ICD-10? The future is ICD-11. Keynotes focus on transitions, quality

While the U.S. transitions to ICD-10, the rest of the world is rapidly moving toward ICD-11, due in 2015. Also: AHRQ perspective on health IT and quality of care.

SALT LAKE CITY -- Intentional or not, when T. Bedirhan Üstün, M.D., left the stage after his keynote at the American Health Information Managers Association 83rd Convention and Exhibit, it was fitting that whomever was working the sound board piped in Bryan Adams' "Cuts Like A Knife."

That's because the World Health Organization's Department of Health Statistics and Informatics team coordinator of classification, terminologies and standards had used his pulpit to extol the virtues of ICD-11, currently in alpha and due in 2015, to the assembled AHIMA 2011 audience of health information managers -- all of whom presently are knee-deep in the transition to ICD-10 that will take place in 2013.

Examining the differences between ICD-10 and ICD-11, Üstün said that ICD-11 first and foremost integrates medical data that has been discovered globally since ICD-10 was published in 1990. While there have been updates to ICD-10 in the two decades since, it isn't as current as ICD-11 will be.

"If you don't have [current medical data], you won't capture it," Üstün told a group of journalists assembled after the keynote for a question-and-answer session. "In any system: Garbage in, garbage out." He went on to point out that if the rest of the world standardizes on ICD-11 and the United States lags behind, it will pose health data interoperability problems among countries.

ICD-11 built as a Web platform

The multinational group of experts -- mostly statisticians -- developing ICD-10 didn't have the benefit of Web collaboration, as ICD-11's much larger group does. Nor did they have social media like a YouTube channel to get the word out and offer early training information. Furthermore, ICD-11 will be released in many languages, not just English as ICD-10 was.

While ICD-10 resembles a flat "laundry list" of codes, ICD-11 will include an updated-daily Web platform, with a search site that Üstün hopes will make it easier for physicians and coders alike to learn the codeset as well as to find the codes they need for clinical documentation.

Üstün thinks smartphone apps and other software tools will help health care practitioners and information managers code more accurately in ICD-10 and beyond. He cautions, though, that physicians need tools that help steer them through the process of finding codes using language and diagnostic thinking with which they're familiar -- not necessarily coding reference books ported to the iPhone. One theoretical example he demonstrated during his keynote featured graphical representations of coding paths to help practitioners quickly determine specific codes for a particular patient.

"Doctors are terrible coders," Üstün said in the media session. "They are not trained for it, they are not made for it…[but] they can be given tools that will assist them to code what they are doing."

If you don't have [current medical data], you won't capture it. In any system: Garbage in, garbage out.

T. Bedirhan Üstün, MD, Team Coordinator of Classification, Terminologies and Standards, WHO

Üstün sympathized with the HIM managers in the audience who are making the transition to ICD-10 while in the midst of other significant changes in information technology. However, he continued to push for faster adoption of ICD-11 than the 23 years between when the WHO completed ICD-10 and when the United States health care system will switch over in 2013. In a media session following his keynote, Üstün said he didn't think the rapid expansion of U.S. health IT would necessarily make a future transition to ICD-11 any easier than the present switch from ICD-9 to ICD-10.

"I don't believe in magic," Üstün said. "Unless we proactively plan for a more seamless and effective transition, there will be hiccups, and there will be pain."

AHRQ's Clancy: Health IT = quality of care boost

In the keynote address before Üstün, Agency for Healthcare Research and Quality Director Carolyn Clancy, M.D., said that the present U.S. health IT expansion is making a difference in quality of care. Among several promising statistics and trends she cited to back up that premise, she said that her agency has annually reported an overall improvement in health care quality to Congress each successive year since 2003 -- across all settings and populations.

Clancy called 2011 a "fantastic time to be alive" because of new information technologies moving the health care system toward personalized medicine for each patient. Getting patients to use personal health records could be one means of getting us closer to that ideal, she said later in an audience question and answer session following her keynote.

"We do have research that suggests that people who play an active role health care have better outcomes," Clancy said.

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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