Coding our way to a more agile health system

by Jia Hu. Originally published on Policy Options
March 19, 2021

If COVID-19 has consistently underscored one key element of our health system, it is the importance of nimbleness. When a system is nimble, it is well-placed to adapt quickly in the face of emerging challenges or to leverage opportunities such as those afforded by technology and digital innovation.

The rapid modernization of the Canadian health system as a result of the pandemic is undeniable and a clear sign that our system is capable of this sort of rapid change.

A national poll conducted in May 2020 by Abacus Data for the Canadian Medical Association found substantial increases in the percentage of Canadians who obtained advice from a doctor via virtual methods (phone, video conference, for example) in the initial months of the pandemic, compared with prior to COVID-19. Significantly, this poll also indicated that 46 per cent of Canadians who used virtual care during this timeframe “would prefer a virtual method as a first point of contact with their doctor” moving forward.

On a global scale, the accelerated development of COVID-19 vaccines and the collaboration across sectors that brought these vaccines to Canada – less than one year after our first confirmed case of COVID-19 – is another example of necessary nimbleness in our historically complex and often cumbersome systems.

COVID-19 has showcased, in a way that is accessible to most Canadians through lived experience, the great potential of a health system capable of responding to challenges and opportunities in real-time, including modern service delivery and rapid innovation. Looking beyond the pandemic, Canadians will continue to expect this from our sector.

However, a significant barrier to our health system’s ability to keep up with the pace of technological and medical innovation is the outdated coding system that medical professionals use to document procedures and other patient services. Each province and territory has its own set of codes, meaning that data related to health services is not standardized across the country and cannot be effectively compared between jurisdictions for tracking and quality improvement.

Another challenge posed by the current coding framework is that the systems used by each province are infrequently updated, and each new iteration is rapidly outpaced by innovations in medicine such as new procedures and shifting best practices.

An example of this occurred last year in Ontario when the province’s coding system was ill-equipped to operate in a pandemic environment dominated by virtual care. Ontario doctors were required to wait months for payment while their coding system was updated to enable billing for services offered virtually as a result of the pandemic. The same is seen in Alberta, where billing codes for virtual care lagged behind the emergence of virtual care.

In a post-pandemic world, where Canadians continue to expect modern service and innovation from their health system, we need to introduce a modern coding framework compatible with these values.

There has been discussion of modernizing coding systems for years in different provinces. Now, as we reflect on lessons learned from the pandemic and determine how we will collectively recover as a system, we need to use every tool in our toolbox to ensure this pivotal moment improves our system in the long run.

We don’t need to start from scratch, but can look to our global peers, such as the American Medical Association’s current procedural terminology (CPT). In the U.S., it serves as a common national language for coding medical services and procedures, streamlining the reporting process. As a result of CPT codes, national data is standardized and can be easily compared to measure performance, assess gaps, and identify trends across the country.

More importantly, as we now see the need for agility, CPT content can keep pace with emerging medical developments in a way that Canada’s patchwork of coding systems has not. A panel of clinical experts leads the development and management of CPT codes through a rigorous, transparent and open process. The code set is frequently updated, and codes are regularly issued and amended by the expert panel to best reflect current practice and medical innovation. In fact, an entire section of CPT codes, known as category III codes, is dedicated to emerging technologies, services, and procedures.

Throughout the pandemic, the CPT code set process has supported the proactive development of codes for procedures related to COVID-19. For example, on March 13, 2020, a code was released to enable accurate reporting and tracking of COVID-19 testing conducted by doctors. At the time of writing, 24 new CPT codes related to COVID-19 had been introduced, including vaccine and dose-specific codes to track immunization efforts.

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A pan-Canadian commitment to adopting a standardized and regularly updated coding system would allow us to embrace innovation and change while consistently improving patient care through interoperability, consistent data to monitor trends and the agility to respond to future health system crises.

This article first appeared on Policy Options and is republished here under a Creative Commons license.