ICD-10 coding errors, reporting doctor mistakes, your ‘fitness age’ and more
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Health Management Technology News
November 4, 2013 / Issue 51

In this issue:

Report: Only 63 percent of ICD-10 documentation accurately coded

As robot-assisted surgery expands, are patients and providers getting enough information?

Texas Health Resources selected as 2013 Enterprise HIMSS Davies Award winner

When docs make mistakes, should colleagues tell? Yes, report says

What’s your ‘fitness age’?


ICD-10

Report: Only 63 percent of ICD-10 documentation accurately coded

In a recent ICD-10 pilot project, healthcare coders were accurate only 63 percent of the time, on average, in their documentation from medical records.

In addition, coders averaged two medical records per hour, compared with four per hour under ICD-9, which equates to a 50 percent drop in productivity.

The results came from the ICD-10 national pilot program, which started in April 2012 and ended in August 2013. The Healthcare Information and Management Systems Society and Workgroup for Electronic Data Interchange released a report on the program, and the groups said ICD-10 coding accuracy varied wildly depending on what was being coded.

Read the Becker's Hospital Review article.

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Robot Tech

As robot-assisted surgery expands, are patients and providers getting enough information?

The use of robotic surgical systems is expanding rapidly, but hospitals, patients and regulators may not be getting enough information to determine whether the high-tech approach is worth its cost.

Problems resulting from surgery using robotic equipment – including deaths – have been reported late, inaccurately or not at all to the Food and Drug Administration, according to one study.

The study, published in the Journal for Healthcare Quality earlier this year, focused on incidents involving Intuitive Surgical’s da Vinci Robotic Surgical System over nearly 12 years, scrubbing through several data bases to find troubled outcomes. Researchers found 245 incidents reported to the FDA, including 71 deaths and 174 nonfatal injuries. But they also found eight cases in which reporting fell short, including five cases in which no FDA report was filed at all.

The use of surgical robots has grown rapidly since it was first approved for laparoscopic surgery (a type of surgery that uses smaller incisions than in traditional surgery) by the FDA in 2000. Between 2007 and 2011, the number of da Vinci systems installed increased by 75 percent in the United States from 800 to 1,400, according to the study.

Noting that robotic surgery has promising benefits, the study also called it “essential that device-related complications be uniformly captured, reported and evaluated,” so the medical community fully understands “the safety of the new technology.”

Intuitive Surgical, the makers of the da Vinci device, released a statement last month taking issue with the study’s findings.

The company said it agreed regarding the “need for a more robust and standardized system for reporting adverse events” but also encouraged the study’s authors “to conduct a comparable study that assesses the under reporting of both open and laparoscopic surgical events and would welcome a comparison with robotic-assisted surgery.”

Health care professionals say benefits to robotic surgery compared with traditional open surgery include smaller incisions, shorter hospital stays and less pain after the operation.

Dr. Martin A. Makary, an associate professor of surgery and health policy and management at John Hopkins University and one of the study’s authors, said that, while the future for robotic surgery is promising, there is a gray area when it comes to assessing the difference between doctor and device error. And benefits from the use of the device may be inconsistent, he said. Robotic surgery has shown benefits when it comes to head and neck surgery, he said, but there’s not necessarily a stark difference between a conventional laparoscopic or robotic-assisted surgery when it comes to gall bladder removal.

“If you as a patient are going to a doctor, and they’re using a robot, it’s a question of who’s in charge,” said James F. Blumstein, director of the Vanderbilt Health Policy Center and Professor of Constitutional Law and Health Law & Policy. “If it’s a mechanical malfunction, would the professional standard of care apply to a robot?”

Read the KHN article.

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EHRs

Texas Health Resources selected as 2013 Enterprise HIMSS Davies Award winner

HIMSS is honoring Texas Health Resources located in Arlington, Texas, as a winner of the 2013 Enterprise HIMSS Davies Award of Excellence. Since 1994, the Nicholas E. Davies Award has recognized excellence in the use of health information technology, specifically the use of the electronic health record (EHR) to successfully improve health care delivery processes and patient safety while achieving a demonstrated return on investment.

Winning enterprise organizations, including academic medical centers, community hospitals, rural health hospitals and critical-access hospitals, must demonstrate the value of the EHR in supporting delivery of patient care as well as document improved patient outcomes, identify the challenges faced, and describe the solutions implemented in a manner that can be replicated by other organizations. Winners of the HIMSS Enterprise Davies Award must have achieved Stage 6 or Stage 7 on the HIMSS Analytics EMR Adoption Model (EMRAM).

Texas Health Resources one of the largest faith-based, nonprofit healthcare delivery system in the nation; including 13 acute-care hospitals, one transitional care hospital and 2,950 licensed hospital beds. All 14 wholly owned hospitals have been awarded HIMSS Analytics EMR Adoption Model Stage 6 or above designation. Annually, THR has more than 1.3 million inpatient and outpatient visits including 24,000 deliveries and 469,000 emergency visits. Through the innovative use of health IT, including the establishment of a modified early warning system, clinical decision support protocols, and advanced clinical analytics, Texas Health has significantly improved outcomes for cardiac patients, reduced cases of venous thromboembolism, and significantly reduced hospital acquired infections.

UC Davis Medical Center was also chosen to receive this honor.

Read the winners’ core case studies and more.

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Ethics

When docs make mistakes, should colleagues tell? Yes, report says

Medical mistakes are now estimated to kill up to 440,000 people in U.S. hospitals each year, making preventable errors the third leading cause of death in America behind heart disease and cancer. Wrong doses of drugs, undetected tumors, objects left behind in patients’ bodies: Such errors – and many more – are an “everyday occurrence,” experts say.

But eliminating errors has proven difficult, especially in a health care culture where doctors and other providers are reluctant not only to admit their own lapses – but also to report when others mess up as well.

New guidelines issued Oct. 30 are aimed at tackling that problem, and helping ease the thorny dilemma of whether, when – and how – doctors should disclose their colleagues’ mistakes.

“Progress on patient safety has been much more limited than anyone would like,” said Dr. Thomas Gallagher, a University of Washington professor of medicine and bioethics who led the team behind guidelines published in the New England Journal of Medicine.

“We haven’t made enough headway in improving communication. The difficulty physicians have in communicating with one another when something goes wrong is an important factor,” added Gallagher, who has been working on the issue for a decade.

Power dynamics, professional courtesy and a medical culture that shies away from confronting colleagues all play into the problem.

“The historical norm is that being a good colleague means not saying anything, having their back, when you think they’ve made a mistake,” Gallagher said. “We’re asking people to turn toward their colleagues in those instances.”

The overall goal is to help patients, particularly those who’ve been harmed by a medical mistake. They deserve a full accounting of the problem and “should not bear the burden of digging for information” – or encounter a system that closes ranks against them, the paper says.

The trouble is, colleagues detect or observe others’ errors all the time, said Art Caplan, a bioethicist at NYU Langone Medical Center, whose job includes the duty of refereeing such sticky situations.

“Dealing with errors and near misses is an everyday occurrence at a big hospital,” he said.

Read the NBC News article.

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Personal Health

What’s your ‘fitness age’?

Trying to quantify your aerobic fitness is a daunting task. It usually requires access to an exercise-physiology lab. But researchers at the Norwegian University of Science and Technology in Trondheim have developed a remarkably low-tech means of precisely assessing aerobic fitness and estimating your “fitness age,” or how well your body functions physically, relative to how well it should work, given your age.

The researchers evaluated almost 5,000 Norwegians between the ages of 20 and 90, using mobile labs. They took about a dozen measurements, including height, body mass index, resting heart rate, HDL and total cholesterol levels. Each person also filled out a lengthy lifestyle questionnaire. Finally, each volunteer ran to the point of exhaustion on a treadmill to pinpoint his or her peak oxygen intake (VO2 max), or how well the body delivers oxygen to its cells. VO2 max has been shown in large-scale studies to closely correlate with significantly augmented life spans, even among the elderly or overweight. In other words, VO2 max can indicate fitness age.

In order to figure out how to estimate VO2 max without a treadmill, the scientists combed through the results to determine which of the data points were most useful. You might expect that the most taxing physical tests would yield the most reliable results. Instead, the researchers found that putting just five measurements — waist circumference; resting heart rate; frequency and intensity of exercise; age; and sex — into an algorithm allowed them to predict a person’s VO2 max with noteworthy accuracy, according to their study, published in the journal Medicine & Science in Sports & Exercise.

The researchers have used all of this data to create an online calculator that allows people to determine their VO2 max without going to a lab. You’ll need your waist measurement and your resting heart rate. To determine it, sit quietly for 10 minutes and check your pulse; count for 30 seconds, double the number and you have your resting heart rate. Plug these numbers, along with your age, sex and frequency and intensity of exercise, into the calculator, and you’ll learn your fitness age.

The results can be surprising.

Read the NY Times article.

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