AFRICA COUNTRIES NEED TO BRACE UP TO ACHIEVE THE WORLD HEALTH “TARGET-18” ON ICD IMPLEMENTATION
It has been internationally said many times that there is a general lack of empirical evidence to guide African Countries in their health systems reforms which puts a great emphasis on the monitoring and evaluation of performance of Data Collection Systems. This therefore has institutionalized data collection, monitoring and evaluation, and dissemination of information on population, health, and nutrition for improving programs and policies by many Agencies in Nigeria and around the world. Right now, all Countries are putting in enormous effort to meet the “TARGET-18 (2018 has been set by WHO when all Countries should have started to use the new ways to clinical coding ICD-10 for Diagnosis and ICD-10PCS for the 16 newly categorized clinical procedures” of the World Health.
In line with this development, it has become very important amongst other functions that State Health Management Authorities should begin to maintain and disseminate the state Health Profile on: a. Demography – Population statistics; Vital statistics
b. Health Status – Morbidity and Mortality (communicable disease; Non communicable disease); reproductive and child Health; Disability
c. Website to contain general information on their Agencies, Health Information / State Health Profile, State Recommendations on HIS, National recommendation on improving and strengthening the use of ICD10 and Medical Record System, Training Calendar, Application Forms, Module and Work Book on ICD10, Formats for Health Data flow from states and various publications of the State.
d. Capacity Building and Operation Research for Efficient HIS including ICD10 and ICD10-PCS use in the state.
e. Inventory and GIS mapping of government medical and health care facilities in the state etc.
When a physician evaluates a patient, the physician collects subjective and objective data (the “history and physical”) to diagnose the patient’s condition and develop a plan for treatment. The most widely used diagnostic taxonomy in health care is the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (ICD). The ICD is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases that is used internationally to classify morbidity and mortality data for vital health statistics tracking and in the health Research, insurance claim reimbursement.
As medical advances continue, public reporting of quality indicators is expected to become more prevalent, with greater emphasis placed on payment for quality. The use of ICD for the coding of hospital discharge (morbidity) or death certificate (mortality) data, using the rules established by WHO, ensures data which is comparable between individual hospitals, communities, states or internationally, as well as at different points in time. Hitherto, the USA ICD-9-CM volume 3 Procedural Coding System for coding operations was in use by some countries including Nigeria and this has now become obsolete and must be replaced. It was designed and implemented over 20 years ago, and since that time dramatic advances in medicine and medical technology have occurred that were not anticipated and have not been adequately accommodated.
For example, laser and laparoscopic surgery were not performed at that time, but are now utilized for many types of procedures. At the time the ICD-9-CM procedural coding system was developed, only one surgical approach, "open," was used for many procedures that can now be performed using a variety of approaches. Consequently, over these years, the ICD system has outgrown its intended level of specificity and affects the ability to compare data precisely for clinical, research, and Payment purposes as classification system is unable to accommodate yearly updates and advances in medicine and technology.
This has necessitated the development and adoption of ICD-10 (Diagnosis) and ICD-10-PCS (Procedure Coding System) mainly for coding procedures that have also been categorized into 16 groups. ICD-10-PCS is an alphanumeric procedure classification system used for inpatient hospital settings only.
ICD TRANSITIONING ICD-10 is the biggest change facing the health care industry around the world today simply because of the impact it would have on the healthcare sector. Some countries have adopted the use while USA is about the last country among the highly industrialized country not yet but promised to go live by October 1, 2014. Among countries that have adopted, the outpatient setting is often excluded. Germany carved out an exception for primary care physician office visits for example. However, the world has flogged the issue of ICD10/ICD10PCS implementation so much that we now know what we stand to benefit from the transition to the new system. A lot of contributors especially the new entrant to the contribution terrain who are naïve of the whole genesis may talk from their understanding and perspectives alone. For instance majority of the physicians see ICD-10 implementation as a means to enhancing revenue through effective reimbursement system as most people play low on the clinical aspect while others want quality documentation and data for research and health reporting purposes.
The main reason the world is moving to ICD10/ICD10PCS is primarily due to the obsolescence of ICD9 because of the dramatic advances in medicine and medical technology which have occurred that were not anticipated and have not been adequately accommodated. This is the primary terms of reference. Therefore we have to exercise caution in what we intend to make out of the transition or how we intend to go about the process. ICD-10 and ICD-10PCS classifications will form the foundation for critical national healthcare initiatives such as meaningful use, value-based purchasing, payment reform, quality and quality reporting, patient and population safety, as well as yield information that will optimize health data, allow for a more uniform health information exchange and create a move to a reimbursement system based on quality and outcomes. The partial list of benefits includes:
o Opportunity to improve the capture of information about the increasingly complex delivery of health care e.g. Ebola, SARS, Anthrax etc.
o Bring grater coding accuracy and flexibility to hospitals, health systems, presenting opportunities for detailed record-keeping and enhanced documentation to support the quality, safety, and efficacy of care
o Conducting research, epidemiology studies , and clinical trials as well as setting health policy & designing healthcare delivery systems
o Managing care and improved disease management and Tracking public health and risks
MYTHOLOGY OF ICD10 TRANSITION There is a mythology that considers ICD10/ICD10PCS implementation a daunting and very cumbersome process. The myth has been aggravated by the fact that ICD9 has been around for many decades during which most of the users have gone to schools and worked in facilities. Consequently, they have forgotten that there was a migration from ICD8 to ICD9 but because ICD9 has been used for too long, it has indirectly been taken as standard that may never change.
Let us liken the scenario to what happen just before the millennium when the people of the world were jittery about what would happen to all processes as a result of limitations in information system. They went as far as buying guns, selling their properties and so on. Today, some countries have implemented the ICD10 even though not without challenges while some have not even started thinking about the transition. All countries can come out clean with the transition as long as it has to be done.
There should be no reason why some physicians or facilities may not be ready for the implementation including payers and clearinghouses while nobody should even be thinking at this stage whether to do or not to do. There may be challenges in the areas of information systems and infrastructure but these have their solutions out there. The absence of transition will mean that the physician will pay for coding errors, the patients also will suffer unjustly when services are not covered or in effective.
COMPLIANCE LEVEL ACROSS THE GLOBE
Health information is the glue that holds a health system together. In most countries stronger, more integrated information systems are required. One example is vital registration systems - the ability to count births and deaths. These systems are still missing for most of the countries' population, especially in countries with high disease burdens. Today sadly there is an ‘information paradox’ in the world: countries with the greatest health burdens and needs have the biggest information gaps. They not only have the least information but also limited capacity (skills, systems) to generate, analyze, present and disseminate information. This is no surprise given the toll of HIV/AIDS, tuberculosis and malaria as well as injury and violence in those countries It’s important to acknowledge that a broad transitional effort to ICD10 will not succeed without input and buy-in from every key stakeholder. All medical and health institutions, including hospitals of any size, in the country should equip themselves with WHO publication on ICD 10 (3 volumes) and ICD10PCS as a reference and ICD 10 code relevant to each medical specialty be prominently made available in concerned wards in the hospitals. No medical records should remain without ICD 10 codes for the diagnosed disease and procedures.
The new ways to clinical coding - Diagnoses with ICD-10 and the 16 newly categorized Procedures with ICD-10-PCS, the main basis towards unified data collection system has taken over diagnosis and procedures worldwide and provide a significant opportunity to improve the capture of information about the increasingly complex delivery of health care apart from bringing greater coding accuracy and flexibility to hospitals, health systems, and payers, autopsy and death certificates presenting opportunities for detailed record-keeping and enhanced documentation to support accurate payment apart from other numerous benefits. This will have real potential for improvement in care management, given the greater level of detail inherent in the new systems. Among the several reasons for disease coding, at the minimum, it allows for easy storage and retrieval of information thus facilitating the analysis and interpretation of disease-related data. Disease coding allows for standardization among users and producers and for international comparability. Disease coding also allows for efficiency in billing. The de-facto standard for disease coding is the WHO family of disease and health related classification of which the core is the International Classification of Diseases (ICD) system.