Intersection of ICD-10 and meaningful use: Clinical documentation improvement

By Brian Levy, MD
08:01 AM
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As hospitals, health systems and payers navigate the new risk-bearing landscape, synergies exist when clinical documentation improvement strategies are expanded to address both meaningful use (MU) SNOMED CT requirements and ICD-10. While the magnitude of the ICD-10 transition itself and the ongoing rumors of additional delays may tempt some organizations to pause in their pursuit of readiness, the bottom line is that advantages to clinical documentation can be realized even before the transition by using SNOMED CT within electronic health records.  

When fully leveraged, healthcare organizations can realize significant benefits — improved capture of diagnosis and severity of illness, reporting, access to decision support and outcomes research to name a few. Financial analytics can also be applied to identify documentation changes that could result in improvements in capturing the appropriate case mix index and severity of illness.

Understanding the SNOMED opportunity
As multiple federal initiatives converge to support greater health information exchange, one challenge that has to be overcome today regardless of the ICD-10 changeover date is semantic interoperability.  Lack of a common clinical vocabulary diminishes the accurate and timely sharing of critical patient data across disparate systems.

Clinical terminology standards introduced through meaningful use are a critical step toward achieving semantic interoperability and improving data capture. Specifically, SNOMED CT has been introduced as a comprehensive clinical terminology system for documenting problem lists, family history, drug/allergy reactions, smoking status and hospital procedures. The system enables computers to understand clinical language and act on it through a very large set of concepts and descriptions representative of many standard terminologies in the industry.

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Like ICD-10, a key benefit of SNOMED CT is the granularity of its concepts, allowing greater specificity in the documenting of patient issues, which ultimately will improve care delivery and lay a solid foundation for achievement of such high-level industry initiatives as population health management and accountable care organizations. Consider that SNOMED CT encompasses more than 310,000 concepts, 794,000 descriptions, 19 hierarchies, and 920,000 relationships. As a point of comparison: the 17,000 codes currently available in ICD-9 will expand to 155,000 under ICD-10.

The reality is that the granularity of both coding standards often correlate. Under ICD-10, for example, providers will begin documenting asthma as mild, moderate or severe. These same designations can be made for SNOMED CT now. Thus, why would healthcare organizations wait until ICD-10 to improve documentation when they can use SNOMED and the EHR now to improve the granularity of patient information captured? 

As implementation of SNOMED CT ramps up within the Stage 2 meaningful use timeline, providers will already be able to document to the granularity of ICD-10. When ICD-10 documentation strategies are put into play in complementary fashion, healthcare organizations will be better positioned for heightened quality metrics and reporting as well as more prepared for the ICD-10 transition deadline.

Terminology management and financial analytics
There are still significant challenges to crossing the MU and ICD-10 finish lines successfully. While both ICD-10 and SNOMED CT offer great potential in aligning providers and healthcare organizations with federal quality initiatives, the process can be daunting for resource-strapped IT departments.

Healthcare organizations will need to consider how to address the ICD-10 and SNOMED CT conversion issues from a system remediation (tools and updated health IT applications) and operational effectiveness and remediation (improved documentation and coding practices).  

Workflow challenges will need to be addressed as clinician time is at a premium in today’s healthcare climate. When a clinician is searching for the right SNOMED CT or ICD-10 code, the efficiency and accuracy of documentation can be negatively impacted.

Workflow-enhancing search tools can also be leveraged to decrease clinicians’ documentation time by providing access to a provider friendly search engine that allows physicians to use terms familiar to them, such as abbreviations or synonyms. The familiar terms are then converted to an appropriate SNOMED CT and ICD-10 code behind the scenes. This workflow-enhancing search addresses both system and operational remediation requirements.

Third-party terminology conversion tools exist in the industry and can be a great asset to easing the burden of these initiatives by providing maps between ICD-9 or ICD-10 and SNOMED CT, further addressing system remediation needs. While a number of industry tools are available to assist organizations in their mapping strategies, there simply is not a single “gold standard” that addresses all use cases. Other terminology mapping issues involve drugs and labs as well. Simply put: healthcare organizations will have to consider their own customized mapping strategies to succeed.

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When leveraging terminology management tools, it is often the best strategy for organizations to roll-out SNOMED CT now regardless of the eventual ICD-10 date. Because these two terminologies are synergistic when used concurrently, many EHR vendors are implementing SNOMED CT and ICD-10 simultaneously.

For example, advanced conversion tools enable ICD-10 codes to be dragged easily from an electronic superbill to the problem list and automatically translated to SNOMED CT and vice versa.  This kind of seamless mapping between the two code sets supports revenue cycle efficiency and accuracy by eliminating the time associated with trying to identify the correct ICD-10 code.

In order to identify those ICD-10 areas that are of greatest concern to a provider, financial analytics can be used on current claims data to find those potential ICD-10 codes that may pose the greatest financial risk.  Once identified, improvements in documentation today may help to mitigate these potential ICD-10 risks.  

As these financial analytics expose areas where documentation needs to be improved for ICD-10, healthcare organizations can begin these improvements now using SNOMED.

Conclusion
The move to ICD-10 is a critical component to achieving healthcare’s Triple Aim of improved patient experiences, better population health and lower costs. The benefits of the specificity and granularity of the expanded code set cannot be denied.

As healthcare organizations consider ICD-10 readiness strategies, its synergies with SNOMED CT should be leveraged to their fullest sooner than later. Regardless of ICD-10 implementation delays, the opportunity exists now for healthcare organizations to realize the competitive edge that readiness can deliver.

Brian Levy, MD, is vice president of global clinical operations for Health Language.