Coding the Coronavirus

Note: CDC has released an emergency update announcing that there will be a single ICD-10 code for COVID-19 as of April 1, much earlier than the annual ICD-10 updates in October as stated below. The announcement is here. All relevant IT systems should be prepared to update to this new code and staff should be trained to use it. This change will increase the reliability of diagnoses data as an important counterpoint to lab data (see our post above, “Lab Data is the Gold Standard.”

As developments over the past several days have made clear, monitoring and addressing the coronavirus effectively will require consistent documentation of cases as they emerge, and accurate sharing of this information across organizations and IT systems. To this end, the CDC’s National Center for Health Statistics has announced that it will implement a new ICD-10-CM diagnosis code for the 2019 Novel Coronavirus (COVID-19), effective with the next update on October 1. 

In the meantime, the CDC released interim guidance for the coding of encounters related to coronavirus. We recommend that you confirm that your ICD-10 code sets include the codes in this interim CDC guidance, and that you begin relevant staff training on documenting COVID-19 in accordance with these guidelines as soon as possible. Local public health authorities may issue further notices and requirements in the days ahead, so be on the lookout for those as well.

In addition to accurate public health reporting, accurate health information exchange among providers and labs will be critical for communities to stay ahead of COVID-19 through effective treatment of individuals, coordination across organizations, and population monitoring.

Coding scenarios covered in the CDC interim guidance include:

  • Pneumonia case confirmed as due to COVID-19
  • Acute bronchitis confirmed as due to COVID-19
  • A case with COVID-19 documented as being associated with a lower respiratory infection, not otherwise specified or an acute respiratory infection, not otherwise specified
  • Acute respiratory distress syndrome developed in conjunction with the COVID-19
  • Cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation
  • Cases where there is actual exposure to someone who is confirmed to have COVID-19

Thanks to the courageous front-line health care and public health workforce responding to the virus, and to everyone else supporting them with the information, training, and tools necessary for them to succeed – for all of our benefit.

An Invitation

Welcome to the new Intrepid Ascent website. We hope it provides a better way to share our work, ideas, and enthusiasm with colleagues and friends. This page – Thinking – is an invitation to conversation on our shared journey. I encourage you to respond to any thoughts that stir you here by reaching out to members of our team or by sending us a message at hello@intrepidascent.com. We’d love to hear from you.

As you’ll see if you click around the site, our original focus on health information exchange has matured and grown in new directions. One path continues the climb toward the interoperability of IT systems based on common tech & data standards. Another leads to robust governance of enterprises with shared data assets. A third path branches into the territory of collaboration across sectors to address social determinants of health. And a fourth switchbacks from IT implementation to user experience, by way of quality improvement techniques that incorporate design feedback from the field.

While we maintain our youthful ambition to guide clients up their next mountain along these and other emerging routes, we find ourselves increasingly grateful for the community on the journey. We are fortunate to partner with inspired client teams dedicated to making the experience of health care and allied services impactful – especially for the most vulnerable among us. I hope this combination of passion and appreciation comes across in the experience you have on our site, on projects with us, and in many conversations to come.

See you on the trail.

– Mark

Five Questions for Damon Francis

Damon Francis, MD is the Chief Clinical Officer of Health Leads

What’s motivating your work with Health Leads these days?

We are really focused on leveraging data from health-related social needs initiatives to inform community wide decisions about social determinants of health. In the past, we focused entirely on the clinical interaction — making sure that patients were being asked about social needs and something was done about it. We are still focused there, but trying to make sure that our quality improvement efforts to reduce those needs reach into the community to improve the lives of people, whether they are patients or not. One of my favorite partnerships is with the WIC program in New York, where we have used data on barriers to enrollment from clinical referrals to make policy and programmatic changes statewide.

Who out there in your network is doing transformative work that you’re learning from, that we all could learn from?

I really love the work happening within the All Children Thrive network in Cincinnati. They have brought quality improvement methods and infrastructure to community wide challenges. They educate and empower community residents themselves on quality improvement, and they start in the neighborhoods that are most affected. They set a small number of community wide goals that motivate work across sectors, and they develop and refine policy and programmatic efforts to address social determinants. They have achieved some impressive results reducing hospitalizations and extremely preterm births that will change the trajectory of children’s lives for the better and is probably saving a few, too.

We hear a lot about what clinicians don’t like about health IT: all the clicks, the seemingly endless documentation, distracting alerts. But what do you and other clinicians want out of technology? What’s the positive vision?

The positive vision was there at the beginning but I think it’s been lost. I’ve always been intrigued by the Problem Knowledge Coupler idea – where the health record is a place to bring everyone’s knowledge together in a way that is organized to address the problems (and opportunities) of patients/clients. There is a doctor in Maine who has been using that model, with in house technology since the early 1990s.

I see EHR companies and some other health tech starting these principles more, so maybe we’ll get there. Software is eating the world, but if there is any place where the limitations of software are obvious it is in caring for and educating other humans. Businesses are often interested in cutting humans out of the picture, but the future is about closer partnerships and better teamwork among clinicians, programmers, informaticists, etc., not more specialization and not computers instead of people.

What are you reading right now for insight and inspiration?

I’ve gone back to reading a lot of fiction recently. The problems we are facing are rooted in history and too much of my world is about “fast-paced innovation” which is often ineffective for improving lives at best and automates inequity at worst, so I’m trying to counter balance that. Multi-generational novels told from a lot of different perspectives are my latest thing — There There, Homegoing, Pachinko, The House of Broken Angels.

Please share a personal ascent outside your professional life. We want to know!

I’ve recently started backpacking and last year went up to the continental divide in Bridger-Teton Wilderness in Wyoming on a 4 night trip. At the alpine lakes at the top we caught a few cutthroat trout, cleaned them, and cooked them over the fire. A high point in both the literal and abstract sense!

Damon Francis, MD is the Chief Clinical Officer of Health Leads, a national nonprofit that fosters innovative partnerships among health systems and community organizations to advance health equity. He is especially interested in the ways we can align care focused on individuals with strategies to achieve community health. Prior to joining Health Leads, Dr. Francis led population health initiatives related to HIV and homelessness in Oakland and the East Bay. He received his M.D. from the University of California, San Francisco, where he is now a member of the volunteer faculty.

We Believe

At a staff retreat earlier this year we decided to blow off some steam by white-boarding things that we’re against. It was highly therapeutic. Since then we turned around some of these ideas into positive statements about what we believe, issues on which we’re not only able to advise clients but on which we feel compelled to put a stake in the ground and take a position. We hope some of these statements resonate with you too!

-Mark

We believe that access to meaningful data expands human potential, seeding opportunities for insight and innovation, while the centralization of data for top-down decision-making limits opportunities for learning and growth.

We believe that technology can – and should – make the experience of health care and allied sectors better for both providers and consumers. This means that technology fades into the background, enabling meaningful interactions.

We believe in the integration of health, human, and social services to address individual’s whole person needs, and in harnessing technology to enable collaboration across sectors.

We believe that technology adoption requires proactive leadership for change management. Such leadership identifies priorities that guide actions through potentially messy transitions, engages stakeholders early and often, and listens to user experience – remaining open to recalibrations along the way. Ultimately, the sustainability of scaling up technology requires learning from experience, building authentic connections, and prioritizing depth before breadth.

We believe that there should not be a digital divide in health care. Safety net providers and the people they serve deserve the same quality of technology and access to data found in advanced health systems. As Americans move from uninsured to Medicaid to commercial insurance status and back, from community health centers to private practices to hospitals and back, their data must travel with them.

We believe that people own their health information and everyone else is a data steward. As such, health information should be treated as a valuable resource to be protected and enhanced at each phase of its lifecycle.

We believe in standards-based interoperability between IT systems and we are against competitive information blocking.

We believe in shared technology infrastructure, services, and governance whenever possible to enhance value, control costs, and support health improvement at the community level.