[EXTERNAL] Re: [IMPROVEDX] DX measures

Rory Jaffe rjaffe at CHPSO.ORG
Fri Dec 7 16:42:18 UTC 2018


I don’t even think they’d need NLP for this. ICD 10 diagnosis codes are in a logical tree structure. All they need to see is how far the closest ICD10 code in the discharge list of codes is in the tree to the admitting code. It doesn’t have to be a perfect match.

For example, a person’s diagnosis could bounce around many of these codes, and the changes wouldn’t be due to diagnostic error, just new complications showing up or the complications being better-defined. For example, E10.3291 could change to E10.3213 as a natural evolution of the disease or futher evaluation by an ophthalmologist.

 E10<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10> Type 1 diabetes mellitus
·          E10.1<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.1> Type 1 diabetes mellitus with ketoacidosis
o     E10.10<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.10> …… without coma
o     E10.11<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.11> …… with coma
·          E10.2<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.2> Type 1 diabetes mellitus with kidney complications
o     E10.21<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.21> Type 1 diabetes mellitus with diabetic nephropathy
o     E10.22<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.22> Type 1 diabetes mellitus with diabetic chronic kidney disease
o     E10.29<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.29> Type 1 diabetes mellitus with other diabetic kidney complication
·          E10.3<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3> Type 1 diabetes mellitus with ophthalmic complications
o     E10.31<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.31> Type 1 diabetes mellitus with unspecified diabetic retinopathy
§   E10.311<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.311> …… with macular edema
§   E10.319<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.319> …… without macular edema
o     E10.32<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.32> Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy
§   E10.321<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.321> Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema
§   E10.3211<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3211> …… right eye
§   E10.3212<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3212> …… left eye
§   E10.3213<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3213> …… bilateral
§   E10.3219<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3219> …… unspecified eye
§   E10.329<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.329> Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema
§   E10.3291<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3291> …… right eye
§   E10.3292<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3292> …… left eye
§   E10.3293<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3293> …… bilateral
§   E10.3299<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3299> …… unspecified eye
o     E10.33<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.33> Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy
§   E10.331<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.331> Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema
§   E10.3311<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3311> …… right eye
§   E10.3312<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3312> …… left eye
§   E10.3313<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3313> …… bilateral
§   E10.3319<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3319> …… unspecified eye
§   E10.339<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.339> Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema
§   E10.3391<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3391> …… right eye
§   E10.3392<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3392> …… left eye
§   E10.3393<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3393> …… bilateral
§   E10.3399<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3399> …… unspecified eye
o     E10.34<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.34> Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy
§   E10.341<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.341> Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema
§   E10.3411<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3411> …… right eye
§   E10.3412<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3412> …… left eye
§   E10.3413<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3413> …… bilateral
§   E10.3419<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3419> …… unspecified eye
§   E10.349<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.349> Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema
§   E10.3491<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3491> …… right eye
§   E10.3492<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3492> …… left eye
§   E10.3493<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3493> …… bilateral
§   E10.3499<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3499> …… unspecified eye
o     E10.35<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.35> Type 1 diabetes mellitus with proliferative diabetic retinopathy
§   E10.351<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.351> Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema
§   E10.3511<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3511> …… right eye
§   E10.3512<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3512> …… left eye
§   E10.3513<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3513> …… bilateral
§   E10.3519<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3519> …… unspecified eye
§   E10.352<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.352> Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula
§   E10.3521<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3521> …… right eye
§   E10.3522<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3522> …… left eye
§   E10.3523<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3523> …… bilateral
§   E10.3529<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3529> …… unspecified eye
§   E10.353<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.353> Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula
§   E10.3531<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3531> …… right eye
§   E10.3532<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3532> …… left eye
§   E10.3533<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3533> …… bilateral
§   E10.3539<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3539> …… unspecified eye
§   E10.354<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.354> Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment
§   E10.3541<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3541> …… right eye
§   E10.3542<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3542> …… left eye
§   E10.3543<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3543> …… bilateral
§   E10.3549<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3549> …… unspecified eye
§   E10.355<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.355> Type 1 diabetes mellitus with stable proliferative diabetic retinopathy
§   E10.3551<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3551> …… right eye
§   E10.3552<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3552> …… left eye
§   E10.3553<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3553> …… bilateral
§   E10.3559<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3559> …… unspecified eye
§   E10.359<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.359> Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema
§   E10.3591<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3591> …… right eye
§   E10.3592<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3592> …… left eye
§   E10.3593<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3593> …… bilateral
§   E10.3599<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.3599> …… unspecified eye
o     E10.36<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.36> Type 1 diabetes mellitus with diabetic cataract
o     E10.37<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.37> Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment
§   E10.37X1<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.37X1> …… right eye
§   E10.37X2<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.37X2> …… left eye
§   E10.37X3<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.37X3> …… bilateral
§   E10.37X9<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.37X9> …… unspecified eye
o     E10.39<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.39> Type 1 diabetes mellitus with other diabetic ophthalmic complication
·          E10.4<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.4> Type 1 diabetes mellitus with neurological complications
o     E10.40<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.40> Type 1 diabetes mellitus with diabetic neuropathy, unspecified
o     E10.41<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.41> Type 1 diabetes mellitus with diabetic mononeuropathy
o     E10.42<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.42> Type 1 diabetes mellitus with diabetic polyneuropathy
o     E10.43<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.43> Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy
o     E10.44<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.44> Type 1 diabetes mellitus with diabetic amyotrophy
o     E10.49<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.49> Type 1 diabetes mellitus with other diabetic neurological complication
·          E10.5<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.5> Type 1 diabetes mellitus with circulatory complications
o     E10.51<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.51> Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene
o     E10.52<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.52> Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene
o     E10.59<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.59> Type 1 diabetes mellitus with other circulatory complications
·          E10.6<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.6> Type 1 diabetes mellitus with other specified complications
o     E10.61<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.61> Type 1 diabetes mellitus with diabetic arthropathy
§   E10.610<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.610> Type 1 diabetes mellitus with diabetic neuropathic arthropathy
§   E10.618<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.618> Type 1 diabetes mellitus with other diabetic arthropathy
o     E10.62<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.62> Type 1 diabetes mellitus with skin complications
§   E10.620<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.620> Type 1 diabetes mellitus with diabetic dermatitis
§   E10.621<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.621> Type 1 diabetes mellitus with foot ulcer
§   E10.622<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.622> Type 1 diabetes mellitus with other skin ulcer
§   E10.628<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.628> Type 1 diabetes mellitus with other skin complications
o     E10.63<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.63> Type 1 diabetes mellitus with oral complications
§   E10.630<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.630> Type 1 diabetes mellitus with periodontal disease
§   E10.638<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.638> Type 1 diabetes mellitus with other oral complications
o     E10.64<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.64> Type 1 diabetes mellitus with hypoglycemia
§   E10.641<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.641> …… with coma
§   E10.649<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.649> …… without coma
o     E10.65<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.65> Type 1 diabetes mellitus with hyperglycemia
o     E10.69<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.69> Type 1 diabetes mellitus with other specified complication
·          E10.8<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.8> Type 1 diabetes mellitus with unspecified complications
·          E10.9<https://www.icd10data.com/ICD10CM/Codes/E00-E89/E08-E13/E10-/E10.9> Type 1 diabetes mellitus without complications




Rory Jaffe, MD MBA, Executive Director, CHPSO<http://www.chpso.org/>
1215 K Street, Suite 930
Sacramento, CA 95814
rjaffe at chpso.org<mailto:rjaffe at chpso.org>
(916) 552-2600

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From: Jarrett, Mark P <MJarrett at northwell.edu>
Sent: Friday, December 07, 2018 3:38 AM
To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>; Rory Jaffe <rjaffe at chpso.org>
Subject: Re: [EXTERNAL] Re: [IMPROVEDX] DX measures

This is a case for NLP coming to the rescue.
Sent from my iPhone

Mark P. Jarrett, MD, MBA, MS
SVP & Chief Quality Officer
Northwell Health
2000 Marcus Avenue
New Hyde Park, NY 11042
P: 516-321-6044
C: 917-796-3935

On Dec 6, 2018, at 9:49 PM, Rory Jaffe <rjaffe at CHPSO.ORG<mailto:rjaffe at CHPSO.ORG>> wrote:

External Email. Use Caution.
And coding rules are involved too. They are only looking at the principal exit diagnosis—so the initial admitting diagnosis may still be present as a secondary diagnosis, not a principal discharge diagnosis (multiple diagnoses are included in each discharge). Therefore, any diagnosis changes identified in the study may be unrelated to a change from the admitting diagnosis, as the principal diagnosis may be an additional diagnosis, without replacing the admitting diagnosis.

Rory Jaffe, MD MBA, Executive Director, CHPSO<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.chpso.org_&d=DwMGaQ&c=vq5m7Kktb9l80A_wDJ5D-g&r=OdFSWyd_9B_X_P7v0350Bl1aeyp7F5zA-lXlf2CKjKY&m=j1zppO64IibA-hLuwJ8bfDixteVL9HB6Eo5z5olV6fw&s=0o-bqcrQvD6CgnyujPyT6HnWizCK_VaQN76nY7K-rOs&e=>
1215 K Street, Suite 930
Sacramento, CA 95814
rjaffe at chpso.org<mailto:rjaffe at chpso.org>
(916) 552-2600

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From: Lehman, Greg T. (MD) <greg.lehman at PARKNICOLLET.COM<mailto:greg.lehman at PARKNICOLLET.COM>>
Sent: Thursday, December 06, 2018 10:27 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] DX measures

I agree Mark.  The difference in initial and final diagnosis during hospitalization may be a marker of great diagnostic work.

From: Mark Graber [mailto:Mark.Graber at IMPROVEDIAGNOSIS.ORG]
Sent: Thursday, December 06, 2018 10:29 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] DX measures

Jason – thanks for continuing to press us all to develop practical measures we could all support that would lead to improved diagnosis.

I do agree that concordance between an admission and discharge diagnosis might be one measure of the adequacy of the diagnostic process in the ambulatory setting.  But at the end of the day, I’d argue that ‘getting it right’ is likely more important than getting it right in the clinic alone.

The agreement between admission and discharge diagnosis is fairly easy to measure and study, but this parameter is complicated !  First, in many hospitals the discharge diagnoses are assigned by coders whose primary goal seems to be centered on optimizing billing, not to capture diagnostic accuracy.  Second, and I may be old-fashioned here, but in my humble opinion there is no better time or place to make a diagnosis or to revise an initial impression.  It is so much easier to concentrate on a patient’s problems, consider and complete diagnostic evaluations, and get opinions from others during an inpatient stay compared to stretching these out over time and space in the ambulatory setting.  In this framework, any difference between the admitting and the discharge diagnosis is likely to be to the patient’s advantage and a good thing.  The disagreement noted in this study is almost certainly multifactorial, but if I had to guess, this data may be saying something positive about the diagnostic process in showing that the recorded diagnosis did in fact evolve during the admission.

    Mark

Mark L Graber, MD FACP
Chief Medical Officer; Founder and President Emeritus, SIDM
Professor Emeritus, Stony Brook University, NY


From: Jason Maude <jason.maude at ISABELHEALTHCARE.COM<mailto:jason.maude at ISABELHEALTHCARE.COM>>
Reply-To: Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, Jason Maude <jason.maude at ISABELHEALTHCARE.COM<mailto:jason.maude at ISABELHEALTHCARE.COM>>
Date: Thursday, December 6, 2018 at 9:41 AM
To: Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
Subject: [IMPROVEDX] DX measures

This is a very interesting study (freely available) looking at the degree of match between the admission diagnosis and what the authors call the exit diagnosis.

“Our results show that only the 21.67% of cases are identified correctly on admission….”

Could this be used as a measure for diagnosis quality in hospitals? I am sure there will be concerns about the admitting diagnosis and clinicians being rushed to put something down without enough time but the ratio between the 2 diagnoses for an institution as a whole should be a useful indicator as would the trend over time. If the measure drove institutions to focus of getting the admitting diagnosis more accurate then that would be good.

This should also be practical to produce as would not involve the clinicians in any additional work.

In an earlier discussion, I asked if there were any measures that were practical, where there were no concerns and that we could all support but got replies. I really feel that if we are to get diagnosis the respect it deserves from hospitals and health systems then we need a measure. We have all been talking about this for a long time, but I do not sense we are any further forward!

Regards

Jason Maude
Founder and CEO Isabel Healthcare
Tel: +44 1428 644886
Tel: +1 703 879 1890
http://www.isabelhealthcare.com<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.isabelhealthcare.com_&d=DwMGaQ&c=hx0HUg_nG-xRkKlwWZeJFCbvzzw0Ym5DwdL_1FKbReI&r=ykcs2wU25yxj5BckI49bSg&m=u_OYsvoMqtAmaIYs29VEePvm5SdCeRswLjyF6bu0rKY&s=ssIVAaSk3pDk659f_28xiEfRiRmRBG6bfe8d8sqs6Vo&e=>


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