ICD-10 vs. SNOMED CT. Yeah, I know these technologies are supposed to solve different problems, complement each other, work together like peanut butter and chocolate. But in researching SNOMED CT, I am continually struck by how often ICD-10 dominates the conversation, and how many doctors are somehow expected to learn more than humanly possible about ICD-10 codes—all because ICD-10, not SNOMED CT, will pay the bills come October 1, 2014. Meanwhile, SNOMED CT addresses not just disease classification but also a range of clinical diagnoses and procedures. Clever software is out there that lets docs comfortably select medical concepts and terms that then generate SNOMED CT and ICD-10 codes under the covers. It seems too many CIOs are busy simply trying to turn the ICD-10 crank, and won't have enough SNOMED CT codes to show meaningful use Stage 2 auditors round about the same time. No wonder CHIME is screaming for relief from MU Stage 2.
Nurse practitioners and health coaches versus doctors. This one depends on whether you're still billing fee-for-service or if you've moved to risk-based payment. More and more EHR technology enables NPs and health coaches to flag and field patient care and follow-ups, medication management, or various and sundry check-ins, without bothering the doctors. But some state regulations still require doctors to sign off on virtually everything, creating a workflow traffic jam. Still other doctors are control freaks and, rules or no rules, aren't going to feel good about not micromanaging these workflows. Just because technology enables distributed care and decision-making doesn't mean healthcare is ready for it.