From the January/February 2014 issue of HealthCare Business News magazine
By Dr. Albert Shar
The New York Times recently ran an article talking about the expanding use of scribes supporting physicians by taking notes and entering them into EMR systems. While that takes a burden off the doctor, it does add cost to the system of providing health care. While it certainly makes for less stressed physicians, it is interesting that it appears to add inefficiency due to complex EMRs in a world where automation is needed and supposed to save money while at the same time provide better care. This got me thinking about the October 1 deadline for the implementation of ICD-10. With about seven times as many codes as the coding scheme it will replace, CMS states that “transition to ICD-10 is occurring because ICD-9 produces limited data about patients’ medical conditions and hospital inpatient procedures.” They believe that new codes will ultimately result in better care.
ICD-9 is 30 years old, contains many outdated terms and procedures and was certainly in need of updating. While, in theory, having more refined data about coding and the outcomes, some of the new codes are just silly and the sheer number of terms is likely to yield less rather than more usable information.
Years ago, when I was helping implement a new financial system, the head of purchasing wanted us to include precise supplies (pencils, pens, pads, etc.) coding for some under-orders that would usually total under $25. He felt that knowing precisely those numbers would help him negotiate the best prices for those supplies. What he didn’t realize was that the cost of collecting that data would exceed any possible savings. I believe that is also true with ICD-10. What is certain is that the implementation is costing a substantial amount of money for a theoretical return that may never be realized.
The reason for this situation is as understandable as it is unfortunate. A large number of researchers and bureaucrats who have limited experience dealing with the realities of patient care had the opportunity to dream about what could happen if they had every possible data point for analysis. A change like this is, after all, a once in a lifetime opportunity to change the way health data is collected and classified. They then had significant input from Health IT vendors and professionals for whom this was an opportunity for sales and implementation of new coding schemes. As one of my friends in clinical medicine said, “This won’t affect me much; our IT people will handle it.” Those people in the trenches, who do the actual work, didn’t really have a voice that was heard. The ultimate outcome will be a combination of unreliable data paired with the need to hire more “scribes” to enter it. It’s unfortunate that we’re likely to squander an opportunity that only occurs once in 30 years.
About the author: Albert Shar, PhD, is managing principal at QERT, a technology consultancy that works with businesses providing expert advice in the strategies necessary for success in today’s rapidly changing and competitive business environment. Prior to QERT, Shar was VP for IT and senior program officer for the Pioneer Portfolio at the Robert Wood Johnson Foundation (RWJF) where he helped developed innovative approaches to the uses of technology in transforming health care. Previously, he was director for IT Research and Architecture at the R.W. Johnson Pharmaceutical Institute, a Johnson & Johnson company. Shar was director of technology services at the University of Pennsylvania Health System, and CIO of its Medical School. He has held a number of faculty positions and holds a patent in medical imaging and is the author of more than 50 articles in health care, computer science, and pure and applied mathematics.
