The Wall Street Journal put out an interesting article about the switch from ICD-9 coding to ICD-10. The title mocks the ICD-10 codes, Walked Into a Lamppost? Hurt While Crocheting? Help Is on the Way”, and the subtitle is funny as well, “New Medical-Billing System Provides Precision; Nine Codes for Macaw Mishaps”

I must admit that I’m not very well steeped in the history of ICD-9 and ICD-10. Nor am I that familiar with the process that was used for creating the voluminous ICD-10 coding system. I’m more of a practical person and so I’ve been more interested in EHR’s ICD-10 preparedness and the timeline for ICD-10 implementation. Seems like we won’t have much choice.

I guess I should have known that going from 18,000 codes (which doctors can’t even stay up with as is) to 140,000 codes would offer some crazy and hilarious codes. Here’s some examples from the article linked above:

There are codes for injuries in opera houses, art galleries, squash courts and nine locations in and around a mobile home, from the bathroom to the bedroom.

And the appropriate follow up question from a family physician, “Really? Bathroom versus bedroom? What difference does it make?”

Some other interesting codes mentioned in the article:
R46.1 is “bizarre personal appearance”
R46.0 is “very low level of personal hygiene”
W22.02XA, “walked into lamppost, initial encounter
W22.02XD, “walked into lamppost, subsequent encounter”
V91.07XA, “burn due to water-skis on fire”

There are codes for injuries received while sewing, ironing, playing a brass instrument, crocheting, doing handcrafts, or knitting—but not while shopping. There are codes for injuries from birds such as: a duck, macaw, parrot, goose, turkey or chicken. I’d hate for my doctor to choose the “bitten by turtle” versus “struck by turtle” code. My insurance company might not reimburse the second.

Do people know of any other off the wall ICD-10 codes?

While this has me a little concerned to see ICD-10 in action, hopefully it will give all of you a good laugh going into the weekend. I can’t say I saw a code for any sort of Friday inefficiency, but there probably should be.

I may have missed this somewhere else, but today was the first time I have found one of the major newspapers actually talk about EHR certification possibly being worse than what a competitive EHR marketplace can produce.

You can read the Wall Street Journal opinion article to see what I mean. Here’s the conclusion which describes the problem with certified EHR:

The stimulus hands the Obama Administration the power to define and approve “certified” records, therefore the power to create a health-tech monopoly. With stimulus money being shoveled out as quickly as possible, doctors and hospitals may end up prematurely investing in the costly systems that happen to have the government seal of approval — and in the process freezing out an innovative marketplace.

Granted, this was just in the opinion section of the Wall Street Journal, but I think more people need to stand up and make this opinion known. If you think we have problems now imagine what will happen when the government becomes the “arbiter of health information technology.”

“If it’s [EMR investment and implementation] too hasty, you can create so many bad experiences that people say…’My data’s a mess and my patients are angry,’” Mr. Glaser said in a recent Wall Street Journal article on the possible wasted investment in EMR. 

The scary thing is that John Glaser, chief information officer for Partners Healthcare, is probably right.  I know that President Barack Obama wants to “wield technology’s wonders to raise health care’s quality and lower its costs.”  I want to do that too.  In fact, I think we’d all like for that to happen.  Unfortunately, I think we have to seriously ask ourselves if the current electronic medical records offerings can raise health care’s quality and lower its costs.

I think there are two points that have been proven time and time again in implementing an electronic medical record in a doctor’s office.

Point 1: A Well Implemented EMR Yields Great Results – Hundreds (possibly thousands) of doctors can attest to how happy they are using an EMR.  My personal finding is that the key to a successful EMR implementation is deeply related to how well a clinical practice is run before implementing an EMR.  In fact, I believe an EMR will exacerbate any problems a clinic may have been experiencing pre-EMR.  However, many clinics have shown that when done right there are tremendous benefits associated with an EMR.

Point 2: A Poorly Implemented EMR Causes More Harm Than Good – Blame it on the software.  Blame it on the clinic.  Blame it on the technology.  Blame it on the health care culture.  It’s probably a mixture of all of these things that has caused so many EMR implementations to fail.  Regardless of the reason, all of these failed EMR implementations have shown the damage that can be done to a practice that fails in their implementation.  Unhappy patients.  Unhappy and frustrated doctors.  Thousands of hours evaluating, learning, training, testing and implementing down the drain.

It’s no wonder that the New England Journal of Medicine found that only 4% of U.S. physicians were using a “fully functional” electronic health record system.  The huge failure rate among physicians has created a fear in doctors that’s difficult to overcome.  Sadly I think it might take a generation for doctors to overcome this bias.

The reality is that implementation of an EMR CAN increase health care’s quality and lower its costs.  The problem is that most clinics haven’t yielded these promised benefits and most are living with failed EMR implementations.  The huge numbers of failed implementations can not be ignored.  Ignoring this will lead to even more failed implementations which could set the movement to digitizing patient records back years.

It’s not enough to poor money onto something without looking at and solving the reasons why so many people have failed in their implementation of electronic medical records.

I don’t want to give the impression that I’m not for investment in EMR and health care IT.  I think that help is needed and could be beneficial to the future of health care in the US.  I also really believe that EMR does open up a whole world of opportunities that we couldn’t consider without broad adoption of electronic medical records.  However, I don’t think enough attention is being paid to understanding what factors are important to implementing an EMR successfully.  By understanding these facets of implementation we can invest in electronic medical records that are actually being used and effective.  Otherwise, we’re just lining the pockets of the EMR vendors without any benefits to health care or doctors.

In a recent Wall Street Journal article on electronic medical records, they talk about Allscripts’ CEO’s take on the governments planned $20 billion investment in EMR.  Here’s a portion of the article:

Glen Tullman, chief executive of the health IT outfit Allscripts-Misys Healthcare and an advisor to the Obama campaign on health information technology issues, argues that that any legislation should first help doctors buy and install electronic medical records, then give them financial incentives to actually use them in a way that could reduce waste and improve care. “That one-two punch would dramatically change the adoption rate for physicians,” he said in an interview with the Health Blog.

I’ve talked about Obama EMR many times before on this blog and over the next 6 months I expect I’ll talk about it a lot more.  This could be the most significant change in health care IT that we’ve ever seen.

However, it should scare all of us that Obama’s health information technology advisor is the CEO of Allscripts-Misys Healthcare any EMR vendor.  I know Obama’s from Chicago, but could this be a more blatant conflict of interest?  Why not call in the tobacco companies to see if they think that smoking will help improve the condition of America.  I’m pretty sure I know there answer.  Why would an EMR company be any different?

Even more interesting is this quote from the same Wall Street Journal article on EMR:

He[Glen Tullman] points to the success of a similar incentive program, courtesy of Medicare, to get more doctors to use electronic prescriptions — Allscripts’ other big business besides electronic health records. 

I just wanted to thank Glen Tullman for pointing out that not only does he have a huge conflict of interest in regards to EMR adoption, but he’s also had success influencing other Medicare legislation for which he would be even more biased (Allscripts being the most widely used e-prescribing software).  This sure doesn’t sound like the CHANGE that Obama’s been talking about.  Sounds like business as usual to me.

I can understand why Obama would want to talk to some of the main EMR vendors out there.  It would be interesting and insightful to hear their biased point of view.  However, I’m talking about a discussion with these EMR vendors.  I’m not talking about having them as an advisor to Obama.  Are there really no unbiased consultants that can inform Obama on the challenges of EMR implementation?  There has to be something better.

I just think that Obama and the US governemnt don’t have anyone telling him the true realities associated with EMR implementations.  Nothing proves this more than the idea that the government will probably use CCHIT certified EMR as a criteria for who will get some of the $20 billion allocated to healthcare in the economic stimulus package.

The crazy part is I feel like I shouldn’t blame Obama for these decisions.  I hope and think that he’s trying to make the best decisions he possibly can with the limited information he’s receiving on the subject.  Does anyone have Obama’s blackberry number?  I’d like to send him a short message with my thoughts on his proposed investment in EMR.

Thinking along those lines, I think I might send a tweet to John Culberson, Congressman from Texas.  Talk about someone who’s really trying to listen to the people and have an open dialog about subjects.  I’ll let you know how that goes and if he even cares about electronic medical records.