rochester regional health informational management association preparing for icd-10: changes in...
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ROCHESTER REGIONAL HEALTH INFORMATIONAL ROCHESTER REGIONAL HEALTH INFORMATIONAL MANAGEMENT ASSOCIATIONMANAGEMENT ASSOCIATION
PREPARING FOR ICD-10:PREPARING FOR ICD-10:CHANGES IN EMERGENCY MEDICINECHANGES IN EMERGENCY MEDICINE
September 24, 2015September 24, 2015Keith Grams, MD
Chief, Emergency MedicineAssociate CMO, throughput & Capacity Management
Rochester General Health System
Keith Grams, MDChief, Emergency Medicine
Associate CMO, throughput & Capacity ManagementRochester General Health System
Objectives:
• To review the primary changes ICD-10 will bring to Emergency Medicine
• To demonstrate the charting process
• To review the current preparation
• To understand the potential impact of ICD-10 on patient care
Quick Quiz
• When was ICD-9 adopted?
• 1979
Quick Quiz
• Who created ICD-10?
• The World Health Organization
Quick Quiz
• What does ICD stand for?
• International Statistical Classification of Diseases and Related Health Problems
• ISCODARHP
• ICD
Quick Quiz
• When was ICD-10 adopted by WHO?
• 1994
Quick Quiz
• When was ICD-10 first supposed to go-live in the US?
• 2013
Quick Quiz
• When is ICD-10 going live in the US?
• October 1, 2015
CHANGES IN EMCHANGES IN EM(PROFESSIONAL)(PROFESSIONAL)
CHARTING IN EPICCHARTING IN EPIC(CARECONNECT)(CARECONNECT)
How We Teach the Providers
• Documentation
• Communication
• Coding
• Medico-legal
ED Professional Coding
• Relative Value Unit
• Medicare
• Omnibus Budget Reconciliation Act, 1989
The Game
The TrackBoard
The Chart
HPI
HPI
HPI
HPI
ROS
Physical Exam
Procedures
Procedures
Medical Decision Making
Attestation Tab
The Note
What’s Missing?
What’s Missing?
What Missing?
• Past medical/surgical history
• Social history
• Family history
Orders
Orders
Orders: Indications
Diagnosis“Clinical Impression”
Diagnosis“Clinical Impression”
17,000 141,000
ICD-9 ICD-10
Diagnosis“Clinical Impression”
Diagnosis“Clinical Impression”
Diagnosis“Clinical Impression”
Diagnosis“Clinical Impression”
Diagnosis“Clinical Impression”
• Detail, detail, detail
• Initial, subsequent, sequela
• Location, location, location
• Abdominal pain
• Contusions, sprains,…
CURRENT PREPARATIONCURRENT PREPARATION
What’s Been Done?
• RRH Online education
• HLC modules
• Coding company education
• On line modules
• Direct feedback loop
• Dual coding deficiencies
What Happens When We See Data?
1. Denial/Blame 1. Denial/Blame
2. Anger 2. Anger
3. Bargaining 3. Bargaining
4. Depression4. Depression
5. Acceptance5. Acceptance
Stages of Data Grief
1. Denial/Blame 1. Denial/Blame
2. Anger 2. Anger
3. Bargaining 3. Bargaining
4. Depression4. Depression
5. Acceptance5. Acceptance
Coping with Loss …
Deficiencies Charts %
Department 100 1000 10%
Coping with Loss …
Deficiencies Charts %
Dr. A 0 250 0%
Dr. B 0 250 0%
Dr. C 0 250 0%
Dr. D 100 250 40%
Coping with Loss …
Deficiencies Charts %
Dr. Bentley 0 250 0%
Dr. Benziger 0 250 0%
Dr. Cavallaro 0 250 0%
Dr. Grams 100 250 40%
Are We Ready?
• Dual coding feedback …
Are We Ready?
2015 Batch#
Coded Defiencies %
1 570 24 4.21%
2 302 1 0.33%
3 128 0 0.00%
4 96 0 0.00%
5 42 0 0.00%
6 75 0 0.00%
Deficiencies
Deficiencies
Deficiency Breakdown
# Percentage
Total 24 100%
Location 13 54%
Type 3 13%
JPW 8 33%0.7% of all charts
Now We’re Ready
IMPACT ON PATIENT CAREIMPACT ON PATIENT CARE
Volume
2014 = 125,323
2015 = 128,000+
2014:22,000 more than next
largest ED in area
Door-to-Provider
LWO
How We Keep Up
• Team triage model
• CareConnect optimization
• ASAP tools
• Documentation
• Scribes
What Does the EMR Cost?
4,000 clicks/shift
1 click/sec
66 minutes (of clicking) in 12 hr shift
What Does the EMR Cost?For RGH
13.2 hours/day of clicking
26.5 pt/day not seen
9665 pt/yr not seen
Cost of EMR = $966,574
EMR Pro’s & Con’s
• Con’s
• Time away from the patient
• Operational challenges
• Availability of information
• Pro’s
• Availability of information
• Integration
• Data
• …
Coming Soon …
• Previous based on general EMR numbers
• No RGH specific data…
• Usage data coming soon
Recap:
• EM changes in ICD-10
• The charting process
• Current preparation
• EMR impact on patient care
