OrderConnect/InfoScriber New Diagnosis Functionality March 22, 2014 Background On October 1, 2014, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA). In addition, among the most noticeable revisions to the Fifth Edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is the inclusion of dual codes for every mental disorder to account for the currently used ICD-9-CM codes as well as new ICD-10-CM codes. OrderConnect/InfoScriber undertook changes to its Diagnosis screen and the way that one searches for diagnoses and how they are displayed within the application. This document will help the reader understand the changes that were made and choices available. Note: Most clients that use a Netsmart care record have patient diagnoses automatically transfer from the care record to OrderConnect/InfoScriber. The change made to the Diagnosis screen in OrderConnect/InfoScriber will not affect this process. It will continue working. Current OrderConnect/InfoScriber clients will continue to see their existing diagnoses and diagnostic history in the diagnosis screen regardless if they are looking at the new screen or the existing screen. They will notice a slightly different format when they begin using the new screen as seen in the above figures. OrderConnect will now be able to receive ICD-9, ICD-10, DSM-IV and DSM 5 diagnoses from Netsmart care records. What are our options in OrderConnect/InfoScriber? As an organization, you must choose if you wish to use the following: Do you wish to use the new ICD-10 / DSM 5 Diagnosis screen? --YES: If you choose yes, you must have first purchased the ICD-10 upgrade for your Netsmart care record (eg, Avatar, myavatar, MIS, TIER, Insight, Evolv, and Helper). If you have not already done this, contact your Client Alignment Executive. If you use OrderConnect/InfoScriber but do not use a Netsmart care record then you ll need to purchase an ICD-10 upgrade for OrderConnect (contact Support for more information). --NO: If you choose no, your diagnosis screen in OrderConnect/InfoScriber will remain as it is today and you will not have ICD-10 or DSM 5 content available. For those organizations that choose to use the new ICD-10 / DSM 5 Diagnosis screen, you must choose one of the Diagnosis Content Options below. Netsmart will then activate the option for you. Content Option #1: Access, select and view ICD -9 and ICD-10 codes and Universal Dx Descriptions. Content Option #2: Access, select and view ICD-9, ICD-10, and DSM-IV codes and Universal Dx Descriptions. Content Option #3: Access, select and view ICD-9, ICD-10, DSM-IV codes and Universal Dx Descriptions and DSM 5 Dx Descriptions. If you choose Option #2 or #3, you can then also use your organization s OC/ISC Admin Tool to select a code viewing preference for each practitioner. That is described later in this document. What do the options look like? Below are a series of screenshots showing the differences among the options and how they are operationalized within the application.
Diagnosis Content Option #1 When this option is selected, the end users will only see the diagnosis codes for ICD-9 and ICD-10 on the Diagnosis screen of the application. In addition, when they search for a new diagnosis they will only see diagnosis codes for ICD-9 and ICD-10 in their search results. Finally, if they click on the name of a diagnosis, the Diagnosis Record Detail screen will only present them with ICD-9 and ICD-10 codes. Figure: Diagnosis screen in OC/ISC for Option #1. DSM codes are not shown (unless they were selected or imported from your Care Record before switching to the new Dx screen). Figure: Diagnosis Search/Assign screen in OC/ISC when Option #1 is chosen. DSM codes are not shown when searching for a new diagnosis.
Figure: Diagnosis Record Detail screen in OC/ISC when Option #1 is chosen. DSM codes are not shown. Figure: Current Diagnosis box on the Current Medication Profile screen in OC/ISC when Option #1 is chosen. ICD-10 codes are shown.
Figure: Diagnosis display based on assigned diagnosis on the Rx Libraries screen when Option #1 is chosen. The same will happen on the Custom Order screen. ICD-10 codes are shown. Diagnosis Content Option #2 When Option #2 is selected, the end users will see the diagnosis codes for ICD-9, ICD-10 and DSM-IV on the Diagnosis screen of the application. In addition, when they search for a new diagnosis they will see diagnosis codes for ICD-9, ICD-10, and DSM-IV in their search results. Finally, if they click on the name of a diagnosis, the Diagnosis Record Detail screen will present them with ICD-9, ICD-10 and DSM-IV codes. Figure: Diagnosis screen in OC/ISC when Option #2 is chosen. DSM-IV codes are shown.
Figure: Diagnosis Search/Assign screen in OC/ISC when Option #2 is chosen. DSM-IV codes are shown, when available, in the search. Figure: Diagnosis Record Detail screen in OC/ISC when Option #2 is chosen. DSM-IV codes are shown.
Figure: Current Diagnosis box on the Current Medication Profile screen in OC/ISC when Option #2 is chosen (and the practitioner s profile is set for DSM preference described below). Figure: Diagnosis display based on assigned diagnosis on the Rx Libraries screen when Option #2 is chosen. The same will happen on the Custom Order screen. Diagnosis Content Option #3 When Option #3 is selected, the end users will see the diagnosis codes for ICD-9, ICD-10, and DSM-IV on the Diagnosis screen of the application. In addition, when they search for a new diagnosis they will see diagnosis codes for ICD-9, ICD-10, and DSM-IV in their search results. Finally, if they click on the name of a diagnosis, the Diagnosis Record Detail screen will present them with ICD-9, ICD-10 and DSM-IV codes and the DSM 5 description.
Figure: Diagnosis screen in OC/ISC when Option #3 is chosen. DSM-IV codes are shown. Figure: Diagnosis Search/Assign screen in OC/ISC when Option #3 is chosen. DSM 5 titles are shown as well as DSM-IV, ICD-9 and ICD-10 codes, when available, in the search. Figure: Diagnosis Record Detail screen in OC/ISC when Option #3 is chosen. DSM 5 descriptions are shown.
Figure: Current Diagnosis box on the Current Medication Profile screen in OC/ISC when Option #3 is chosen (and the practitioner s profile is set for DSM preference described below). Figure: Diagnosis display based on assigned diagnosis on the Rx Libraries screen when Option #3 is chosen. The same will happen on the Custom Order screen. Setting Individual User Preferences in the Admin Tool (isc_admin) Once an Option has been chosen by the organization and activated by Netsmart, using their Admin Tool> Providers tab, the organization s OrderConnect/InfoScriber system administrators can indicate an individual user s preference on whether they would rather see ICD codes or DSM-IV codes in the application. This is done by accessing the user s profile and then selecting the desired option. By default, the ICD option is selected. This will affect the codes that the individual sees in the Current Medication Profile screen (Current Diagnosis box) and the diagnosis display based on assigned diagnosis on the Rx Libraries screen and the Custom Order screen.
Figure: Admin Tool>Providers tab, system administrators can indicate on individual users profiles which diagnosis code preference the user would like.
END USER INSTRUCTIONS Using the New Diagnosis Screen Adding New Diagnoses To search for a new diagnosis, click on the Search for New Dx link found on the upper left of the screen. This will open up a search screen. You can search for a diagnosis by its description or its code. Just type in whatever you are looking for regardless if it is an ICD-9 description, an ICD-10 description, a DSM-IV description or a DSM 5 description. The results that appear are ones that best match what you typed in the search field. The descriptions that are shown are called the Universal Descriptions. Depending on what diagnostic codes the facility indicated it wishes to see (eg, ICD or ICD and DSM), columns will appear to the right of the search results which will give available codes for the search results shown. To see more information about the diagnosis click the Details link on the left side of the diagnosis description. To select the diagnosis that best fits that which you are searching, click on the Add link on the left side of the screen. Note: Once you click Add it becomes a permanent part of the record. Figure: To search for a new diagnosis, click the Search for New Dx link on the Diagnosis screen. Figure: To search for a diagnosis, enter your search word(s) in the Search Term box and then click the Search button. Select your choice by clicking the Add button on the left side of the screen. Note: Once you click Add it becomes a permanent part of the record!
After selecting your diagnosis you can indicate if it is the primary diagnosis or a provision diagnosis by clicking the appropriate YES/NO links to the left of the diagnosis description. If you wish to attach a notation or comment to the diagnosis you can do so by clicking on the note pad icon on the right side of the screen. To see additional detail about a diagnosis, click on the name of the diagnosis and a Diagnosis Record Detail box will open. Figure: You can indicate if a diagnosis is Primary or Provisional by clicking the YES/NO links on the left side of the screen. You can add notations/comments to a diagnosis by clicking on the note pad icon on the right. Figure: The Diagnosis Record Detail box. Setting a GAF Score Although the DSM 5 no longer uses the GAF score, some clients may still wish to assign a GAF score to patients. To do this, click on the GAF Score link at the top of the Diagnosis screen. Choose the exact score you wish to assign. It will then be displayed on the Diagnosis screen as well as the Current Medication Profile screen in the Diagnosis box. Each time you click on the GAF Score link, you will see a history of GAF score changes including the date it was changed and the user who changed it.
Figure: To assign a GAF score to a client, click on the GAF Score link. Figure: Choose the GAF score you wish to assign. Figure: A GAF history of changes is retained.