Digital transformation in health care, Medical ICD coding system can shorten the time of coding and the quality of medical record

Source：China Medical University & Healthcare System

National Health Insurance uses the International Classification of Disease referred as the ICD system. The outpatient and hospital admission diagnosis and treatment codes have been fully used for ICD-10-CM/PCS declarations since January 1 in 2016. The main purpose is to make clinical and health-related data to be exchanged internationally to compared and analyzed with consistent disease diagnosis classifications.

National Health Insurance implements Tw-DRGs （Diagnosis- related Groups）to replace case payment and give hospitals bigger incentives. ICD-10-CM/PCS will impact on Tw-DRGs classification and medical payment. The hospital needs to offer the right diagnostic code of ICD-10-CM/PCS and reply to the severity of hospital admission and develop Clinical Pathway in CMUH. To raise medical care quality and efficiency for purpose and active control of medical costs to achieve reasonable health care benefits and profits.

ICD-10-CM/PCS include 68,000 disease codes and 90,000 disposition codes. The disease classification coding of medical records is more complicated and multifaceted than ICD-9, it required to review the complete medical record to code correctly, which would spend more time, and if the coding staff of medical classification does not have enough experience would impact the quality of disease coding and impact the payment of it.

Dean Kai-Chen, Hsu who is the director of AI center said that our research team of AI Center use Natural Language Processing(NLP) to overcome unstructured medical records and the complex coding rules of ICD-10, it can quickly identify the appropriate disease codes and improve coding efficiency and save coding time for the coding staff of classification, and it can subsequently help doctors identify the appropriate codes in real-time based on medical records to increase coding consistency and ultimately improve to optimize hospital health insurance reporting and the Case Mix Index (CMI) of a hospital.

Medical ICD coding system can assist the physician to choose the right diagnosis and effectively reduce the working burden of coding staff of disease classification and assist the new and those employees who don’t have inadequate work experience and assist recruits and inexperienced personnel in coding operations, and it can reduce omissions of human work and to assist declare health insurance expenses correctly plus, it can obtain reasonable payments. DRGs will also help the physician to make an accurate diagnosis and make better clinical decisions in the out-patient clinic, emergency and hospital admission, and precise care for patients based on clinical data and standard of clinical pathways.

Medical ICD coding system can create high value for medical care institutions, hospital workers, and patients and push it into a digital healthcare transformation of time transgressive.