A number of themes have been prevalent at this year’s AHIMA show, taking place this week in Salt Lake City. Healthcare information management professionals have a number of big priorities – the transition to ICD-10 being the most prevalent, at least from what I’ve seen on the show floor so far. Recruitment is a close second. With a number of colleges and healthcare systems present as exhibitors, it’s obvious there is a need for trained HIM professionals. In speaking with folks from the Region D Health IT Workforce Development Program, part of the Community College Consortia Program, which hopes to train more than 10,500 healthcare IT professionals by the end of this year, it is evident that there are resources out there to train folks, and they are willing to get the word out about it.

AHIMA has recognized this need for job creation. It announced at the show on Monday that it has created the HIM Jobs for America Initiative, and has entered into a public-private partnership with the Department of Health and Human Services and North Shore Medical Labs.

In announcing the initiative, Bill Rudman, vice president, educational visioning at AHIMA and executive director of the AHIMA Foundation, explained that “AHIMA wants to build a partnership with business, academia and the federal government to create the estimated 40,000 jobs required to properly build and maintain a national electronic health records initiative.”

As part of the initiative, AHIMA will provide six hours of free healthcare IT training to healthcare professionals in underserved communities, first focusing on physicians in small practices in North Carolina, Mississippi and Alabama. The program will provide 100 participants with EHR licenses for one year. North Shore will donate electronic health record software and services via Nortec Software, a provider of EHR technology, as well as medical billing and transcription services.

As I mentioned above, the transition to IDC-10 has been THE big theme in the exhibit hall. I’ve noticed solution after solution exhibited at booth after booth created to help physicians make the transition. As John Lynn mentioned in an earlier post, some companies are taking a light-hearted approach in marketing their ICD-10 solutions. Take QuadraMed, for example, which kept attendees happy Sunday night during the evening reception with special ICD-9 and ICD-10 cocktails. Or, as John mentioned last week, Conifer Health, which has quickly run out of its ICD-10 stickers.

All kidding aside, the transition to ICD-10 and the impact the new codes will have on patient care is no joke. Paula Lawlor, RHIA, President of Clinical Revenue Cycle Services HIM at Conifer, spoke with me briefly about what Conifer is doing in the area health information management and clinical revenue cycle services:

I’ll be walking the show floor today, and hope to have a wrap-up of EMR-related technologies for next week’s post.

In case you missed it, I wrote an entertaining (at least I thought it was) post about some of the amazingly specific ICD-10 codes that are out there. I’m headed to AHIMA which starts on Sunday and I’ve had a preview of a vendor, @coniferhealth, capitalizing on some of these codes with some stickers they’re handing out. I’ll embed a picture of one of these stickers at the bottom of this post.

Turns out that not everyone is happy with this light hearted approach to discussing what amounts to a major major shift from ICD-9 to ICD-10. The Wall Street Journal posted some of the responses they got to their original article. Here’s one sample response:

Having a different code for every single artery or the specific bone that’s fractured helps improve continuity of care. A patient who is hemorrhaging can get lifesaving care more quickly when the physician can immediately identify precisely where the broken suture is located. In addition, including the specification that the patient was “bitten by turtle” justifies the patient receiving additional tests or treatments, as turtles carry different bacteria than, say, parrots or turkeys. This and other tidbits of information will support more efficient and effective reimbursement processes.

The benefits we will derive from our global health-care community are tremendous. Once the U.S. finally transitions to ICD-10, we will again be able to share important data with every other civilized country

Although, not everyone is so serious. Arthur Broaderick, M.D. offered the following question, “Doctors closing their practices in droves; is there a code for that?”

As you know, I regularly like to highlight some of the best and most interesting comments on my various websites. Especially since I know many of you don’t read all the comments (shame on you). This comment on meaningful use comes from someone who identifies themselves as SoftwareDev and works for an EMR vendor:

Coincidentally, I actually came up with the exact same conclusion [see original post] when reviewing the specs the other day. What I mean is, I identified that the way that we track “problems” in our software serves our customers well, but doesn’t really meet the measurement method of Meaningful Use.

In my app, I can record a “problem” using an ICD-9 code on the patient record (chronic) as well as on the visit (acute/episodic, based on Dx attached to the charges posted for that encounter). I also track descriptive (non-standardized) phrases in our Medical History. The former is good because it meets the standardized terminology requirement, but it fails because I don’t keep a “history” of active, or inactive problems. The latter is good because it is more “all encompassing”, including problems that the patient isn’t actually being seen by this particular doctor for, but also fails because it isn’t recorded by ICD-9 code and descriptor.

Either way, I have to revise the software’s method of recording “problems”, both for historical purposes and for proper coding, and ONLY to meet the Meaningful Use requirement. Not a single customer has ever voiced a request remotely like this to me in my 12 years of handling software in this sector.

Descriptions like this is why I’m concerned about the impact of meaningful use. There’s little doubt that the EHR incentive money has stimulated interest and even purchasing of EMR software. I just wonder what unintended consequences will come from meaningful use and EHR certification. Sadly, the above description may meet meaningful use, but doesn’t sound like meaningful patient care.

While it’s all well and good to prepare for Meaningful Use compliance, IT departments may be going a bit overboard.  A new survey by HIMSS has concluded that providers are being diverted from critical efforts like the HIPAA 5010/ICD-10 transition by efforts to capture MU bonuses.

It’s hardly surprising, given the tempting candy MU incentives offer, but it’s a bit worrisome too.  After all, preparing for 5010 transactions requires a mountain of work, touching electronic claims, eligibility verification, claim status, referral certification and more.  This is NOT something you can afford to ignore, particularly given the risk of incurring CMS’s wrath.

Consider this:  a full 35 percent of the providers responding to the HIMSS survey this summer said they had no plans at all in place to implement a 5010 readiness project. This despite the fact that they were supposed to begin testing by January 1 of this year.

Instead, HIMSS found, providers are spending much of their time working to qualify for MU money, neglecting the 5010 transition for now.  The HIMSS folks hypothesize that providers are laying low on 5010 now, hoping to squeeze in under the January 1, 2012 final deadline. Hey, maybe if IT leaders stick their heads in the sand long enough, the deadline itself will go away!

In reality, we all know what will happen — the same thing that happens whenever an enterprise punts on a critical initiative. Over the next several months, expect facilities to dump truckloads of money on vendors and tech help. Consultants, start your engines!

I got the following email from an EMR vendor talking about a simple feature in their EMR that really adds value to their end users. The feature revolves around making the ICD-9 billing codes into something useful beyond billing. Here’s his message:

I was talking with one of my pediatrician docs the other day and she was saying how un-useful ICD-9 is for her. As part of her note in the EMR she has to code things saying otitis media. But, the important thing to her is saying “3rd ear inf. in 2mo”. It is this brief summary note that she includes in what we call an “interim” field in our EMR. That is what she looks for to get her “ah-ha” in working with kids. Looking down a list of previous visits which show date of service and primary dx takes mental work and analysis. But, being able to see this brief note on the next visit is what makes her do her job better – more meaningful shall we say?

These are the things that make EMRs great.

If you have other useful features that make your EMR great, feel free to submit them on my Contact Us page and I’ll post them in the future.

Today’s guest post is from Tony Lavinio, the principle software architect behind Progress DataDirect’s XML Converters and an expert on data exchange. Understanding the integration and data compliance pains experienced by healthcare organizations, Tony and DataDirect have developed a HIPAA toolkit to help Healthcare IT developers alleviate some of the challenges they’re facing with HIPAA 4010 and 5010 and ICD-10 projects.

The government has allocated healthcare providers over $36 billion of ARRA stimulus money to help the adoption of Electronic Health Records (EHRs) and in support of Health Information Exchanges (HIEs). Healthcare providers that coordinate EHR clinical information with administrative data will streamline their health records administration. Those organizations that implement a single, unified IT infrastructure to handle both EHR and administrative data will gain a significant cost saving and, ultimately, improve the quality of patient care.

However, to unify IT infrastructure healthcare providers face the estimated $14 billion challenge of complying with new coding standards. These standards set forth by the United States Department of Health and Human Services on Jan. 15, 2009 specify that X12 Electronic Data Interchange (EDI) transaction definitions for version 5010 – used in conjunction with HIPAA transactions, which are exclusively administrative data transactions – must be completed by January 2013. The new standards also require healthcare providers to comply with an International Classification of Diseases (ICD) standard update, from ICD-9 to ICD-10 by October 2013. The close relationship between HIPAA transaction sets that can directly refer to ICD-9 or ICD-10 codes have health industry IT professionals on the ropes.

The HIPAA 4010 to 5010 upgrade is a positive evolutionary change, improving the efficiency of healthcare data transactions. The ICD-9 to ICD-10 change is much more radical. ICD-9 list was first developed over 30 years ago and over that time has become deeply embedded into systems. Making the ICD-9 to ICD-10 transitions even more difficult is that the list for ICD-10 code updates is approximately 10× the length as ICD-9, with generally no 1:1 mappings between them. Sometimes there are a series of codes, sometimes there are alternatives that will take external information, and sometimes there are no direct alternatives. Healthcare IT professionals must figure out a way to accommodate changes in data when it has been moved, and overcome the fact that new data must be extracted from new sources to augment the legacy data.

With so much data to convert, Healthcare IT professionals struggle to find a logical starting place. Progress DataDirect has given Healthcare IT professionals a way to jump-start their EDI transaction definitions version 5010 and ICD-9 to ICD-10 data conversion projects with the company’s HIPAA/ICD Upgrade Toolkit.  Though each healthcare application is different and will need tweaking, using the examples provided in the Toolkit will make it far easier than starting from scratch. Some of what you’ll find in the starter-kit includes:

• XQuery source for upgrading each of the 10 transaction sets from the HIPAA 4010 to equivalent 5010 version
• 50 sample 4010 files to use with the above
• ICD-9 to ICD-10 maps
• A sample tool to compare the changes between ICD-9 codes and their closest ICD-10 analogs with HTML output
• An XQuery program which will read a HIPAA file containing ICD-9 codes and report on any potential conversion troubles with ICD-10
• An XQuery program to read a HIPAA EDI file and covert it from 4010 to 5010 and from ICD-9 to ICD-10  simultaneously

How it works is DataDirect XML Converters make EDI behave like XML. Then a small XQuery program, which is really good at rearranging XML, is able to transform thousands of EDI and flat-file formats to XML and back with little or no development time or expense or major re-architecting. For more information on transforming data in HIPAA 4010 X12 files and translating ICD-9 codes visit DataDirect’s Blog.