Love it, James! Great diagnosis of an important and pervasive problem in health care. Liked this line in particular..."a generalized, categorical problem list...preserves the patient's timeline, makes the chart more readable, and facilitates better care."
Hi James, you will be interested to know that we addressed the issue you described for pretty much the exact same reason over 20 years ago - we wanted a system to capture clinical diagnoses whilst preserving the timeline of the development of the disease, all in a way that is intuitive to clinicians, easy to operate, infinitely extensible and which automagically generates the codes required. We presented it at MEDINFO in 2001 and it has been working across the entire Hospital Authority ever since. Our EMR is homegrown, the Clinical Management System (CMS), and has always been intensely focused on the clinician experience and how to help clinicians deliver better care throughout their day. The writeup on the Clinical Data Framework is available here https://pubmed.ncbi.nlm.nih.gov/11604809/ or you can drop me a note at cheungnt@ha.org.hk to discuss further
Absolutely spot on! I too, look forward to part 2--and plan to use this as a way to better educate the operational/exec leaders on why the clinicians do what they do. I suppose one way to think about it is to provide a way to sort by condition...all the DM codes under a general header of DM, so folks get the broader idea...slightly different from sorting problem list by organ system, specialty, etc.
Spot on! The other complexity we're approaching is billing Z codes for social risk factors--can't just document that the patient is couch-surfing, have to select and bill the specific Z code Z59.811 for housing instability, at risk of homelessness. Looking forward to Part 2.
Hi Jonathan, hope part 2 answered this at least partly - the dynamic system of problem choice via menu selections. Interestingly, I had a comment from a doctor who helped develop a complex coding system in Hong Kong to extend ICD-9, with additional digits for clinically relevant things not captured by ICD. Much of that got better (too much better even) with ICD-10, but there is still a lot of ambiguity in ICD-10 Z-codes. For instance, Z98.890 can be History of eyelid surgery, History of foot surgery, Hx of eyelid surgery or many other things. Z91.89 can be SO many things - a partial list:
H/o: poisoning
High risk for cervical cancer
History of awareness under general anesthesia
History of difficult intubation
History of exposure to dexfenfluramine
To be complete, the extended menu system of oriole would have to cover ICD-10, then extend beyond it in some cases - and maintain detailed and specific synonyms for ambiguous codes, sort of "reverse hiding" it - giving the clinician more detail, and simplifying the language to a general code for the payer! It could work; AI could help; god help the clinical system who leaves oriole and tries to migrate the data, of course...
Love it, James! Great diagnosis of an important and pervasive problem in health care. Liked this line in particular..."a generalized, categorical problem list...preserves the patient's timeline, makes the chart more readable, and facilitates better care."
Very clear description of a horrible problem
Hi James, you will be interested to know that we addressed the issue you described for pretty much the exact same reason over 20 years ago - we wanted a system to capture clinical diagnoses whilst preserving the timeline of the development of the disease, all in a way that is intuitive to clinicians, easy to operate, infinitely extensible and which automagically generates the codes required. We presented it at MEDINFO in 2001 and it has been working across the entire Hospital Authority ever since. Our EMR is homegrown, the Clinical Management System (CMS), and has always been intensely focused on the clinician experience and how to help clinicians deliver better care throughout their day. The writeup on the Clinical Data Framework is available here https://pubmed.ncbi.nlm.nih.gov/11604809/ or you can drop me a note at cheungnt@ha.org.hk to discuss further
Absolutely spot on! I too, look forward to part 2--and plan to use this as a way to better educate the operational/exec leaders on why the clinicians do what they do. I suppose one way to think about it is to provide a way to sort by condition...all the DM codes under a general header of DM, so folks get the broader idea...slightly different from sorting problem list by organ system, specialty, etc.
Spot on! The other complexity we're approaching is billing Z codes for social risk factors--can't just document that the patient is couch-surfing, have to select and bill the specific Z code Z59.811 for housing instability, at risk of homelessness. Looking forward to Part 2.
Hi Jonathan, hope part 2 answered this at least partly - the dynamic system of problem choice via menu selections. Interestingly, I had a comment from a doctor who helped develop a complex coding system in Hong Kong to extend ICD-9, with additional digits for clinically relevant things not captured by ICD. Much of that got better (too much better even) with ICD-10, but there is still a lot of ambiguity in ICD-10 Z-codes. For instance, Z98.890 can be History of eyelid surgery, History of foot surgery, Hx of eyelid surgery or many other things. Z91.89 can be SO many things - a partial list:
H/o: poisoning
High risk for cervical cancer
History of awareness under general anesthesia
History of difficult intubation
History of exposure to dexfenfluramine
To be complete, the extended menu system of oriole would have to cover ICD-10, then extend beyond it in some cases - and maintain detailed and specific synonyms for ambiguous codes, sort of "reverse hiding" it - giving the clinician more detail, and simplifying the language to a general code for the payer! It could work; AI could help; god help the clinical system who leaves oriole and tries to migrate the data, of course...
Thank you so much for sharing your wisdom and insight! I wish the EMR Vendors would incorporate your common-sense design elements.