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ED prepares for the risks and rewards of ICD-10

By Sunny Sanyal, CEO, T- System

As the 30-plus-year reign of ICD-9 ends and ICD-10 becomes healthcare’s offi cial coding system, hospitals must pay close attention to the impact on the emergency department (ED). ICD- 10’s requirement for more detailed information may have profound effects on ED workfl ow and productivity, and thus the entire hospital’s patient fl ow and profitability. Hospitals are faced

with numerous challenges in switching to ICD-10, the most onerous of which will be physician training for increased documentation needs and IT system readiness. Already overburdened by rising patient volumes, the severity of the productivity slump will depend on the approach the ED and hospital information-systems vendors take to comply with ICD-10. To deal with the complex documentation to support ICD- 10 code generation, some vendors may comply with ICD-10 by incorporating lengthy pick lists (perhaps with fi lters) from which providers can select the appropriate ICD-10 code into their EDIS and EHR systems. This approach will be the most interruptive to clinician workfl ow and will cause severe productivity declines as clinicians navigate a thicket of drop-down menus.

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Other vendors will make more extensive modifi cations to their systems to accommodate ICD-10, and their efforts will lead to far less signifi cant impacts to the ED. Streamlined user interfaces with minimal mouse clicks and screen transitions will

enhance effi ciency rather than detract from it. Providing robust content from which to document can ease ICD- 10 preparedness. Systems that algorithmically generate ICD-10 codes based on the providers’ documentation will improve productivity at the point of care and downstream in the back offi ce. Hospitals that prepare by reviewing their current practices to identify and address the most problematic areas of their ICD-10 implementation and by training staff (both coders and providers) will see minimal impacts to productivity and revenues. These organizations will also realize its greatest benefi ts: improved clinical data collection, advances in evidence-based medicine and enhanced quality of care.

Key 2012 trends: medical homes, digitization and automation By Steve Schelhammer, CEO, Phytel

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Automation tools for population health management will become more important than ever in 2012 as a growing number of healthcare providers begins to take responsibility for the cost and quality of care. Some organizations will further integrate their information systems and automate their care-coordination processes to prepare for the assumption of fi nancial risk. And more and more providers will focus on the patient-centered medical home (PCMH), which can produce short-term fi nancial and clinical benefi ts while paving the way for the formation of accountable care organizations (ACOs). The PCMH is already generating tremendous enthusiasm among providers and payers. In 2012, it will join the mainstream of healthcare delivery as organizations

recognize that it is the best vehicle for attaining the objectives of accountable care. Without the ability to leverage digitized clinical data, it is impossible to achieve the medical home’s primary goal of improving care coordination in a scalable way. Fortunately, the federal government’s HITECH incentive program is driving the rapidly increasing adoption and meaningful use of EHRs. As structured electronic data becomes the norm, many more providers will be able to tap clinical databases for real-time identifi cation of care gaps, automated outreach to patients who need preventive and chronic care, care coordination, predictive modeling and risk stratifi cation of the population. These tools will help providers build successful medical homes and ACOs. Meanwhile, efforts to promote patients’ engagement in their own care will benefi t from the accelerating use of automation technology to replace outmoded, ineffi cient manual processes. In addition to automated patient outreach methods, online educational tools and health-risk assessments will become commonplace. Mobile health applications will proliferate. Most important, physicians and care teams will have the tools they need to maintain continuous contact with patients between offi ce visits or episodes of care. Finally, care management will benefi t from the new automation approaches. Healthcare systems are placing care coordinators within physician practices, and those professionals are beginning to leverage digitized health data to help them manage patient populations. We will see much more of this kind of activity in 2012.


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