Will ICD-10 Solve Interoperability Problems?

I’ve been hearing a bit of discussion about ICD-10 really helping to solve some of the problems of interoperability. Their contention is basically that ICD-10 is more precise in its description of the diagnosis and so therefore the information that is coded using ICD-10 will then provide more specific codified information that can then be rather easily shared. If you haven’t read about the transition from ICD-9 to ICD-10, here’s a good article about the transition.

In theory, this is completely accurate. If everything went as outlined, we could really get a lot of interesting information for studies and for interoperability of health data out of our ICD-10 codes.

The problem is that in reality ICD-10 is just going to cause even more problems for sharing quality data. Not because we can’t share the data. That’s a topic for a different discussion. The problem is that we’re never going to achieve quality input of diagnosis codes.

I’m not a doctor and so I’m not going to give a specific example here. However, I think all we have to do is look at the current ICD-9 diagnosing patterns. I’ve seen from first hand experience that 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 NOW (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.

I’m not trying to place blame. I believe this is a chronic problem in our health system that those in the trenches have known about for years. My point here is that if we can’t get the rather “simple” set of ICD-9 codes right, then how can we ever expect the much more complex set of ICD-10 codes right?

Everyone knows the common phrase of garbage data in produces garbage data out. When we’re talking about interoperability of EHR software, doctors really have to think if they want other people’s garbage in their system.

ICD-10 really could produce some awesome information if used properly. The challenge we face is producing systems that codify the data properly so we have meaningful interoperability of healthcare data.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

5 Comments

  • I’m not really sure how improved specificity enhances “interoperability” but the article makes a point that, which may be true now, won’t be true for long. I disagree with the premise that “in reality ICD-10 is just going to cause even more problems for sharing quality data.” Perhaps in the first year of usage there’ll be issues and challenges – like there always are with any new, major process change. But I’d argue these negative will go away over time as natively-coded ICD-10 data is assembled and as newer payment models are deployed; namely risk-sharing, diagnosis based reimbursement, pay for performance and risk-assignment models. “Quality input of diagnosis codes” is a key part of and critical to the success of these new reimbursement models.

    This topic really deserves more than a comment to a short blog post and perhaps I should take the time to share more of what I know from being ‘in the trenches” – here are a few thoughts to consider and arguments I’d expound on in a more complete response:

    1. The enhanced specificity and expanded universe of ICD-10 codes will ameliorate – if not solve – the very problem of doctors not having a code to select and defaulting to an NOS code.

    2. When an accurate code must be provided because reimbursement depends on it – and not just because a claim edit or medical policy requires it, then providers will take the time to accurately assign the code; essentially a force de rigueur that is ignored by providers at their peril.

    3. I believe increasing opportunity, need and, in some cases, requirement to share data that is being brought about by HIE’s, ACO’s, etc. will force transparency and shine light on shoddy coding practices; forcing certain providers to clean up their act.

    So while I’m not sure about ICD-10 solving “interoperability problems,” I believe it will be an essential part of helping address current healthcare measurement and reimbursement challenges.

  • Thanks for pulling this one out of the archive (maybe Twitter helped). That’s some interesting analysis of the situation with ICD-10 coding. I can’t argue against anything you say. I’m still torn between ICD-10 being a benefit and it being a hindrance. I think it’s probably a wash from what I can see.

  • LOL! I did see this on Twitter and thought it was current. I suppose leaving the “born on” date off a blog post is a good thing as I probably wouldn’t have responded had I know this was one of your old posts. 🙂

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