With everyone who’s covered under HIPAA preparing to transition to ICD-10 on October 1, 2015, there’s a lot of information out there on the both the positive and less-than-positive aspects of the change. One of the main benefits that the Center for Medicare & Medicaid Services (CMS), World Health Organization (WHO), and other healthcare organizations are citing about the new diagnosis codes is improved interoperability—quite the innovative concept. Outside of these massive government groups, though, folks have their reservations. While some argue that ICD-10 will not solve interoperability issues or that interoperability might be possible but it isn’t the goal of ICD-10, one could suggest that improving interoperability predominantly rests, for now, on the people in the trenches—the practitioners, billers, and administrators directly affected by the transition.
What is interoperability?
Interoperability occurs when diverse systems and organizations work together for an overarching goal. In healthcare, interoperability focuses on successful information exchange across all healthcare platforms. Both communication and technology play massively important roles in achieving seamless data exchange.
How would ICD-10 aid interoperability?
The ICD-10 diagnosis code sets are super specific, therefore the data produced will be super specific, too. Furthermore, ICD-10 allows for simplified coding of information, and simple coding is easier to share. Better data + easier sharing = improved interoperability.
Of course, systems have to talk to each other for true interoperability to occur. This is a whole other ball of wax. Technology must evolve to facilitate the seamless and simple exchange of information, and that’s not currently happening consistently across the healthcare spectrum. According to David Shaywitz’s Epic Challenge: What The Emergence of an EMR Giant Means For the Future of Healthcare Innovation, “Any one company’s EMR system isn’t particularly compatible with the EMR system from another company, resulting in—or, more fairly, perpetuating—the Tower of Babel that effectively exists as medical practices often lack the ability to share basic information easily with one another.” As detailed above, ICD-10, helps solve this issue. That and lightweight, agile, and cloud-based EMR systems. After all, another stipulation of true interoperability is constant interconnectivity and communication. We need always-on, web-based systems for that—not the gargantuan, server-based dinosaurs of yesteryear.
Why should we care?
Like I said above, improving—or helping propel the industry toward a truer form of—interoperability depends on the people involved.
In a Healthcare IT News post entitled Will ICD-10 Solve Interoperability Problems?, author John Lynn explains that ICD-10 will hinder, rather than help, interoperability because practitioners will never achieve quality input of diagnosis codes. “All we have to do is look at the current ICD-9 diagnosing patterns...often a doctor gets stuck searching for the right ICD-9 code. Right or wrong, they end up picking a code that may not be exactly the right code for what they’ve seen. Maybe they choose NOS (Not Otherwise Specified) instead of the specific diagnosis that would be more appropriate. Add in the complexity of diagnosis requirements for getting the most out of your insurance billing and I don’t think anyone would disagree with the assertion that ICD-9 code entry is far from accurate.” He goes on to ask how we can possibly get a complex set of ICD-10 codes correct if we’re not getting simple ICD-9 codes right. He furthers the conversation by asking if “garbage data in produces garbage data out” hold true, in terms of interoperability, do you really “want other people’s garbage in [your] system”?
Lynn wrote this article about doctors (and hopefully what he describes above is the exception and not the norm), but his point still applies to rehab therapists. If and when you receive data from a primary care physician, do you want data that’s inaccurate? Most definitely not, just as I’m sure physicians do not want inaccurate information from you. Thus, it’s on all providers to have a higher standard about their data and enter the correct information always.
In another article entitled Chasing the Tail of Interoperability, author Gary Palgon explains that improved interoperability has a great deal to do with communication. He encourages readers to “understand that ‘interoperability’ means more than just ‘connectivity.’ Organizations seldom encounter ongoing challenges with connectivity, yet the language—or semantics—used across different disciplines changes frequently.” Thus, we must ensure that interoperability doesn’t start and stop with ICD-10. When changes occur anywhere in the patient data cycle, we must ensure all systems register and compute those changes. Essentially, we must all speak the same language—at least from a technological standpoint. Like Shaywitz, Palgon believes cloud-based solutions will best facilitate this.
In the meantime, though, whether you work in a hospital or a small private practice, choose the right attitude about ICD-10. The transition will happen, and rather than fear or resist the inevitable, you and your clinic should prepare. That way when the switch occurs, your clinic is putting its best foot forward in terms of effective communication and correct data. If we all make this effort, hopefully those best feet will get us stepping in the right interoperability direction.