Impact of assigning 2-field HLA alleles from real-time PCR on deceased donor assessments and conformance with high resolution alleles.

Waitlisted sensitised transplant recipients with HLA allele level antibodies to their own HLA antigen family are disadvantaged by current deficiencies in HLA typing for deceased donors. This is primarily because at time of organ allocation, HLA typing is provided at antigen level whereas solid phase assays provide allele level antibody definition. The gold standard for HLA allele typing is next generation sequencing (NGS), however time limitations with established NGS systems prevent NGS use for deceased donors. Instead, many labs use a real-time PCR (qPCR) antigen level result for deceased donors, which can disadvantage sensitised patients. Here, we compared assigning qPCR 2-field alleles to qPCR antigen level to determine the impact on virtual crossmatch (VXM) and discuss impact on donor-specific antibody (DSA) assignments. 244 consecutive deceased donors were HLA typed to allelic level by qPCR (LinkSeq SABR) and subsequently by NGS (One Lambda Alltype). The impact of qPCR allele assignments on potential DSA identification was investigated, by retrospectively investigating all 3904 VXMs, where recipient DSA assessments were assessed against donor HLA, was performed within the cohort. There was 96.3% concordance between qPCR and NGS for all allele level loci, with HLA-A; DQB1; and DPB1 having best agreement (99.4%, 98.4% and 99.4% respectively). Of the 3904 VXMs with qPCR allele assignment, there were 13 (<1%) occasions where the potential DSA assignment was impacted, with DQA1 having the most impact. Assigning alleles derived from qPCR to define unacceptable antigens for VXMs, can allow improved access to donor offers for sensitised patients by better defining alleles.

There are critical reasons for not further delaying the implementation of the new ICD-10 coding system.

On April 17, 2012, the Department of Health and Human Services (HHS) published a rule proposing postponement of the implementation date for the International Classification of Diseases, 10th Edition diagnosis codes (ICD-10-CM) and procedure codes (ICD-10-PCS) by one year to October 1, 2014. An article in Health Affairs titled "There Are Important Reasons For Delaying the Implementation Of The New ICD-10 Coding System" asserts that the ICD-10-CM conversion will be "expensive, arduous, disruptive, and of limited direct clinical benefit." Contrary to the conclusions in this article, implementation of the ICD-10-CM and ICD-10-PCS code sets will provide major advantages over the existing ICD-9-CM code set. Implementation is long overdue and will provide significant cost benefits. Any further implementation delay will increase the cost of the transition as well as perpetuate the costs and negative consequences associated with continued reliance on imprecise diagnosis and procedure information.

Strategies for ICD-10 implementation.

Hospitals and health systems should consider seven strategies for preparing for the conversion from ICD-9-CM to ICD-10-CM/PCS: Form a project planning team. Assess the range of impact on each department and on productivity, revenue, and resources. Perform a gap analysis. Analyze data. Develop a training strategy specific to coding professionals and heavy data users. Work to improve documentation. Communicate with vendors regarding their plans for the transition to ICD-10.

A Strategic Plan for Integrating ICD-10 in Your Practice and Workflow.

The adoption of the International Classification of Disease (ICD) 10th Revision (ICD-10) diagnosis code set in the United States has been legislatively delayed several times with the most recent date for implementation set for October 1, 2015. The transition from ICD-9 to ICD-10 will be a major undertaking that will require a substantial amount of planning. In the following article, we outline the steps to develop and implement a strategic plan for the transition to the new code set, identify training needs throughout the practice, and review the challenges and opportunities associated with the transition to ICD-10.

A primer on ICD-9-CM coding.

Complete and accurate ICD-9-CM coding is important because coded data are used for a variety of purposes. This article provides a primer for home care clinicians and managers to master this essential function.

Impact of electronic health record systems on information integrity: quality and safety implications.

While the adoption of electronic health record (EHR) systems promises a number of substantial benefits, including better care and decreased healthcare costs, serious unintended consequences from the implementation of these systems have emerged. Poor EHR system design and improper use can cause EHR-related errors that jeopardize the integrity of the information in the EHR, leading to errors that endanger patient safety or decrease the quality of care. These unintended consequences also may increase fraud and abuse and can have serious legal implications. This literature review examines the impact of unintended consequences of the use of EHR systems on the quality of care and proposed solutions to address EHR-related errors. This analysis of the literature on EHR risks is intended to serve as an impetus for further research on the prevalence of these risks, their impact on quality and safety of patient care, and strategies for reducing them.