MORE PROBLEMS IN DOCTOR OFFICES

BRYCE ON HEALTH CARE

- Poorly designed systems, as dictated by the federal government, are strangling physicians.

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In the past, you have heard me talk about system snafus in Doctor offices, both systems and their inordinate dependence on fax machines. Suffice it to say, doctor offices are perhaps the most barbaric from an administrative point of view, not because they want to run this way, but because the federal government is forcing them to. Now, it appears it is going to go from bad to worse, thereby stretching their patience to the breaking point.

As I've written earlier, the government is forcing doctors to prepare extensive electronic records on their patients. This means doctors and nurses are spending more time performing data entry and less time caring for people. I might understand if the data is assembled according to standards, thereby providing the means to easily transfer it from one system to another. Unfortunately, it doesn't which explains why doctors are so dependent on fax machines to transfer patient data, a horribly primitive approach in this day and age.

According to my doctor friends, more trouble is brewing. On October 1, 2014, all medical diagnosis coding will convert from ICD 9 to ICD 10 codes. The number of codes will increase from 17,000 to 141,000. The codes are supposed to be very specific so that disease processes can be narrowly described with one code number. Here are some examples:

W59.22 Struck by turtle
W59.22XA ... initial encounter
W59.22XD ... subsequent encounter
W59.22XS ... sequela
W59.29 Other contact with turtle
W59.29XA ... initial encounter
W59.29XD ... subsequent encounter
W59.29XS ... sequela

V96.01 Balloon crash injuring occupant
V96.01XA ... initial encounter
V96.01XD ... subsequent encounter
V96.01XS ... sequela
V96.02 Forced landing of balloon injuring occupant
V96.02XA ... initial encounter
V96.02XD ... subsequent encounter
V96.02XS ... sequela
V96.03 Balloon collision injuring occupant
V96.03XA ... initial encounter
V96.03XD ... subsequent encounter
V96.03XS ... sequela
V96.04 Balloon fire injuring occupant
V96.04XA ... initial encounter
V96.04XD ... subsequent encounter
V96.04XS ... sequela
V96.05 Balloon explosion injuring occupant
V96.05XA ... initial encounter
V96.05XD ... subsequent encounter
V96.05XS ... sequela

V91.05 Burn due to canoe or kayak on fire
V91.05XA ... initial encounter
V91.05XD ... subsequent encounter
V91.05XS ... sequela
V91.06 Burn due to (nonpowered) inflatable craft on fire
V91.06XA ... initial encounter
V91.06XD ... subsequent encounter
V91.06XS ... sequela
V91.07 Burn due to water-skis on fire
V91.07XA ... initial encounter
V91.07XD ... subsequent encounter
V91.07XS ... sequela
V91.08 Burn due to other unpowered watercraft on fire
V91.08XA ... initial encounter
V91.08XD ... subsequent encounter
V91.08XS ... sequela
V91.09 Burn due to unspecified watercraft on fire
V91.09XA ... initial encounter
V91.09XD ... subsequent encounter
V91.09XS ... sequela

Seems kind of silly doesn't it?

For each injury or symptom, the physician will be required to enter one of these codes into the electronic patient records, from a list of 141,000. Hopefully, there will be some on-line help to point doctors in the right direction, but more likely they will have to reference a paper manual in order to look-up the proper entry.

In systems parlance, the code itself is referred to as a "group" data element, meaning it is a concatenation of data elements. We can find examples of "group" data elements in such things as a telephone number (area code-exchange-number), credit card numbers (financial institution-branchID-account-number), check numbers, power company numbers, and many more. It is simply a way to uniquely assign numbers in order to prevent redundancy.

In the example above, the code is probably decomposed accordingly:

First character (alphabetic) - Type of condition
Positions 2+3, Accidents/Conditions by general category
Position 4 - a decimal (presumably to delineate categories from treatment of conditions)
Positions 5+6 - Specific accident/condition
Positions 7+8 - Treatment

In other words, it's a taxonomy for specifying a specific medical action. The government's solution though is to force medical personnel to memorize these codes or look them up in a voluminous document or on-line help. A simpler way would be to provide a series of simple prompts to guide people through the taxonomy and assign the proper code.

One doctor friend claims he was told the new coding system will be very difficult to implement, such that insurance claims submitted will not likely be processed because of "computer glitches" in accepting the claims. Errors in uploading and downloading the encrypted codes are likely. So much so, the government is encouraging physicians to secure a six month line of credit to ensure their practices can remain open while the claims fiasco is corrected. He claims this is described by the government and mentioned on Medicare websites in many states.

I have dealt with a lot of information systems over the years, but I'm beginning to think we no longer know how to build them. Obamacare is as glaring an example as I can think of, this is another.

Currently, physicians are spending as much as 2-3 hours each day on meaningless computer work to satisfy government regulations. Time which does not improve the care of patients. Unfortunately, as of next October 1st, it will get worse and we'll likely see many experienced doctors finally throw in the towel.

Keep the Faith!

Note: All trademarks both marked and unmarked belong to their respective companies.

Tim Bryce is a writer and the Managing Director of M&JB Investment Company (M&JB) of Palm Harbor, Florida and has over 30 years of experience in the management consulting field. He can be reached at timb001@phmainstreet.com

For Tim's columns, see:   timbryce.com

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Copyright © 2013 by Tim Bryce. All rights reserved.

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