3 Tips for Adjusting to ICD-10

ICD-10 is here – the new comprehensive coding system for everything that could possibly affect your health and wellbeing, including those pernicious squirrel bites. This is not a guide to the ins and outs of ICD-10; this information is quite capably covered by the inimitable Every ICD-10 Twitter account that regularly plumbs the depths of human ill health, as uncovered by the classification system.

Instead, here are three practical tips to help you and your practice transition to the coding system. All of these are common sense and simple and cost-effective to implement, yet often forgotten in the rush to get everything just right.

Tip 1: Focus on those codes that cover your practice

A radiologist won’t be looking at squirrel bites. A dermatologist or General Practitioner might be asked to repair the damage done by the squirrel, and an infectious diseases specialist might be interested in the health of a squirrel that bites humans. But even though those practitioners could potentially see a squirrel bite in their practice, how often do they see them? Rarely.
General practitioners, for example, are far more likely to see coughs, colds, or mental health problems.

There are two ways of determining which codes are most relevant to your practice – the first is to audit your own documentation, and the second is to poll the doctors and nurses who work there. While audits provide objective data, their quality crucially depend on the diligence with which practitioners have been coding their consultations. Subjective opinions are very good at identifying your practice’s bread and butter.

Tip 2: Focus on incentivised codes

Different health care systems vary in the incentives they have for getting practitioners to use appropriate codes. The US health care insurance system has a whole billing infrastructure system that is geared to punish the unwary coder, while in the UK, General Practitioners have the Quality and Outcomes Framework, which focuses on common chronic diseases and key services, such as maternal and child health.

Getting those incentivised codes right will provide the biggest immediate pay-off. So, once you have made an inventory of the codes that cover most of your practice, you can drill down further by separating out the incentivised ones.

Tip 3: Focus on your single most important coding problem

This is where you need to be able to critically analyse your own failures – areas that go underreported, bills for codes that are constantly returned by insurers. Instead of instigating sweeping reforms or revising your processes from the ground up, it is easier and faster to pick out the one code that is costing you the most in late payments, the one indicator that is most consistently underreported, and fix this coding problem only.

This approach has several advantages:

  • It overcomes paralysis by analysis by giving you a clear focus
  • It maximizes the payoff and minimises the initial investment of time and effort
  • Finding and fixing one large problem will shed light on what might need to be done to fix smaller, related problems

What are your main coding problems? How are you tackling ICD-10 in your own practice?

Are you interested personalized consultation to make your own electronic health record system work for you? Then contact me – I also offer 24-hour turn around Quick Clinics for fast, useful feedback on nagging problems.

How Safe are Diabetes and Hypertension Apps?

mHealth apps have been in the news recently, but not exactly favourably. A team of researchers at University College London, headed by Kit Huckvale, found that many of the apps in the carefully curated NHS Health App Library have clear privacy and security gaps.

This is not an isolated finding. Earlier this year, Konstantin Knorr of the University of Applied Sciences, Trier, Germany, David Aspinall, University of Edinburgh, and I published a paper where we examined the privacy and security of the 154 most popular diabetes and hypertension apps for Android.

We focused on these two conditions because they require regular monitoring, can be monitored through a single parameter (diabetes: blood glucose; hypertension: blood pressure), and are very common. What is more, monitoring their blood pressure at home can help people lower their blood pressure, if the self-monitoring is linked with appropriate clinical support.

Monitoring your own blood pressure works – but can apps deliver the security you need?

In order to assess privacy and security aspects, Konstantin and David developed a comprehensive methodology that looked at four key aspects of an mHealth app:

  1. How safe is the code? Questions included: Does the app allow ads, which means that ad companies be able to see the data that is being tracked? What permissions does the app require?
  2. What happens when the app is used? Questions included: Does the app accept illegal input? Does the app safely export data? What about log files and backups?
  3. What happens when the app contacts its dedicated web server? Questions included: Are data encrypted? Are strong passwords encouraged?
  4. Does the app have a good privacy policy? Questions included: How up to date is the policy, how long and comprehensive is it?

Needless to say, none of the findings were particularly encouraging.
You can find the full data set at http://tinyurl/mhealthapps.

In this initial post, I would like to highlight three key results:

74 of the 154 apps use advertising add ons, and 27 use analytics that track how people use the app. Both types of add ons transfer data out, and these data can include IDs such as a the user’s Google Account ID, and might even contain some of the user’s health data – not necessarily encrypted. Analytics are not necessarily evil; they are an important way for app developers to get feedback on their app and find out whether people actually use it regularly. The question is what data is transmitted, and how.

All apps need to have a certificate before they can be installed on a mobile phone, be it Apple or Android, to indicate who is responsible for the app. While there are external certificate providers, all of the apps we tested had self-signed certificates, and only 40 provided more information than the name of the developer. 83% used the most basic SHA1 encryption to secure their certificate, and only 17% the safer option, SHA256.

Apps that store data on a dedicated web server are not necessarily safe, either. 20 of the apps we tested used their own web portal, and a third of these transferred medical data to it without encryption. Almost none of the apps that allowed people to send email reports to family, carers, and health professionals encrypted the content of the emails, which makes them easy targets for people who happen to be listening in via the Internet connection at your favourite coffee shop.

Does it Matter?

That depends on whether you want to share the details of your blood pressure or blood glucose readings with the world or not. Note I said “world” – not a carefully selected list of friends, family, and health care professionals. This world may use your data for purposes that you haven’t thought of, from personalized in-app advertising to selling your data to insurance providers.

Many research centres, including my colleagues at the University of Edinburgh Centre for Advanced Studies in Cybersecurity and Privacy, are currently looking at ways of changing this situation.

If you were to use an app to log an aspect of your health and wellbeing, how secure should it be? Who should be able to access your data?

Enjoy Your Food – Go Beyond Diet Apps

Health and wellbeing can be sensitive topics for many people. They are associated with a lot of guilt – I know I should go to the gym, I know I should be eating an apple instead of apple pie with cream, I know I should relax more. But in the end, guilt doesn’t get you results. All it does is make you feel bad about yourself, and guess what makes you more likely to fall back into behaviors that feel good in the short term, but are bad for you in the long run? Feeling bad about yourself. (10 points to Sherlock.)

For diet, guilt is particularly pernicious. In his excellent book “The Diet Fix” (Amazon), Dr Yoni Freedhoff calls it one of the Seven Deadly Traumas of dieting. Freedhoff argues that one of the keys to eating more healthily and losing weight is to eat food you enjoy, and that fits your life, not the other way around.

The form that your ideal diet takes may vary, and many people need to experiment until they find a good fit for them. Some people might be happiest with a version of the paleo diet, which is heavy on all types of animal products, and most of their meals will consist of delicious animal protein and well prepared vegetables. Other people might be committed to a vegan lifestyle, which affects many parts of their lives apart from diet. Yet others have an allotment, grow most of their own produce, and want to use what they harvest for delicious recipes.

Each person is unique, and no one app will work for everybody. For the allotment folk, the best choice might be a good recipe app that quickly shows them delicious, healthy options for their produce. Vegans might benefit from a service that helps them spot hidden animal products in otherwise innocuous-looking foodstuffs. Paleo dieters who don’t want to spend lots of money on prime cuts might have a library of recipes that transform neglected cuts of meat into feasts that is indexed by cut of meat and lives on their Google Drive.

Apps can also help you plan and track your dietary experiments. Use todo list apps to make a list of approaches to eating you want to try, and tick them off once you have eaten that way for a week or two. Make a spreadsheet with several options, record how you feel, how easy it is for you to follow that particular approach to nutrition, and most importantly, how delicious the food is!

The solutions are as varied as the people who need them. If you are interested in a personalized consultation, contact me!

Welcome to my online Consulting Room!

Have a seat!

Would you like some tea? Coffee? Hot chocolate? A smoothie with mango, Greek yoghurt, and kale? Or just some nice fresh water?

More often than not, technology hinders more than it helps. And often, it’s the little things that grate.

For people who use technology to live a healthy, active life, it’s the smartphone that keeps running out of battery; the small Fitbit that vanishes underneath the sofa; the food app that gives you three very different combinations of carbs, protein, and fat for the same standard dish.

For health care professionals from doctors to doulas, from trainers to therapists, it’s the electronic health record that takes ages to complete – time you’d rather spend helping your patients, clients, and customers. Or maybe you have a beautiful web site, but your booking form is hidden where nobody can find it.

All of these are obstacles to making eHealth work for you, and I’m in the business of helping you remove those obstacles.

I focus on simple, straightforward suggestions that you can start putting into place straight away – without breaking the bank. (That’s stressful. We want less stress, not more).

I focus on where it hurts, what exactly it is that’s causing you to tear your hair out, throw up your hands in despair, or drown your sorrows in whisky (the water of life, uisge beatha), and together, we will come up with a set of strategies that will take the edge off the pain.

I am not interested in selling you apps or IT solutions. I am completely independent and do not take commission if I recommend apps, books, or resources.

Interested? Contact me for more information!