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Best of the Blogs

October 28, 2008
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The following commentaries are the most-read postings from HCI's Blogosphere. To read other postings and leave your comments and questions, visit, register with a username and password, and make your voice heard.

A 10 Beats a Nine, No Matter How You Cut the CardsPosted on: 9.16.2008 5:39:50 PM Posted by Joe Bormel, M.D., MPH

Accepting the Inevitable is No Way to Implement ICD-10

Those who have long fought the transition to and implementation of ICD-10 in the United States are now quickly being silenced by the forthcoming government mandate for providers and payers alike to move forward with this long overdue improvement to our healthcare system.

Over the past several weeks, I have tried to become “smarter” about ICD-10. To a great degree, my efforts have been rewarded with a troubling deluge of information about the billion or so dollars it will cost to transition from the existing 30-year old ICD-9 coding methodology, the problematic learning curve, and the potential for interim reimbursement problems. But what has troubled me most is an overriding position expressed by many highly reputable experts that we might as well shrug our shoulders, accept the inevitable and prepare for the worst. Now I ask you, is that any way to efficiently and effectively manage change?

Five years from now, the arguments against ICD-10 will be as laughable and ridiculous as:

  • MS-DOS works fine, why Windows?

  • X-rays are sufficient.

  • Who needs air bags when we have seat belts?

  • Cell phones are just a novelty.

  • Louis Pasteur's theory of germs is ridiculous fiction.

  • Airplanes are interesting toys but of no military value.

  • Drill for oil? You mean drill into the ground to try and find oil? You're crazy.

  • With over 50 foreign cars already on sale here, the Japanese auto industry isn't likely to carve out a big slice of the U.S. market.

  • While theoretically and technically television may be feasible, commercially and financially, it is an impossibility.

  • There is no reason anyone would want a computer in their home.

  • Sensible and responsible women do not want to vote.

Gartner has called the transition to ICD-10 “a momentous change.” However, it also states that, “In the long run, ICD-10 is a key enabler for quality improvement, better management planning and better care.” Better care, isn't that what every provider organization is trying to achieve?

(To read this posting in its entirety, visit

Healthcare Transparency ' A Vision of ChangePosted on: 9.8.2008 9:57:01 PM Posted by Michael W. Craige, MBA

Like the Newt Gingrich article on the “Future State” (April 2008 issues of Healthcare Informatics), my vision of tomorrow's healthcare system cannot be accomplished with Healthcare IT alone; we need transparency!

The perfect healthcare system should be based on transparency. From a strategic perspective, healthcare IT should allow health plans, physicians, and patients to instantly see their entire set of medical records. Clinicians should be able to receive evidence-based treatment recommendations for frequent diagnoses, and be able to retrieve comprehensive treatment alerts. Healthcare IT strategy should help to push for transparency for every U.S. healthcare consumer and practitioner which will provide quality, cost and other open information to be used to make informed healthcare decisions for all.

The result is a reduction in costly medical errors, the ability to efficiently and effectively treat a greater volume of patients at a lower cost, and the opportunity for informed patients to receive care regardless of location status.

(To read this posting in its entirety, visit

Where Are Those HIPAA Savings?Posted on: 8.26.2008 11:20:49 AM Posted by Reece Hirsch

Back when the “administrative simplification” portion of HIPAA was still a gleam in the eye of a legislator, the primary intent was to standardize certain critical electronic health care transactions and code sets to help the health care industry achieve efficiencies and reduce costs associated with a myriad of transaction formats. The HIPAA privacy and security regulations were somewhat of an afterthought, in recognition of the fact that increased use of electronic health care transactions means increased risk to data.

Which brings us to HHS's August 22 notice of proposed rulemaking, which would require a switch from ICD-9 code sets to International Classification of Diseases, 10th Revision, Clinical Modification in HIPAA standard transactions. The estimated cost to the U.S. health care industry is estimated in the billions of dollars.

Don't get me wrong, I do believe that the HIPAA Privacy and Security Rules have helped raise the bar for protection of medical information. In addition, the move to ICD-10 appears to be necessary; the ICD-9 code sets were developed nearly 30 years ago and can no longer be adequately expanded to address advances in diagnoses and procedures. …

(To read this posting in its entirety, visit

Learning to say “Yes.”Posted on: 9.2.2008 9:19:10 PM Posted by Pete Rivera

I can be moving at 100 miles an hour, working an issue or putting out fires and then I run into a person that brings me to a dead stop. It can be a simple issue or maybe I am seeking something innovative and they say, “No, I can't do it or it can't be done.” Don't get me wrong, if there is something impossible or illegal or has a solid business case as to why it can't be done, then I back up, regroup and work alternatives. What I am talking about are people that find it easier to say “no,” because it is harder to say “yes.” Saying “yes” means that they have to do something, they have ownership for something and they are taking responsibility for an issue.

When I was a senior officer in the military I was told by one of my superiors that I needed to learn to say “yes.” He even had a sign on his desk that proudly proclaimed, “Say Yes!” I didn't get it. My entire military career was spent on achieving a position where everyone had to tell me “yes.” Now I was being told that I had to tell everyone else “yes.” I eventually figured out that it was all about courtesy, professionalism and earning respect. Nobody likes a tyrant, regardless of where they are in the organizational food chain. Being capricious or mean just for the sake of avoiding extra work or proving your authority is a sure fire way to shorten a career.

(To read this posting in its entirety, visit

“…there is a shooter in the hallway!”Posted on: 9.6.2008 4:29:11 PM Posted by L. Albert Villarin, M.D. FACEP

The Columbine High School massacre occurred on Tuesday, April 20, 1999, at Columbine High School in Columbine in unincorporated Jefferson County, Colorado, near Denver and Littleton. Two students, Eric Harris and Dylan Klebold, embarked on a shooting rampage, killing 12 students and a teacher, as well as wounding 23 others, before committing suicide. It is the fourth-deadliest school killing in United States history, after the 1927 Bath School disaster, 2007 Virginia Tech massacre and the 1966 University of Texas massacre, and is the deadliest high school shooting.

Any Emergency Department (ED), hospital, school in the country or the office where you work, could fall prey to gun violence at any time day or night. According to the American College of Emergency Medicine, ED statistics are on the rise and proactive steps are recommended to prevent injury. (1) In 1995, the greatest number of physical assaults (384) and the second largest number of homicides (8) occurring in hospitals occurred in emergency departments. Causes range from a national increase in gang violence, higher patient need for psychiatric evaluation due to the decrease in available behavior health inpatient beds, and increased drug and alcohol abuse — all manifesting anger in overcrowded waiting rooms and emergency departments.

“..Shots fired…Shots fired..!” It's March 6, 2009 and you hear those words from a coworker…what do you do?… where do you go?… how do you get help? Are you ready to save your life and the lives of others around you? The difference between walking out of your office or becoming a statistic may only be how you communicate the incident.

(To read this posting in its entirety, visit

Healthcare Informatics 2008 November;25(11):12-14

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