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Easing ICD-10 adoption with coding, transcription systems

Transcription helps physicians improve documentation, while computer-assisted coding helps billing get the right ICD-10 code. That chain reaction could make ICD-10 easier to bear.

The health care industry faces a tough road to ICD-10 adoption by Oct. 1, 2013, as discussed at last month's American Health Information Managers Association's AHIMA 83rd Convention and Exhibit.

Carol Fowler, HIM director at the two-campus, 553-bed Gwinnett (Ga.) Hospital System, said computer-assisted coding systems will be a great assist to coders navigating the six figures' worth of codes in ICD-10. CACS, however, won't be a magic bullet, or even a replacement for human coders.

This article, the fourth in a series, explains how providers can use CACS and medical transcription software to help ICD-10 preparation efforts.

Fowler's facility, for example, employs OptumInsight CACS, which it currently uses with coders for ICD-10 training in a lab environment and on current ICD-9 claims for both inpatient and outpatient coding. In the lab, coders are getting a feel not only for the new code set in these training exercises, but also how to interact with the CACS and see how, in mock claims, it can -- and can't -- help choose the paths to arrive at the correct ICD-10 codes.

In real-world claims, Fowler said CACS assistance has already improved coder productivity in the present ICD-9 environment as well as the hospital's case index, which is a patient severity yardstick used for improving reimbursements. That's one of several ways, along with research and quality improvement, that ICD-10 codes go beyond billing.

Fowler said health care providers considering a CACS implementation should base their purchase on three key factors:

  • How the system's rules engine works, particularly in conjunction with your coding staff's decision-making process. Some proponents believe CACS based on natural language processing might fare better than other flavors of CACS. In addition, some hospitals might prefer standalone CACS applications, while other might choose modules for existing coding systems.
  • Whether coders find it easy to use.
  • Whether HIM managers or coders had a hand in designing the system; Fowler feels such applications are more efficient.

Set realistic expectations, too. CACS cannot make up for vague or incomplete physicians documentation. "Computer-assisted coding can only code what's documented. It's not going to find something that's not there," Fowler said. "So if the physicians have given you [data] as granular as you need, you'll still need to go back to the source."

ICD-10 adoption throws spotlight on medical transcription software

With more documentation will come more need for medical transcription software, as physicians will be either typing or dictating more text into the patient record. Giving physicians every means possible to get ICD-10 documentation detail into the EHR system is part of the game plan for University of Utah HIM director Connie Tohara.

Tohara spearheaded the centralization of the university's entire transcription workflow -- which had previously utilized many different applications -- onto a Nuance Communications Inc. Web-based platform employing speech recognition for a first pass. In addition, she narrowed the number of transcription vendors across the system from 42 to three. This project is part of the health system's long-range ICD-10 preparation plan, as well as a cost-saving business move.

It took five years to consolidate the workflow and the software at the 23 hospitals and many more clinics affiliated with the health system, but it has paid off. According to Tohara, costs are lower, the in-house transcriptionists who edit the transcripts turned in by the three outside vendors have improved productivity by 128%, and turnaround time has dropped from 48 hours to 18 hours.

Getting the transcription piece of the ICD-10 coding workflow right is crucial, she said. While "EHR purists" might claim that the software will be ready for ICD-10 adoption, experience tells her the applications aren't really able to parse the detail that the more specific codes will require. Physicians will have to make up the deficit by keying or dictating more detail than the EHR system's various fields and pages will ask for.

While 'EHR purists' might claim that the software will be ready for ICD-10 adoption, experience says the applications aren't really able to parse the detail that the more specific codes will require.

Transcribed dictation, Tohara feels, will bridge the gap and provide the extra content the codes will demand. "With ICD-10, you have to have better documentation. That's our No. 1 roadblock to being able to thrive in ICD-10," she said. "[Dictation gives us the] ability to get information into the record by whatever method we use. Physicians are very comfortable with dictation. They've been doing it for years."

When it came to changing transcription systems, the role of the IT staff -- which sat on the University of Utah steering committee that oversaw the transcription workflow makeover -- included many tasks that can make or break physician satisfaction, Tohara said:

  • Procuring recording hardware.
  • Setting up interfaces to port voice notes into the EHR system.
  • Configuring desktops and servers to support medical speech recognition engines.
  • Setting up the plumbing for delivering transcripts and sound files to the transcriptionists who will review and edit them.
  • Training staff and maintaining the whole system.

"I report through IT," Tohara said. "That's another piece that I think is real critical, because we recognize that we have to work together."

Choosing new medical transcription platform

Organizations upgrading their transcription systems and workflow shouldn't opt for the cheapest or most convenient choice, said Kari Leonard, assistant director of transcription for the Mountain Division of HCA, a 10-hospital system in Utah, Alaska, Nevada and Idaho.

"Do your homework," Leonard said. Choose a vendor only after getting to know the feature sets of several different transcription systems and understanding how those features will help your transcription workflow.

While her colleague Teresa Roberts doesn't believe ICD-10 adoption will necessarily increase her department's report load when compared the present ICD-9 workflow, she has seen an increase in dictated patient progress notes. She attributes that increase to nurses moving to transcription systems now that the EHR environment no longer supports handwritten notes.

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

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