我國疾病分類系統採用ICD-10-CM／PCS的重要因素及推動策略探討

An Empirical Study on the Diagnosis Related Groups Information System in Taiwan

ICD-9-CM在美國自1970年代開始使用至目前已超過30年，其編碼組合已不合時宜；而其醫療照護資料的分類亦無法符合現今的需求，對病人照護體系的診斷以及住院病人的處置與手術也無法精確的描述，且它所用的編碼已超出當初設計的目的與用途，在使用上已出現諸多的問題與困境；新增代碼也無空間可編列，無法呈現新增疾病及新的醫療處置，不但影響疾病及手術處置的統計分析，亦影響病人醫療照護品質及健保費用申報的正確性。我國疾病與手術處置的分類系統係採美國ICD-9-CM版本，由於美國已公告自2014年10月改用ICD-10-CM/PCS，且不再對ICD-9-CM作維護（以往每年更新），屆時我國將面臨無新版本可用的困境，故我國健保署計劃於2015年改用ICD-10-CM/PCS。由於ICD-10-CM/PCS較ICD-9-CM繁複，新增的代碼亦增加很多，且推動時牽涉諸多部門，包括病歷管理、疾病分類、保險申報、資訊部門及其他醫護、醫事等單位，建議我國各醫院在推動時可分四個階段進行：（1）組織推動團隊（organizing the effort）；（2）擬訂計畫並分析受衝擊的相關作業（planning andimpact analysis）；（3）落實執行（implementation）；（4）成效評估與持續推動（implementation evaluation and ongoing efforts）。而實際進行時可從四個層面：包括醫院決策層面、病歷管理層面、臨床作業層面及資訊規劃層面執行。ICD-10-CM/PCS的實施對醫界的衝擊將非常大，醫院必須即早準備與規劃方能順利轉換。

ICD-9-CM was introduced and put to use some time in 1970s in the United States, and up to now it has served that country for more than 30 years. As a result, its coding system is out-of-date in many cases, plus its classification of healthcare information is no longer able to meet the current needs. Not only does it lack the elements to precisely describe the diagnoses made by the modern healthcare system as well as the treatments and operations received by the inpatient, the codes it now employs have become so many and varied, way beyond the system's set purposes and usages when it was originally designed, which inevitably causes many problems and difficulties. Even adding new codes has run into a solid wall because the system provides very limited space for them. Consequently, many newly discovered diseases and developed medical treatments have not been able to find their appropriate places in the system. Such inadequacy not only jeopardizes the statistic analyses of diseases and operational treatments, but also has negative influences on the healthcare quality of the patient and the process of health insurance claims. Our existing classification system of diseases and operational treatments has simply followed the US ICD-9-CM version. However, since the United States has formally proclaimed that they shall replace the current version with ICD-10-CM/PCS starting from October 2014, plus they shall stop the needed annual maintenance and modification of the old system (they've been doing this for many years in the past). Should we do nothing now, we are bound to face a dilemma of worn out system in the near future. Therefore, our Department of Health Assurance plans to follow their steps to shift into ICD-10-CM/ PCS as well. Since ICD-10-CM/PCS is more complicated than ICD-9-CM, not only many new codes are added, to get it moving also needs the cooperation of many units of the healthcare system, including health record management staff, disease categorizing specialists, insurance claim processers, members of information sector, and other relevant healthcare and medical personnel. In order to make it work well at every hospital in the country, we recommend a four-step process to follow: (1) organizing a special task force; (2) making plans after impact analyses; (3) implementing the set plans; (4) carrying out evaluation and reviews to sustain on-going efforts. The progress of implementation can be divided into four strata, i.e. that of the hospital decision-making, that of the health recording, that of the clinical operation, and that of the information planning. The implementation of ICD-10-CM/PCS will no doubt cause a great deal of impacts the healthcare system. Hospitals have to prepare and make plans well ahead in order to make a smooth transfer.