Dr Tim Sayed is certainly multi-talented; a board-certified plastic surgeon with over 10 years of practice experience, as well as an undergraduate background in electrical engineering and computer science. He brings both his knowledge of the day-to-day running of a practice and his understanding of a range of computer codes to his role as Medical Director of Electronic Medical Assistant® (EMA) Plastic Surgery.

Created by Modernizing Medicine®, the EMA systems are a cloud based, specialty-specific electronic medical record system with a library of built-in medical content, designed to save the physician’s time during patient consultations and the billing process. While the EMA systems can already be seen as a useful tool to have in your practice, Dr Sayed believes EMA systems will become a ‘game-changer’ for healthcare providers across multiple specialties once the tenth revision of the International Statistical Classifications of Diseases and Related Health Problems (ICD-10) is introduced.

Increased complexity

ICD-10 will be introduced across the US from 1 October 2014 and is set to have a significant impact on your practice and how you see patients. The current classification system, ICD-9, is an agreed on diagnostic tool for doctors and medical providers to record patient diagnoses for all encounters. Based on the International Classification of Diseases, published by the World Health Organization (WHO), the ICD uses unique sets of code to identify known diseases and other health problems.
The codes are also used in the US by payers for billing and reimbursement purposes.

With the introduction of ICD-10, the number of diagnosis and procedure codes will increase from 13000 to over 68000. ICD-10 will also have twice as many categories as ICD-9 and introduce alphanumeric category classifications for the first time. With so many codes in a new classification system, it will be increasingly difficult for practices to correctly code a patient diagnosis and receive appropriate reimbursement from insurance companies.

‘At present, a lot of practices don’t use electronic medical records or billing systems. They have to manually pick the codes based on their diagnoses. This is already a cumbersome process in ICD-9 but to do this on a piece of paper in ICD‑10 is pretty much impossible and practices stand to take a significant revenue hit if they’re not prepared for the ICD-10 switch, which is fast approaching,’ warned Dr Sayed.

Evidence suggests Dr Sayed is right to highlight the substantial revenue disruption practices may face from ICD‑10. According to a report by Nachimson Advisors, the estimated cost to practices of implementing ICD-10 could range from $83000 for a small practice to $2.7 million for a large practice. This covers the estimated cost of everything from staff training, IT system changes, and increased documentation costs.

The five-fold increase in codes will also have a direct impact on your ability to see patients at your current volume under ICD-9, which not only affects patient care, but will again impact your revenue.

‘You can get to a point where you and your staff have a cheat sheet of common diagnoses, but due to the granularity of the codes it will still not be a very fast look-up process. And if the look-up process takes you 2 minutes per patient and your practice, like some of our dermatology clinics, sees hundreds of patients in a day, you cannot afford that kind of wasted time,’ he explained.

Benefits of ICD-10

While the introduction of ICD-10 will require changes to your clinical and administrative systems, and may have a negative impact on your revenue at least in the short-term, Dr Sayed believes the changes introduced in ICD-10 will ultimately benefit patients and healthcare providers.

‘In general, the US healthcare system is trying to take advantage of healthcare data a lot better to improve outcomes, reduce costs and provide more cost-effective, higher quality care.

‘Approximately 90% of health data is archived and never really used again. Now with the emergence of electronic healthcare systems, the government, Medicare, third party payers, the pharmaceutical industry, research organisations, and public health organisations all want to use this data and figure out what are the best treatments and what can improve wellness at a faster rate and at lower cost.’

ICD-10 also aims to address concerns over the lack of specificity in the information conveyed in the codes of ICD-9. For example, if a patient is seen for treatment of a burn on the right arm, the ICD-9 diagnosis code does not distinguish which arm is affected. If the same patient comes in a week later with a burn on the left arm, the same code would be used and additional documentation would have to be filed to explain that treatment is for a new injury in order to make a reimbursement claim. ICD‑10 will allow for greater specificity in describing a patient’s diagnosis and in classifying procedures.

Dr Sayed further explained the level of detail the new codes will achieve, and how this may result in better care for the patient.

‘If everything was just put in a big black box of wounds as a diagnosis, then we wouldn’t really know whether the treatment works for all types of wounds or just wounds to the face, or perhaps the extremities. What about wounds caused by blunt trauma or by previous surgery? With ICD-10 you can keep exploding that tree further and further down to really understand what is driving the quality of care.

‘The hope and aim of ICD-10 is that by taking it to a more granular level, you can delve deeply into different conditions and you can appreciate subtleties in clinical care and presentations. That’s really the objective of changing the nomenclature and changing the system.’

However, these benefits ultimately lead Dr Sayed to mention the negative impact the changes will have on practices.

‘The drawback is that if you don’t have a system that allows you to maintain your throughput of patient volume and the efficiency of how you deliver care. Or if you’re no longer taking care of your patient but taking care of your bill because you’re constantly trying to get things to render correctly and get the bill to be right, it’s actually detracting from care. So if you can automate that process for the providers they can get back to what they’re trained to do, which is to take care of people.’

EMA Plastic Surgery

Dr Sayed tells me there are currently two traditional workflows. The first is the manual process of using a ‘super bill’, a list of common codes used by the practice. The appropriate diagnosis code would be checked and used for billing the clearing house or payer. The second workflow is the early generation electronic systems, which usually use a look-up table to find the diagnosis code you need. You have to do this for each diagnosis, even if you have multiple diagnoses for one patient.

EMA navigates the work flow a lot more simply. With the patent-pending ICD-10 software you can pick the location on the anatomical map, which has almost 100000 touch-sensitive zones, and with just a few parameters to select from a menu, a super bill is generated automatically with all the relevant codes. EMA is designed to interface with hundreds of different practice management systems, and is available as an iPad application, or any web-enabled Mac, PC or smartphone. It also has pre-programmed medical and billing expertise built in, eliminating the need to bill each visit by hand.

‘For established users, it’s just an extension of the workflow they already know and are already comfortable with. For new users I think it will be game‑changing in the market because people are scared of ICD-10.’

Modernizing Medicine

Prior to joining Modernizing Medicine, Dr Sayed was constantly looking for ways to contribute to the use of technology in the field of plastic surgery. Fortunately, Michael Sherling, co‑founder and Chief Medical Officer of Modernizing Medicine, had trained with Dr Sayed at Massachusetts General Hospital and asked him to come on board when they were expanding their EMA systems to plastic surgery.

Dr Sayed now works a couple of days per week writing the Java script and XML computer code which runs EMA Plastic Surgery. He creates content specific to plastic surgery using not only his knowledge and expertise, but also user feedback and requests.

‘I have a better understanding of why our users want additional features and want new content. I can relate to them as I practice in the same environment. This ability to be nimble in terms of our response to client requests, from a content standpoint, really sets us apart from other electronic medical record companies, which usually employ outside consultants. The turn around time is also a lot faster for us.’

While EMA Plastic Surgery will keep Dr Sayed busy throughout the introduction of ICD-10 and beyond, he is looking forward to working with Modernizing Medicine in future projects and continuing to find new ways for information to be used to improve patient outcomes.