Rochester Regional Health Informational Management Association Preparing for ICD-10: Changes in Emergency Medicine September 24, 2015 Keith Grams, MD Chief, Emergency Medicine Associate CMO, throughput & Capacity Management Rochester General Health System

Objectives: To review the primary changes ICD-10 will bring to Emergency Medicine To demonstrate the charting process To review the current preparation To understand the potential impact of ICD-10 on patient care

Quick Quiz When was ICD-9 adopted? 1979

Quick Quiz Who created ICD-10? The World Health Organization

Quick Quiz What does ICD stand for? International Statistical Classification of Diseases and Related Health Problems ISCODARHP ICD

Quick Quiz When was ICD-10 adopted by WHO? 1994

Quick Quiz When was ICD-10 first supposed to go-live in the US? 2013

Quick Quiz When is ICD-10 going live in the US? October 1, 2015

Changes in EM (Professional) Charting in Epic (CareConnect)

How We Teach the Providers Documentation Communication Coding Medico-legal

ED Professional Coding Relative Value Unit Medicare Omnibus Budget Reconciliation Act, 1989

The Game

The TrackBoard

The Chart

HPI

HPI

HPI

HPI

ROS

Physical Exam

Procedures

Procedures

Medical Decision Making

Attestation Tab

The Note

What’s Missing?

What’s Missing?

What Missing? Past medical/surgical history Social history Family history

Orders

Orders

Orders: Indications

Diagnosis “Clinical Impression”

Diagnosis “Clinical Impression” ICD-9 ICD-10 17,000 141,000

Diagnosis “Clinical Impression”

Diagnosis “Clinical Impression”

Diagnosis “Clinical Impression”

Diagnosis “Clinical Impression”

Diagnosis “Clinical Impression” Detail, detail, detail Initial, subsequent, sequela Location, location, location Abdominal pain Contusions, sprains,…

Current preparation

What’s Been Done? RRH Online education HLC modules Coding company education On line modules Direct feedback loop Dual coding deficiencies

What Happens When We See Data? 1. Denial/Blame 2. Anger 3. Bargaining 4. Depression 5. Acceptance

Stages of Data Grief 1. Denial/Blame 2. Anger 3. Bargaining 4. Depression 5. Acceptance

Coping with Loss … Deficiencies Charts % Department 100 1000 10%

Coping with Loss … Deficiencies Charts % Dr. A 250 0% Dr. B Dr. C 250 0% Dr. B Dr. C Dr. D 100 40%

Coping with Loss … Deficiencies Charts % Dr. Bentley 250 0% 250 0% Dr. Benziger Dr. Cavallaro Dr. Grams 100 40%

Are We Ready? Dual coding feedback …

Are We Ready? 2015 Batch# Coded Defiencies % 1 570 24 4.21% 2 302 0.33% 3 128 0.00% 4 96 5 42 6 75

Deficiencies

Deficiencies

Deficiency Breakdown 0.7% of all charts # Percentage Total 24 100% Location 13 54% Type 3 13% JPW 8 33% 0.7% of all charts

Now We’re Ready

Impact on Patient Care

22,000 more than next largest ED in area Volume 2014 = 125,323 2015 = 128,000+ 2014: 22,000 more than next largest ED in area

Door-to-Provider

LWO

How We Keep Up Team triage model CareConnect optimization ASAP tools Documentation Scribes

66 minutes (of clicking) in 12 hr shift What Does the EMR Cost? 4,000 clicks/shift 1 click/sec 66 minutes (of clicking) in 12 hr shift

What Does the EMR Cost? For RGH 13.2 hours/day of clicking 26.5 pt/day not seen 9665 pt/yr not seen Cost of EMR = $966,574

EMR Pro’s & Con’s Con’s Time away from the patient Operational challenges Availability of information Pro’s Integration Data …

Coming Soon … Previous based on general EMR numbers No RGH specific data… Usage data coming soon

Recap: EM changes in ICD-10 The charting process Current preparation EMR impact on patient care

keith.grams@rochesterregional.org