Requirements: Medical Coding
In an ideal scenario, everyone, everywhere would use both agree on and use a common medical coding schemes. For CURE International, a network of hospitals that's just getting underway with network-type activity, that's probably going to happen. For HospitalRun as a product overall, more flexibility is needed.
At the beginning of the project, we settled in on ICD-10 for diagnosis and CPT for procedures and built a pretty awesome typeahead search meant to solve the issue of combing through the 10,000+ diagnostic codes in ICD-10.
That had a few problems:
- There are (of course) multiple flavors of ICD-10 as well as a good deal of lag regarding a move to ICD-10, and the system needs to accommodate for that.
- Even the type-ahead search was insufficient to support our usability requirements for clinicians. This shouldn't be surprising, as few people could or should have command of a coding structure with 10's of thousands of entries.
There are several different ways that systems have/do try to manage the unwieldy nature of coding standards, from multi-click screens to having system admins pre-select codes. For individual clinicians (even if their facility treats a massive spectrum of issues), the reality is that each tends to see and treat a somewhat limited pathology.
So for a healthcare facility, an ideal scenario would be the ability to both select and eventually migrate/re-code a diagnosis automatically through a externally-maintained set of codes (and mappings).
It would also be advantageous for a system to suggest (and allow the explicit editing of) a set of standard (or most commonly accessed) diagnostic codes while still providing access to an entire coding set.
For clinicians, a system would ideally remember and prioritize the most common diagnostic codes that they tend to select first, followed by the facility's most common selections, and finishing with the ability to search through the entire coding standard.
Thus the following requirements (likely broken up into several feature tickets).
The idea here would be a screen under administration where the available diagnostic coding standards (as provided by an outside web request) would be listed, and a user could download that coding standard into that HospitalRun instance. Subsequently, updates in that published standard could be automatically updated by the HospitalRun server application.
JSON response of the list of standards available, including a revision number / timestamp for updating purposes.
REST service for downloading a selected coding standard from the list of available standards on hospitalrun.io
Standard is selected by identifier (URL pattern or HTTP variable) and returns a JSON response
Administration > Medical Coding: Admin Screen for reviewing, downloading, uploading, and updating coding standards
Show a list of coding standards as provided by the REST service above, with actions next to each standard.
- Name of standard (ex. ICD-10 US, ICD-10 WHO)
- Revision / revision date
- Actions: Install (if not installed already), Update (if a newer revision has been published)
Reports screen that allows multiple reports to be run
Select a coding standard from a dropdown of the installed coding standard and tabulate the results of number of times a given code has been used, ordered by the most commonly used codes.
Select a coding standard from a dropdown of the installed coding standard and list the objects that are not coded properly with links directly into the edit screen for each object to set the appropriate medical code.
The system should take advantage of the extensible nature of our ORM database to include new attributes on patients and visits for each coding standard. So rather then having a primary and secondary diagnosis code tracked, those variables would become computed properties that support backwards compatibility and abstracts the coding standard from the business questions, "What is this patient's primary diagnosis?" or "What is this patient's secondary diagnosis?" This would involve the ability for each coding standard to define their attributes on a Patient and Visit object.
It would also (eventually) involve supporting the automatic mapping of one coding standard to another, should I system change it's configuration to use a new coding standard. However, this second concept is not currently a requirement.
Building off the work of the ICD10 type ahead, build an updated (potentially generalized) medical control that given an coding standard as an input, (optionally) a currently selected code(s).
The control should be a hybrid of a select box and a typeahead, that follows the follow priority of content.
- Most common used codes in the given coding standard for the user
- Most commonly used codes in the given coding standard for a HospitalRun installation
- Access to the entire coding standard for searching and assignment
On each selection of a code for a given coding standard, that selection should be stored in two different lists:
- A queue of the most recently unique codes for a given coding standard for a HospitalRun installation.
- A queue of the most recently unique codes for a given coding standard for a given user.
The purpose of both of those lists is multi-faceted.
- Creating the usability experience specified in the above control.
- Capturing a basis for global trending data in HospitalRun across all instances, useful for both product development and research.