Meaningful Use Rant 3: ICD-9 Coding of the Problem List

I am all for standards. The more we define and codify the practice of medicine, the better and more interoperable our EHRs become. But a standard, for the sake of a standard, takes us backwards.

I believe the writers of the Final Rule that defined Meaningful Use of an EHR took us backwards when they specified two different standards for coding the problem list (SNOMED and ICD-9). Most organizations appear to be using ICD-9 to code the problem list. I believe that this is because SNOMED is way too complicated and there is no decent implementation reference.

But ICD-9 coding of problem lists does not make sense. Firstly, this country is in the process of migrating away from ICD-9 codes. Why make that process more laborious by creating one more conversion? Let’s skate to where the puck will be.

More importantly, ICD-9 codes do not describe problems in the hospital. ICD-9 codes are medical billing codes.  Sure, they are based on a disease classification system, but problems are not always analgous with a disease or condition. For example, an important problem to note during a hospital stay is that the patient is “at risk for fall” based on a fall assessment. What is the ICD-9 code for this?

ICD-9 codes collected as part of creating the problem list will not provide any additional data beyond the ICD-9 codes that are already abstracted as part of the billing process. So, this pseudo-standard does not provide any new insights. Furthermore, I don’t believe this codification will do anything to improve the interoperability between providers and systems. In the end this is work for work’s sake. Busy work keeps us from implementing the rest of meaningful use that has true benefit to the patient and those that pay for care.

At least this is the way I see it. Am I missing something?

Augmenting the IT Department’s Offerings

I think that part of being a productive employee in the 21st century is finding online services and mobile appps to meet your needs that are not met by the IT department’s standard offerings. Since Internet service and a modern browser are typically standard offerings, this opens up a whole world of offerings. Browsing gives you a sense for the IT services that are available.

Using web based services is not the same as asking the IT department to install software on corporate devices. That ultimately creates a support burden on the IT department. People don’t understand why we don’t want to buy and install their $100 application. It isn’t the $100. These are the things that IT managers hate about one-off software installs:

  • we need to reinstall that ap every time we upgrade or fix the user’s PC.
  • the help desk team members need to have knowledge of the applications when they call the user
  • in a short period of time we will get a call telling us the software version is no longer supported and we need to purchase the upgrade, convert the data and train the user

But more importantly, locally installed software is increasingly unneccessary as Software as a Service (SaaS) makes everything accessible from the browser. Our corporate QuickBase account gives our user base a simple but powerful way to meet many of their needs for dabases and basic workflow. This is why our employees have created over 7,000 applications. This is 7,000 times that employees were able to meet their own needs instad of requesting software and services from IT.

One of my favorite web-based services is Toodledo. is a web based to do list (there are iPhone and iPad apps) to. I like it betther than Outlook tasks. I like the usability and there are some cool features like automatic prioritization based upon due date and prioirty. Mostly I like that I can access it anywhere without launching a Citrix session. This is important becuse I use it to manage my work tasks and my personal life too. I use the paid version because it allows me to store attachments with my tasks. But the free version is impressive.