MedlinePlus Connect: Planning for Clinical Coding System Changes

CONCLUSION

The MedlinePlus Connect team has two potential methods 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.

REFERENCES

[1] MedlinePlus Connect: Linking Electronic Health Records (EHRs) to MedlinePlus Health Information [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2010 November 9; cited 2011 January 11]. Available from http://www.nlm.nih.gov/medlineplus/connect/overview.html

[2] MedlinePlus Connect: Technical Information [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2010 November 15; cited 2011 January 11]. Available from http://www.nlm.nih.gov/medlineplus/connect/technical.html

[3] National Center for Health Statistics, Centers for Disease Control and Prevention. International Classification of Diseases, Ninth Revision (ICD-9). 2009. Retrieved August 1, 2011 from http://www.cdc.gov/nchs/icd/icd9.htm

[4] Zeisset A. ICD-10-CM Enhancements: A look at the Features that Will Improve Coding Accuracy. Journal of AHIMA. 2009; 80(2):55-8.

[5] Grider, DJ. Preparing for ICD-10-CM: Make the Transition Manageable.US: American Medical Association; 2009. 291 p.

[6] Steindel, SJ. International classification of diseases, 10^th edition, clinical modification and procedure coding system: descriptive overview of the next generation HIPAA code sets. J Am Med Inform Assoc. 2010; 17: 274-282. doi:10.1136/iamia.2009.001230

[7] Kuehn, L. Preparing for ICD-10-CM in Physician Practices. Journal of AHIMA. 2009 Aug; 80(8): 26-29.

[8] American Medical Association. 2010, June 2. Fact Sheet 2: The differences between ICD-9 and ICD-10. Preparing for the ICD-10 Code Set: October 1, 2013 Compliance Date. Available from http://www.ama-assn.org/ama1/pub/upload/mm/399/icd10-icd9-differences-fact-sheet.pdf

[9] Diagnosis Code Set General Equivalence Mappings: ICD-10-CM to ICD-9-CM and ICD-9-CM to ICD-10-CM. 2011 Version. Documentation and User’s Guide. 25p. [Modified 2011 Feb 9; Cited 2011 April 20]. Available from https://www.cms.gov/ICD10/11b1_2011_ICD10CM_and_GEMs.asp#TopOfPage

[10] National Center for Health Statistics, Centers for Disease Control and Prevention. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). 2011. Retrieved August 1, 2011 from http://www.cdc.gov/nchs/icd/icd10cm.htm

[11] American Medical Association. Transaction Code Set Standards: ICD-10 Code Set to Replace ICD-9. Retrieved August 1, 2011 from http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/hipaahealth-insurance-portability-accountability-act/transaction-code-set-standards/icd10-code-set.page

[12] Butler, R. The ICD-10 General Equivalence Mappings: Bridging the Translation Gap from ICD-9. Journal of AHIMA, 2007, 78(9). 84-86. Available from http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_035523.hcsp?dDocName=bok1_035523

[13] Sullivan, T. ICD-9 to ICD-10 translation tools emerge [Internet]. HealthITNews: ICD10Watch. 2010 May 6 [cited 2011 April 20]. Available from http://www.icd10watch.com/blog/icd-9-icd-10-translation-tools-emerge

[14] History of the development of the ICD [Internet]. World Health Organization; [updated date unknown; cited 2011 April 20]. Available from http://www.who.int/entity/classifications/icd/en/HistoryOfICD.pdf

[15] American Medical Association. Fact Sheet 7: Crosswalking between ICD-9 and ICD-10 [Internet]. 2010 Oct 18 [cited 2011 April 20]. Available from http://www.ama-assn.org/ama1/pub/upload/mm/399/crosswalking-between-icd-9-and-icd-10.pdf

[16] Shortliffe, EH [Editor] & Cimino, JJ [Assoc Editor]. Biomedical Informatics: Computer Applications in Health Care and Biomedicine. US: Springer; 2006.

APPENDICES

APPENDIX A: PROJECT PROPOSAL

PROJECT TITLE: Researching Vocabulary Issues for MedlinePlus Connect
SUBMITTED BY: Naomi Miller and Stephanie Dennis

BRIEF DESCRIPTION:

MedlinePlus Connect is a free service of the National Library of Medicine (NLM) and the National Institutes of Health (NIH). This service allows any electronic health record (EHR) system to easily link users to MedlinePlus, an authoritative up-to-date health information resource for patients, families and health care providers. MedlinePlus provides information about conditions and disorders, medications, and health and wellness.

For conditions and disorders, MedlinePlus Connect maps MedlinePlus health topic pages to two vocabularies: ICD-9-CM (International Classification of Diseases, 9th Edition, Clinical Modification) and SNOMED CT Core Problem Subset (Systematized Nomenclature of Diseases.) SNOMED is the vocabulary that the HHS Office of the National Coordinator for Health Information Technology has designated for achieving “meaningful use” of electronic health records. Most medical practices and hospitals in the U.S. currently use ICD-9-CM because that is the system used by the Centers for Medicare and Medicaid Services for reimbursement of Medicare expenses. However, changes are coming in the next few years. Medicare will switch to using ICD-10 in October 2013. Also, more practices will be switching to SNOMED coding to satisfy meaningful use requirements.

The purpose of this project will be to explore the implications of these changes for MedlinePlus Connect and to investigate ways to facilitate changes to coding systems and vocabularies for MedlinePlus Connect.

DURATION: 4 months

FULL-TIME EQUIVALENT: 8 weeks

EXTERNAL SCHEDULES / DEADLINES: None

PRIMARY LEARNING OBJECTIVES FOR ASSOCIATE:

• Learn about provision of patient information through electronic health records

• Become familiar with MedlinePlus Connect operation and infrastructure

• Learn about medical coding systems (ICD-9, ICD-10, SNOMED), including the differences between ICD-9 and ICD-10

• Learn about crosswalks (maps that express relationships) between medical vocabularies

• Investigate existing crosswalk for SNOMED to ICD-10 and availability of ICD-9 to ICD-10 crosswalks

• Research crosswalks with a selected group of MedlinePlus Connect mapping files for conditions

EXPECTED PROJECT EXPERIENCES:

• Problem definition

• Project scope definition

• Design and implementation of research methodology

• Data analysis

• Identification and use of others' technical expertise

• Examination of an unfamiliar technical area

• Development and presentation of recommendations

EXPECTED OUTPUTS/PRODUCTS:

• Documentation of differences between ICD-9 and ICD-10 codes

• Recommendations for modifications to existing mappings

• Recommendations for pursuing crosswalk methods in preparation for 2013 switch to ICD-10

• Recommended background readings for MedlinePlus Connect team

SUGGESTED METHODOLOGIES:

• Become familiar with MedlinePlus and MedlinePlus Connect

• Conduct research on coding systems and coming changes

• Research availability of crosswalks between diagnosis vocabularies. Sources might include the UMLS, Medicare, AHIMA (American Health Information Management Association)

• Conduct tests with subset of MedlinePlus Connect vocabulary mappings

• Develop recommendations for implementing maps between vocabularies

BENEFITS TO NLM:

Project will provide NLM with feedback about and recommendations for improvements to a high-profile service.

PROJECT LEADERS: Naomi Miller, Manager, Consumer Health Information, Public Services Division; Stephanie Dennis, Health Information Products Unit, Reference & Web Services Section, Public Services Division

OTHER RESOURCE PEOPLE: Wei Ma, OCCS; Joyce Backus, Deputy Chief, PSD; Joseph Potvin, OCCS, Loren Frant, PSD; Vivian Auld, NICHSR; Jan Willis, MMS; Kin Wah Fung, Lister Hill