MedlinePlus Connect: Planning for Clinical Coding System Changes



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MEDLINEPLUS CONNECT:

PLANNING FOR CLINICAL CODING

SYSTEM CHANGES

Kristen Lynn Burgess

Associate Fellow, 2010 – 2011

National Library of Medicine

SPRING 2011

PROJECT LEADERS:

Stephanie Dennis, Technical Information Specialist, Reference and Web Services, Public Service Division

Naomi Miller, Manager, Consumer Health Information, Public Services Division

TABLE OF CONTENTS


TABLES & FIGURES 2

ACKNOWLEDGEMENTS 3

ABSTRACT 4

INTRODUCTION 6

BACKGROUND 7

MEDLINEPLUS.GOV & MEDLINEPLUS CONNECT 7

ICD-9-CM AND ICD-10-CM 8

DIFFERENCES BETWEEN ICD-9-CM AND ICD-10-CM 9

METHODOLOGY 12

PHASE I: RESEARCH 12

GENERAL EQUIVALENCE MAPPINGS 12

MEETINGS 15

PHASE II: ANALYSIS 16

ANALYSIS METHOD I: GENERAL EQUIVALENCE MAPPINGS (GEMS) 16

ANALYSIS METHOD 2: LISTER HILL CENTER (LHC) – UMLS ALGORITHM 18

RESULTS 19

GEMS ANALYSIS 19

GEMs METHOD 1: RANDOM SAMPLING 19

GEMS METHOD 2: GEMs SELECTIVE SAMPLE FROM S00 – T89 22

GEMs MASTER FILE 26

LISTER HILL MAPPING EVALUATION 27

ADDITIONAL OUTCOMES & LESSONS LEARNED 28

RECOMMENDATIONS 29

GEMs RECOMMENDATIONS 29

LISTER HILL CENTER RECOMMENDATIONS 31

GENERAL RECOMMENDATIONS 32

DISCUSSION 33

CONCLUSION 34

REFERENCES 35

APPENDICES 38

APPENDIX A: PROJECT PROPOSAL 38

APPENDIX B: PROJECT TIMELINE 41

APPENDIX C: SUGGESTED READING LIST 43

APPENDIX D: ORIGINAL MAPPING GUIDELINES 48

APPENDIX E: NOTES FROM SELECT MEETINGS 51

Kin Wah Fung Meeting Notes 51

Vivian Auld Meeting Notes 54

Olivier Bodenreider and Lee Peters Second Meeting Notes 56

APPENDIX F: ACCESS & EXCEL TIPS & INSTRUCTIONS 59



TABLES & FIGURES



ACKNOWLEDGEMENTS


I have many people to thank for their help and guidance. I thank my wonderful project sponsors Stephanie Dennis and Naomi Miller for their support and insight. I thank the many people who helped me with this project or served as project advisors for their valuable input to this project including: Vivian Auld, Olivier Bodenreider, Loren Frant, Kin Wah Fung, Patrick McLaughlin, Lee Peters, and Jan Willis. I am grateful to Kathel Dunn, Jeanette Johnson, Troy Pfister, and my fellow associates for their support and encouragement this year. Lastly, I thank Dr. Lindberg, Betsy Humphreys, Sheldon Kotzin, Joyce Backus, and Becky Lyon for their support of the Associate Fellowship Program.


ABSTRACT


Objective: MedlinePlus Connect links patient portals and electronic health record systems to targeted health information from MedlinePlus.gov. MedlinePlus Connect currently supports ICD-9-CM and the SNOMED CT CORE Problem List Subset for requests for health information relating to a patient’s diagnosis codes. MedlinePlus Connect will support ICD-10-CM in advance of the October 2013 date when the Centers for Medicaid and Medicare Services will require it for billing transactions. This project explores the methodology for MedlinePlus Connect supporting ICD-10-CM requests.

Methods: Research on the transition to ICD-10-CM and the differences between ICD-9-CM and ICD-10-CM was conducted to determine key areas relevant to MedlinePlus Connect. The General Equivalence Mappings (GEMs) released by the National Center for Health Statistics (NCHS) were applied to the current MedlinePlus Health Topic mappings. The GEMs are forward and backward mappings between ICD-9-CM and ICD-10-CM, and indicate if a proposed mapping is identical or approximate. The author matched the GEMs to the MedlinePlus health topic mappings to determine associations between ICD-10-CM and MedlinePlus Health Topics. The author analyzed a random sample of ICD-10-CM to MedlinePlus health topic mappings, as well as a purposive sample of codes within particular code groupings. Results will be compared with a separate mapping from Lister Hill Center (LHC) researchers that uses the Unified Medical Language System (UMLS) to map the MedlinePlus Health Topics and ICD-10-CM.

Results: ICD-10-CM is approximately 5 times larger than ICD-9-CM and includes greater laterality, specificity, and encounter specifications. Of the 23,485 code pairs in the GEMs forward mapping file from ICD-9-CM to ICD-10-CM, 17,157 could be associated with a MedlinePlus Health Topic. Analysis of an initial random sample from this combined GEMs and Health Topics file indicated that roughly 80% of mappings flagged as approximate and 96% of mappings flagged as identical provide appropriate mappings between ICD-10-CM and the Health Topics. Analysis of code groups from the Injury, Poisoning, and Certain Other Consequences of External Causes chapter indicated patterns that will assist future mappings between ICD-10-CM and the Health Topics. Results from the UMLS mapping from LHC are pending.

Conclusions: Two potential methods are available to transition the MedlinePlus Health Topics from

ICD-9-CM to ICD-10-CM. While analysis is ongoing and the best method has yet to be determined, the process will likely include automated methods combined with human review. Particular categories of the diagnosis codes will require more scrutiny. Regardless, MedlinePlus Connect must support ICD-10-CM prior to October 2013.


INTRODUCTION


MedlinePlus Connect is a free service of the National Library of Medicine (NLM) created to link electronic health record (EHR) systems and patient portals to relevant information from its consumer health website, MedlinePlus.gov. MedlinePlus is a free online consumer health resource of the NLM and National Institutes of Health (NIH) that provides information about nearly 900 Health Topics (diseases, conditions, and wellness issues) as well as drugs and supplements. MedlinePlus Connect links requests from EHRs or patient portals to MedlinePlus information for diagnoses (problem codes), medications, and lab tests.

This project focuses on the requests for information on diagnoses. These are called problem code requests and are supported by MedlinePlus Connect. MedlinePlus Connect currently supports two existing problem code sets: ICD-9-CM (International Classification of Diseases, 9th Edition, Clinical Modification) and SNOMED CT CORE Problem List Subset (Systematized Nomenclature of Medicine, Clinical Terms, Clinical Observations Recording and Encoding Problem List Subset)1 [1]. MedlinePlus Connect currently matches approximately 12,000 ICD-9-CM and 5,500 SNOMED CT CORE Problem List Subset codes to MedlinePlus consumer Health Topics. The codes are mapped to up to three unique MedlinePlus Health Topics.

Recent changes necessitate MedlinePlus Connect to support the next version of the International Classification of Disease, ICD-10-CM, in addition to ICD-9-CM. The Centers for Medicare and Medicaid Services (CMS) requires that all health care providers and stakeholders transition from ICD-9-CM to ICD-10-CM by October 2013 for reimbursement of Medicare expenses. MedlinePlus Connect must be able to map its Health Topics to ICD-10-CM codes by this time.

Naomi Miller and Stephanie Dennis from the NLM Public Services Division (PSD) proposed this project to explore the CMS change to ICD-10-CM and to research how MedlinePlus Connect can best support ICD-10-CM (see APPENDIX A: PROJECT PROPOSAL and APPENDIX B: PROJECT TIMELINE). This project’s challenge is to develop a methodology for MedlinePlus Connect to match these ICD-10-CM codes to specific Health Topics so it can support requests from systems that use ICD-10-CM. This project aimed to address this challenge by answering the following questions:



  • What are the differences between ICD-9-CM and ICD-10-CM for MedlinePlus Connect to consider?

  • What are the options available to facilitate the change?

  • How will MedlinePlus Connect support ICD-10-CM?

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