Members of the physician informatics community expressed surprise, elation and concern in reaction to the CMS' announcement that it will reconsider the Oct. 1, 2013 implementation deadline for the International Classification of Diseases 10th Revision family of diagnostic and procedural codes.
Concern and cautious optimism from IT leaders on possible ICD-10 delay
"I am thrilled that folks are listening," said Dr. Joseph Schneider, chief medical information officer and medical director of clinical information at Baylor Health Care System in Dallas. However, he said, "There are other, better ways to do this other than to go to a system that's 30 years old coming up shortly."
ICD-9 was released by its developer, the World Health Organization, in 1975 and a U.S.-modified version was adopted here in 1979. ICD-10 was released in 1990 and is in widespread use throughout the world but is used only in limited applications in the U.S. Work on its replacement, ICD-11, is already under way; its initial estimated release date is 2015, according to Dr. T. Bedirhan Ustun, team coordinator of classification, terminologies and standards with the World Health Organization's department of health statistics and informatics.
Schneider serves as chairman of the Texas Medical Association's Committee on Health Information Technology. Schneider brought a resolution before the state association in October calling on the federal government to halt the scheduled conversion from ICD-9 codes in current use to the more-robust ICD-10 coding system. The Texas initiative was mirrored by resolutions from several other states, which were combined and passed at the American Medical Association's House of Delegates meeting in November.
That led to Dr. James Madara, the AMA's executive vice president and CEO, writing letters to House Speaker John Boehner and HHS Secretary Kathleen Sebelius calling for the government to halt ICD-10 implementation.
In his letter to Sebelius, Madara said, "The timing of the ICD-10 transition that is scheduled for Oct. 1, 2013 could not be worse." Many physicians, he added, "are currently spending significant time and resources implementing electronic health records into their practices."
Acting CMS Administrator Marilyn Tavenner said in Washington on Tuesday that the CMS will "re-examine the timeframe" through rulemaking.
Dr. William Bria, chief medical information officer at Tampa, Fla.-based Shriners Hospital for Children, shared concerns about what wasn't detailed in the announcement.
"How deep does it go?" asked Bria, who also serves as president of the Association of Medical Directors of Information Systems, a physician informatics group. Is this a temporary delay, he questioned, or will it lead to a change in direction?
From the perspective of his "day job" as a pulmonologist, Bria said, switching to ICD-10 "is actually a really good thing—it gives us more detail that we need."
From a broader, organizational perspective, Bria said, "in terms of retraining everybody, getting people on board, for organizations with long-established EHRs, it's a big deal, but it's not cataclysmic.”
But for organizations trying to catch up to achieve meaningful use, he said, this is a very big deal, given that the conversion to ICD-10 requires a great deal of education and training and system upgrades.
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