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ICD-10 is Worthless

Posted on September 19, 2015 I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

Man it’s been a long time since I have been here…but I have been busy fighting the good fight in other places.   The major push for the past year has come from my position as a board member for the Docs4PatientCare Foundation.  With this has come an every other Thursday chat radio hosting gig for a one hour radio show, The Doctors Lounge.  I frequently discuss health IT topics, but not always.

I have been preparing my practice for ICD=10, a disaster coming soon to a doc’s office near you.  I have one article on ICD-10 that has been published in The Heritage Foundation’s The Daily Signal, which follows.  Another more technical article is also in the pipeline which I will share here when it comes out.

 

 

As Oct. 1 approaches my inbox fills more every day with junk mail from health IT vendors offering solutions to my presumed panic.

What panic? Well, as most inside medicine know, Oct. 1, 2015, is a red-letter day that will bring the biggest single change to medical billing in the last 30 years (thanks to Congress).

Although this might not sound too scary, it will most certainly affect every American, and it has the potential to bring chaos to the health care system.

The current medical coding system, which has been in place for decades, has had successive updates built on the one before in a logical sequence. But the new coding system, named ICD-10, will be a complete break from the nine versions before it.

What’s the Big Deal?

For starters, few outside medicine understand the complex process required for doctors to get paid by insurers for their work, but those who don’t understand are nevertheless affected by the process.

To get paid, a doctor must properly log any work done, along with the reason it was done (the diagnosis), with an assigned code chosen from huge manuals containing tens of thousands of codes.

Medical coding is complex and has no room for error (I know; it’s what I do). Pick the wrong code, and a doctor will not get paid. Pick too many wrong codes over time, and a doctor might be investigated by the government. Over the years, an entire industry has sprung up dedicated solely to medical coding.

The number of codes has increased from about 15,000 to almost 70,000, and no code that appears in ICD-9 is valid in ICD-10.

Decades of coding experience will be carelessly tossed out the window, leaving many doctors to spend precious time figuring the new system out rather than actually treating their patients.

Supporters of ICD-10 (insurance companies, bureaucrats, health IT vendors, and academics) assure us doctors that it is worth the sacrifice.

They say that ICD-9 is outdated and lacks the capacity to cover the breadth of modern medicine, and it is true that almost every other country uses ICD-10, so it is time for us to “get with the program.”

How the New Coding System Was Chosen

I have been preparing my practice for ICD-10 since the congressional hearings on it last February.

After watching the farcical proceedings, it was clear to me that the “fix” was in.

The chairman of the committee professed his support of ICD-10 before the first witness uttered a single word. Those who testified were mostly a parade of IT vendors, all of whom stood to profit handsomely from ICD-10.

When I began studying the ICD-10 code structure for my specialty, otolaryngology (ear, nose, and throat, or ENT), I was shocked. ICD-10 codes are indeed increased in number from ICD-9, but there is absolutely no rhyme or reason to the expansion.

Codes for ear problems are obsessively divided into those for the left ear, right ear, or both.

For the diagnosis of dizziness due to a problem in the brain (which by definition does not involve the ears), one must still choose left ear, right ear, or both.

Although those of us in ENT medicine have yet to find any left/right differences in ear pathology, one could argue that with better data collection, maybe we’ll discover something new.

If that’s the case, then similar logic would assume that all ICD-10 codes for ENT are divided into left and right. Apparently not.

Beyond codes for ear diagnoses, almost nothing is coded by side.

For the rest of the article, click here

What Does ICD-10 Ready Software Really Mean?

Posted on September 18, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve been having a number of conversations with people about the coming switch over to ICD-10. Invariably those conversations lead to a discussion around how EHR vendors have implemented ICD-10. I can pretty much promise you that every EHR vendor still in business has some way to support ICD-10. However, just because they can support entry of an ICD-10 code doesn’t mean they’re providing the EHR user a good tool to discover the correct ICD-10 code.

This discussion was highlighted really well in these two tweets:


And Joe’s response:

I’ve only seen one EHR vendor who had an amazing ICD-10 coding tool. It basically did all the coding for you as part of the documentation. I’ll be interested to see how well that tool plays out in a real life environment, but their approach is unique and beautiful. I’ve seen some others that do a decent job. I’ve seen others that still apply the standard search box methodology that’s been used for ICD-9. Good luck to those people.

However, this tweet from Erin Head made me cringe even more:

I’ll be interested to see how doctors still on paper react to the change to ICD-10. It’s coming! Are you ready? Is your EHR ready or do they just say they’re ready? We’ll know soon.

DeSalvo Says We Need Common Interoperability Standards – I Think There’s More To It

Posted on September 17, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I came across an article on FierceHealthIT which has a really fascinating quote from Karen DeSalvo, National Coordinator for Health IT. Here it is:

“What seems that it would have been helpful is if we had agreed as an ecosystem–the government, the private sector–that we would have a set of common standards that would allow us to have more seamless sharing of basic health information,” she said. “We’re moving toward that with the industry, but I think what that’s created is a complexity and aggregation of data … In hindsight, maybe some more standardization, or a lot more,” was necessary.

Is lack of a standard what’s keeping healthcare from being interoeprable?

I personally don’t think that’s the biggest problem. Sure a standard would help, but even with the best standards in the world if organizations see data sharing as contrary to their best interest then no standard will overcome that view. It’s been said many times that we have an issue of desire and will to share data. It’s not a technical problem. Sure, a standard would be helpful once there is a will to share data, but if organizations wanted to share data they’d figure out the standard.

Later in the article, CommonWell Executive Director Jitin Asnaani said “Standards are not standards because we say they are; standards are standards because everybody uses them.

This is the problem. People don’t want to share health data and so no standard is being used. I still wish they’d blow up meaningful use and use the rest of the money to incentivize organizations to start sharing. People went bat crazy implementing an EHR as they chased government money. I’d love to see healthcare organizations go bat crazy becoming interoperable as they chased the rest of the government meaningful use money.

Ways to Not Rank EHR Vendors

Posted on September 16, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of my pet peeves is organizations that put out rankings for EHR vendors that are based on really low quality factors and metrics. I’ve put a graphic I recently found at the bottom of this post. The graphic uses user adoption level, search traffic, and social media presence to rank “The 10 Most Popular EHR Products.” Yes, the image is at the bottom of the post, because I don’t think you should pay much attention to the ranking. Let’s talk about why.

First, I’ll give credit to them for putting their factors in the graphic itself. Many organizations that put out these rankings don’t even share their methodology for ranking EHR vendors. Although, this compliment falls flat on the first factor: user adoption level.

EHR User Adoption Level
They obtained this ranking and score from a survey of software users. Of course, they don’t say anything about how this survey sample was collected, how they selected who participated in the survey, etc. Long story short, I can think of probably 1000 ways that this sample is going to be biased. There are literally 300 EHR vendors out there. I need to consult my statistician friends, but I can’t imagine the random sample you’d need to get in order to estimate the users of 300 EHR vendors. Plus, there are so many ways to bias this sample based on region, hospital EHR or ambulatory EHR, hospital size, practice size, specialty, etc etc etc.

I also am not sure what they consider “regular users” of the system. Does that mean my 5 front desk staff count as well or is it just providers? Plus, if you look at the scores for the vendors taht are listed, Cerner and Meditech should be much higher when it comes to user adoption level. In fact, it’s possible they have more users than Epic which has the highest ranking possible for user adoption level.

I do think that user adoption level is an ok way to rank EHR vendors. The fact that many healthcare organizations have spent a bunch of money on an EHR vendor is one sign of an EHR vendors popularity and it’s worth considering what’s popular when evaluating software of any kind (including EHR software). However, does anyone have a really good way of analyzing how many users an EHR vendor has? The closest I’ve seen is meaningful use attestation data and it has its weaknesses. Long story short, I’m not buying the user adoption level rankings below.

EHR Search Traffic
Google has a great tool where you can compare search traffic for various keywords. I’ve used it before to compare the popularity of terms like EMR and EHR (They’re about even with EMR still ahead). While this tool is cool and very interesting, is that how you determine how popular an EHR vendor is? What if that EHR vendor has had some major security breaches and everyone is searching their name to find out about the breaches? That seems to be a sign that the EHR vendor is popular, but not for good reasons. Plus, how do you know when someone is searching for the Epic EHR versus Epic the movie and a few million variations of the word epic? Not to mention, if you have Jonathan Bush as your CEO, you’re going to get more searches than other EHR vendors just because of his vibrant personality (was that the politically correct way to describe it?).

Long story short, search traffic is an awful measure to use when ranking EHR vendors. I know some really amazing EHR software that have very little search traffic. I don’t think that’s a bad thing. They’ve focused on creating great software, partnering with doctors, and creating direct relationships with their users. Their search traffic certainly won’t reflect that piece of the puzzle.

EHR Social Media Presence
What’s in a like or follow? Yes, those are the factors the graphic below used to evaluate EHR vendors social media presence. They do weigh this factor less than the others. Does a like or follow on Twitter, LinkedIn or Facebook mean you’re popular? Do you know how easy it is to buy followers if you want to look like you have a lot of followers? $5 per 1000 followers is easy to get. Plus, these counts don’t matter as much as which people are following you and how engaged they are with you on social media. That matters a lot more than follower counts.

I don’t want to totally discredit an EHR vendors involvement in social media. That might be a sign that the company stays up to date and involved with the latest technology changes. It might mean that they’re engaged with and interested in their customers. Then again, it might not. Many EHR vendors just use it as a way to broadcast their company and not actually engage with people. Some EHR vendors don’t even participate in social media at all. That’s not an evil thing, but it might be worth investigating more and seeing if their lack of involvement in technology is seen in other aspects of their product offering.

So while I see value in evaluating an EHR vendor’s social presence, you can’t evaluate and rank it based on likes and followers. A much more complicated assessment is needed.

Conclusion
I understand that many organizations are grabbing hold of any means to differentiate the 300+ EHR vendors out there. It’s certainly a challenge I know first hand. However, I hope that healthcare organizations don’t get led astray by poorly done rankings like the graphic below. There’s always more to the story. If EHR rankings were easy, I would have done them myself a long time ago.

Top 10 Most Popular EHR Vendor Infographic

Miss Colorado Delivers Amazing Monologue on Being A Nurse

Posted on September 15, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I can’t say I was watching Miss America, but I was impressed by this video from the Miss America pageant. Instead of doing the usual song and dance number for her talent Kelley Johnson, Miss Colorado, gave a monologue about how her life was changed as a nurse. Hearing stories like this is valuable for all of us that work in healthcare. It’s a great reminder of the importance of the work we do.

The Impact of Patients Recording Their Doctors Visits

Posted on September 14, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Martine Ehrenclou has a great article titled Patients Secretly Record Visits with Their Doctors that is worthy of further discussion. Here’s an excerpt from the article to get the discussion started:

Since I suspected this office visit might contain some complicated and possibly stressful information, I considered recording what the surgeon said by using an app on my iPhone. I envisioned asking the doctor’s permission to record the conversation and decided against it because he might not have responded well to that idea. Some physicians and other providers react with suspicion and a defensive medicine posture when asked by patients to record what they’ve said.

My husband’s surgeon had a reputation for highly successful surgeries but not the greatest bedside manner. He’d always been pleasant with us, but since my husband’s recovery had been compromised with episodes of pain, I decided that an audio device could have instigated alarm. That would have interfered with the doctor’s focus on Jamie. With only 7-10 minutes, we had to make the most of this office visit. I wanted my husband out of pain.

In place of an audio recording, I took notes instead.

I’m sure that many patients have gone through the same situation. They want to have the valuable information that the doctor has shared, but they’re afraid of the impression they’ll give the doctor if they tell them they’re going to record the visit. Unfortunately, that’s the culture of fear that we’ve created in our healthcare system. Doctors are rightly afraid of the medical malpractice implications of anything they do.

The article goes on to talk about some patients who secretly record their visit with their doctor. A commenter and the author both described this trend of patients secretly recording doctors visits as alarming. However, that feels like a bit of a contradiction to me. The article talks about how asking your doctor to record the visit could compromise the patient-doctor relationship. In order to avoid compromising it, recording the conversation privately seems like the natural alternative.

What’s worth noting is that these private recordings might not be admissible in court depending on your state. I’m not a lawyer, so I’m not sure of the exact laws, but I know that in many states both patients have to be aware that a recording is being made. This should actually provide much comfort to doctors. If a secret recording isn’t admissible in a medical malpractice case, then the doctor should be glad that the patient is secretly recording the visit. It would illustrate that the patient really just wants to review what the doctor said as opposed to trying to ensnare the doctor in some legal lawsuit. Sounds like deep patient engagement to me.

Since pretty much all of us now have an audio recording device in our pocket (better known as a cell phone), this topic is going to become more and more popular. More and more patients are going to want to record their office visit. No doubt some will do this in full disclosure to the doctor and others will do it privately.

I wonder when we’ll see the first doctors flip the script on the patient and suggest that the patient record the office visit. We probably won’t see this happen for the full visit anytime soon, but you could easily see the doctor recording the plan and instructions part of the visit and sending it to the patient or the doctor encouraging the patient to record it themselves. In fact, I recall Kareo doing something like this for doctors using Google Glass. It’s a happy medium where the doctor is likely more comfortable having what they say recorded. A great part of a patient portal would be a list of all the things a doctor’s instructed the patient as part of a visit.

Of course, all of this leads to my concept of a video EHR that captures the audio and video of every visit. I’ve been talking about it more and more lately. I’ll have to do a full post on my vision for a video EHR in a future post. If the idea of a video EHR makes you uncomfortable, that’s no surprise. However, it’s not as far fetched as you might think.

EHR Usage – Best and Worst States

Posted on September 11, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

A recent Becker’s article used some CDC data to rank the best and worst states when it comes to EHR usage. Here’s the top 8 states for EHR usage:

• North Dakota — 79.1 percent
• Minnesota
• Montana
• North Carolina
• South Dakota
• Utah
• Wisconsin
• Iowa — 64.7 percent

And here are the bottom 6 states:

• Tennessee — 38.5 percent
• Florida
• Louisana
• Nevada
• Rhode Island
• New Jersey —29.2 percent

What’s ironic is that just this week I was talking with someone about me writing this healthcare IT blog from the healthcare hub known as Las Vegas (that’s a joke for those following along at home). This person commented that Nevada was way behind on EHR adoption and then they added the small caveat, right? I acknowledged that we were behind, but I must admit that seeing Nevada on this list kind of makes me sad. No one wants their state to be on the bottom of anything.

I did end our discussion by saying that maybe being on the bottom could be a good thing. In other states, they may have rushed their EHR selection and implementation process. If you’re going to choose the wrong EHR or not spend the time to implement the EHR properly, then it might be better to not have an EHR. With that said, I’m still pro-EHR and I hope my state catches up and implements the right EHR in the right way.

Is your state on the list? It would be interesting to see if there’s a correlation between states that have adopted EHR and the quality of care those states provide. Of course, the real challenge is knowing how to measure quality of care.

EHR Certification Termination – What’s It Mean?

Posted on September 10, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The news recently came out that ONC had terminated the SkyCare EHR developed by Platinum Health Information System, Inc. It sounds like those that were using the SkyCare EHR were likely aware of the issues with their EHR. From reports I read, many customers had already reported that SkyCare EHR was no longer responding to them and the company had basically disappeared.

It’s always sad when this happens even when there are only a handful of doctors using this EHR. You’d think that the founders of the company would have enough integrity to provide their users as soft a landing place as possible. Plus, if they didn’t have enough respect for their users, how about respect for the patients that could be put in harms way without a soft landing. Even with the help of an EHR vendor, switching EHR software is tough. Without them it can be brutal and have all sorts of ugly consequences for a practice.

ONC certainly did the right thing to terminate the company’s EHR certification. If they hadn’t done it, then the doctors would be in an even worse situation. With the EHR certification terminated, the doctors can now apply for the exception which will allow them to avoid the EHR penalties. Of course, that doesn’t help them when it comes to the EHR incentive money which they’ll no longer receive.

I hope this is a lesson for other EHR vendors (and many more will fail). Don’t leave your EHR users high and dry. Do the right thing and help them move to a new EHR system. I’m sure there’s more to the story of why SkyCare EHR was shutdown, but I can’t imagine wanting to ever work with the Founders of that EHR in any other capacity.

#SPSM Video Chat on Social Media Campaigns for Suicide Prevention

Posted on September 9, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In case you missed it, I’ve been spending quite a bit of time lately with Blabs and Periscope. These along with things like Google Plus hangouts and Meerkat have made live streaming of video stupidly simple and amazingly interactive. I’d love to hear your thoughts on these platforms and how you think we should use them and how you think healthcare should use them. What would you find valuable.

With that in mind, I was intrigued by this Google Plus hangout with members of the #SPSM community talking about social media campaigns for suicide prevention month:

What do you think of video hangouts like this? Are these discussions good? Will they reach the intended audience? Is video going to be a powerful medium for healthcare? I’d love to hear your thoughts.

Healthcare Hype Cycle Graphic

Posted on September 8, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

There is a lot of really interesting things happening in healthcare. Many are trying to change healthcare as we know it today. Many have the promise of lowering costs, improved care, and better health. However, each of these movements, initiatives, or trends are at different points of the famous maturity lifecycle.

Bonnie Feldman shared the following graphic which shows many of these healthcare changes on the hype cycle:

Here’s a larger version for those who can’t read the smaller Twitter embedded image:
Healthcare Hype Cycle

I should mention that this graphic is focused on Autoimmunity, but you could see how this applies to so many areas of healthcare. A few minor changes and it would be all of healthcare. What other items would you add to this hype cycle? Would you move anything on the chart above farther along the line or backwards on the line?