Comments on: Monday Morning Update 11/3/08 http://histalk2.com/2008/11/01/monday-morning-update-11308/ Healthcare IT News and Opinion Tue, 22 May 2012 14:25:13 +0000 hourly 1 http://wordpress.org/?v=3.3 By: emrsage http://histalk2.com/2008/11/01/monday-morning-update-11308/comment-page-1/#comment-2558 emrsage Sun, 02 Nov 2008 13:08:19 +0000 http://histalk2.com/2008/11/01/monday-morning-update-11308/#comment-2558 I'd love to know when the last time Sage was relative in the ambulatory space. The fact that they are announcing an 8 doc current customer "upgrades" to Intergy is staggering. This company (when it was Med Mgr) had a huge chunk of the market. Now, it's an afterthought unless it's an existing customer. I’d love to know when the last time Sage was relative in the ambulatory space. The fact that they are announcing an 8 doc current customer “upgrades” to Intergy is staggering. This company (when it was Med Mgr) had a huge chunk of the market. Now, it’s an afterthought unless it’s an existing customer.

]]> By: Dr. Herzenstube http://histalk2.com/2008/11/01/monday-morning-update-11308/comment-page-1/#comment-2557 Dr. Herzenstube Sun, 02 Nov 2008 04:33:37 +0000 http://histalk2.com/2008/11/01/monday-morning-update-11308/#comment-2557 Re: ICD-10-CM. I think Frankie Saluto actually referring to post-coordination when he (or she?) uses the term "normalization". Post-coordination is where a user of a structured structured terminology identifies a concept by selecting one code for each of several axes (e.g. one code for the disorder, like "insect bite," one for the anatomic location, and one for the ordinality of visit). Pre-coordination, on the other hand, is where the terminology includes pre-built concepts that specify values for all the relevant axes, like the ICD-10-CM codes. The problems with post-coordination include: 1. You end up with many more potential combinations than with pre-coordinated codes 2. Many post-coordinated codes might be meaningless (e.g. "classic migraine" combined with "right big toe.") 3. It is easier for the user to select a pre-coordinated code (if the user can be presented with a list that is reasonable in length and includes something representing what they have in mind. The problem with ICD-10-CM is that it is really the worst of both worlds. The lists of codes are in general a slavish enumeration of nearly every possible combination of pathology, anatomic location, laterality, and ordinality of visit-It is essentially a set of pseudo-post-coordinated codes. But, amazingly, they have made it impossible for information systems to automate the process of code selection, because of inconsistency as to which of the 7 characters in the code represents what concept. In some cases laterality (i.e. left vs. right) might be represented by the value of 4th character in the code, in others by the 5th. Thus, it is impossible to design a solution for end-users that allows them to, for instance, have a handy radio button to indicate right vs. left, and have the application reliably select the right ICD-10-CM code behind the scenes. FEH. Re: ICD-10-CM. I think Frankie Saluto actually referring to post-coordination when he (or she?) uses the term “normalization”. Post-coordination is where a user of a structured structured terminology identifies a concept by selecting one code for each of several axes (e.g. one code for the disorder, like “insect bite,” one for the anatomic location, and one for the ordinality of visit). Pre-coordination, on the other hand, is where the terminology includes pre-built concepts that specify values for all the relevant axes, like the ICD-10-CM codes. The problems with post-coordination include:
1. You end up with many more potential combinations than with pre-coordinated codes
2. Many post-coordinated codes might be meaningless (e.g. “classic migraine” combined with “right big toe.”)
3. It is easier for the user to select a pre-coordinated code (if the user can be presented with a list that is reasonable in length and includes something representing what they have in mind.

The problem with ICD-10-CM is that it is really the worst of both worlds. The lists of codes are in general a slavish enumeration of nearly every possible combination of pathology, anatomic location, laterality, and ordinality of visit-It is essentially a set of pseudo-post-coordinated codes.

But, amazingly, they have made it impossible for information systems to automate the process of code selection, because of inconsistency as to which of the 7 characters in the code represents what concept. In some cases laterality (i.e. left vs. right) might be represented by the value of 4th character in the code, in others by the 5th. Thus, it is impossible to design a solution for end-users that allows them to, for instance, have a handy radio button to indicate right vs. left, and have the application reliably select the right ICD-10-CM code behind the scenes. FEH.

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