I suspect in general that greater details may produce some more reimbursement but at the expense of multiple times to get right codes in. I suspect the reimbursements will decline for physicians overtime in spite of extensive more documentaton.
2. We should know what percent of the codes ICD 10 documentation improves reimbursement for physicians. I
3. Although ICD 9 to ICD 10 calculators will be helpful, it still is cumbersome mainly because you are going to have detail ingreater depth the diagnoses. You need severity, laterality, associated conditions, etc. This is onerous.
4. Many statements are being made how it will improve quality of care, outcomes, better data, better reimbursement. I take all these statements for granted and there is not much to support these claims.
5. Like a family practic doctor said,the laterality and other specificy in coding does not make much difference for healthcare insurances for reimbursement. There are going to be exceptions but I do not see the granualrity that has needed here .
6. ICD 10 would be ideal for one problem: Death certificates. IF Information in ICD 10 if it could be entered on death certificates will be a better tool to document events leading to a patients death and therefore a bettter comparison on outcomes on international level for various countries.