IT experts push translator systems to convert doc-speak into ICD-10 codes

Despite the recent congressional delay in implementing the ICD-10 coding system, there is growing interest in a high-tech way of helping physicians convert their standard clinical terminology into the complex new payment codes. It's called “language-to-code” translation.

These translation systems are essentially computerized medical dictionaries stuffed with clinician-friendly descriptions in English or Latin of patient complaints, diagnoses and procedures, which are then linked to lists of clinical and billing codes. These words are presented to clinicians during preparation or updating of a problem list, for example, through software built into their electronic health records. Once a clinician selects a word or phrase, the software links it to code sets such as SNOMED CT—now available for free through the National Library of Medicine—the American Medical Association's Current Procedural Terminology, and ICD-9 and ICD-10.

IT experts say these translation systems can remove some but not all of the hassle physicians will experience translating doc-speak into ICD-10 code sets if and when ICD-10 is implemented in the U.S. Such systems could ease physician fears about ICD-10 disrupting their workflows and cash flows.

“Implementation of SNOMED CT will help providers with the transition to ICD-10,” Dr. Amy Helwig, acting chief medical officer of HHS' Office of the National Coordinator for Health Information Technology, wrote on the ONC's blog. That's because computer systems can use SNOMED “to seamlessly generate ICD-10 codes.”

The ONC's 2014 edition criteria for testing and certifying EHRs require them to be able to record clinical information in SNOMED codes. To meet Stage 2 meaningful-use criteria, physicians are required not only to have systems capable of recording in SNOMED, but to actually use SNOMED codes “to document problem lists, procedures and some clinical findings, Helwig said.

Language-to-code translation systems have different names. It's called clinical interface terminology by commercial developer Intelligent Medical Objects and an enterprise clinical terminology management platform by Health Language Inc., and branded as Convergent Medical Terminology by Kaiser Permanente.

The delay in shifting to ICD-10 (See related story, p. 2) gives only the most tech-savvy provider organizations enough time to build translation tools into their EHRs, said Dr. Andrew Wiesenthal, director of healthcare practice at Deloitte Consulting. Wiesenthal helped develop Kaiser's translation system while working there.

Several top EHR vendors have had one or more of these translators installed in their systems for some time. Many EHRs for office-based physicians will at least let them look up SNOMED terms. Many clinicians support using SNOMED codes because they make medical records more amenable to analysis for research and population management, in addition to serving as a federally endorsed aid to the ICD-10 transition.

Kaiser developed its CMT translation system more than a decade ago. Starting first with clinical language mapped to 650 or so of Kaiser's most commonly used SNOMED codes, Kaiser has since expanded CMT to include about 100,000 medical concepts.

The system converts these doc-language terms into SNOMED, ICD-9 and ICD-10. In 2010, Kaiser donated CMT to the International Health Terminology Standards Development Organisation, which allows the National Library of Medicine to distribute the translator, as well as SNOMED codes and cross maps, free of charge in the U.S.

There have been 4,400 free downloads of the CMT system since the library released its first free cross map of SNOMED to ICD-10 in 2012, said Betsy Humphreys, the library's deputy director. She thinks the cross map is being used by federal agencies, including the Veterans Affairs Department and the Indian Health Service; EHR vendors; and large healthcare organizations.

Dr. Lyle Berkowitz, medical director of IT and innovation at Northwestern Memorial Physicians Group, said his group has used a translator from Intelligent Medical Objects for at least five years. While it is useful for physicians in compiling patient problem lists to help formulate treatment plans and create research registries, it's problematic for coding a care episode in ICD-9 or ICD-10 for billing purposes.

“I can put (congestive heart failure) on my problem list, but for billing I need to be more specific,” he said. Spending that extra time on coding for ICD-10 “is where the worry is.”

Robert Tennant, senior policy adviser for the Medical Group Management Association, said few if any smaller physician groups now are using computer-assisted code translators in their EHRs. “I've not come across anybody using it,” he said. “I know Kaiser has been a strong proponent for many years, but they're kind of a unique animal in the industry.”

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