What’s the wonderful marvellous thrilling thing about doing SNOMED diagnostic code entry on your EMR? There’s always something to do!
You wouldn’t want to be just sitting around and reading the paper. Or having coffee, talking to someone by the water cooler. Concrete, physician specific work that needs to be done. That’s what we need.
I tried to get my 17 year old son to help me with SNOMED diagnostic code entry. He’s a good guy, an “A” student, and very computer literate. This technique was suggested during the last OntarioMD conference I went to, a meeting of computer minds and vendors meant to help the struggling MD. The suggestion was, that you could invite senior high school students to do this kind of work, and even call it “community service.” The problem is, it just simply isn’t that easy. I had to put him in under my password, and trust that he wouldn’t go looking at charts he shouldn’t be into. (That’s easy to monitor with computers, unlike the old paper chart days. Security is way up.) But you know what? Often what I put into the CPP as a diagnosis wasn’t easily coded.
I’d have things like DM/05, meaning diagnosis of DM in 2005. DM in itself was a problem, as I’d have DM1, DM2, MODM, glucose intolerance, ^ FBS 2012, etc. A real mess. I’d also have things like, “watch microalbumin,” which of course should have been in reminders. What’s a kid, even a smart, conscientious kid, do?
The other thing, of course, is that SNOMED diagnostic code entry is just simply dead boring.
There’s seeing patients, you see, and then there’s the paperwork. It shouldn’t seem separate, but that’s how it feels. Seeing patients doesn’t tire me. Doesn’t aggravate me. I find it actually fairly stimulating; I feel I’m actually (at least attempting) to help someone. Helping someone up is that wonderful positive psychotherapeutic thing we ask our patients to do, correct? It makes the doldrums just dissipate like mist.
Then there’s the computer. Labs. Community labs. Hospital labs. Consultant reports. OLIS. Hospital Report Manager. Medication renewals. Phone calls.
And SNOMED. Keeping up the CPP.
You see a new lab report, or consultant report, and, ideally, you update your CPP, and enter that new diagnosis, or diagnosis clarification. But that’s not the end. Then, you need to put in ICD-9, or SNOMED, or something, as the computer as yet can’t decipher our code. English. Or French, or Botsawanian, or whatever.
Numbers. That’s what the computer wants. We’re still in that transition generation where we’re trying to jam the computer into a hole into which it doesn’t quite fit. The only way to do this is to change ourselves. Change the way we work in order to use the thing. Aggravating but true.
I hadn’t done it for a while. At least, sit at the desk, plow through charts and do the SNOMED diagnostic code entry. Want a boring job? Well, this may just define it.
Until I started doing a bit MORE. Sorry, I wish I could say LESS. Doing MORE, makes the SNOMED challenge less… challenging. There’s a way you can do this that can actually help.
Try to just quickly look at the med profile. How many drugs are on it? > 20? Do you have septra, amoxil, biaxin, all on the med profile? That just screams for a clean up.
If you have that irksome DM SNOMED quandary, just take a peek and see when the last Hba1c was done.
I have to confess I’ve gone through charts in my SNOMED’ing where I haven’t done this. Lots of them, frankly. I’ve just woken up.
But we can’t wake up all at once, can we?
What are some SNOMED tips? You have to spell properly. I learned how to spell eczema! After 30 years of using an x! (shame, shame). The biggest tip is that you can leave your personalized CPP diagnosis (something like colonic polyps, recheck scope 2017***) as they are. In PS suite, you click on the diagnosis, then push “ADD” in the next box. The SNOMED searcher then comes up, and often gives you some kind of warning like, “only alphanumerics” or, “only one diagnosis”, or something. Just start typing right over the blue highlighted diagnosis what you think would be a simpler diagnosis. If you’ve got “OA L knee, R hip,” you can just put in “Knee OA”, and it’ll work. If you’re really obsessed, you can then put in “Hip OA”, also.
Wake up, and realize that doing SNOMED diagnostic code entry can do more than ready your EMR for the next QIP, or action research plan, sort of indirect ways to help your patient population as a whole.
It can improve patient care directly. If you do just a bit MORE.