ICD-10 Has Unintended Consequences for EHR Users

To the Editor:

Your Oct. 29 posting -- "AAFP Challenges Wisdom of Adopting ICD-10" -- is the best article I've seen in ages describing the downside of ICD-10. Thank you for the realistic plea to spare primary care physicians.

I thought I would mention a serious unintended consequence of ICD-10 policy.

What is never mentioned in the conversation about ICD-10 is the potentially even greater impact on physicians who are using electronic health records, or EHRs.

EHRs have evolved using ICD-9 as the common language of the patient's problem list. So not only are they used for the back office coding/billing processes, but they are used to identify a patient's diagnosis and then track that condition. The EHR triggers treatment alerts, launches protocols and more.

Typically, an ICD-9 diagnosis, such as hypertension, is identified and remains unchanged on the patient's list of diagnoses for years, allowing the physician to track the condition throughout the patient's life. This is a nonfinancial function of EHRs that is critical to patient care.

ICD-10, which requires a modification of the code at every visit to articulate the patient's current condition, could potentially turn that embedded clinical function of the diagnosis code on its head.

Perhaps in five or 10 years, EHRs could evolve to help providers manage the ICD-10 coding discipline in a constructive and informative way. However, current EHRs would need to be redesigned, perhaps from the ground up, to accommodate the change. This will be incredibly costly for the vendors and disruptive to physician practices. Physicians would have to retrain everyone in the practice who uses the EHR on new and different methods of documenting and tracking health conditions.

My comments are based on experience rather than actual research in the EHR vendor community. I very much hope that policy makers will take this knowledge gap seriously and invest some time in a survey of vendors and knowledgeable users.

AAFP has a strong EHR advocacy program and would be a powerful voice in this arena.

Susan Thomas, M.D.
Augusta, Maine