Status check

In little more than 18 months, the U.S. healthcare industry is expected to join most of the industrialized world in the adoption of the International Classification of Diseases 10th Revision code system, which promises to be the biggest single-day switch in healthcare information technology since the Y2K conversion at the turn of the century.

After acquiescing to several previous postponements, HHS vows this time it will hold fast to that ICD-10 deadline—Oct. 1, 2014—even in the face of renewed calls for further delays, most prominently coming from the American Medical Association.

At the recent Healthcare Information and Management Systems Society convention in New Orleans, we asked healthcare information technology experts to give us a status check on ICD-10. Here are some of the edited responses:

H. Stephen Lieber, president and CEO, HIMSS:

“I met with (acting CMS Administrator) Marilyn Tavenner while we were in New Orleans at the conference and she tells me, 'No change in the deadline.' It is not going to be extended again, despite the cries of the AMA and the AHA. She said, 'We gave them the one year, that's all it's going to be.' So it is moving ahead. Our research says we are ready for it. The technology is largely in place. Overwhelmingly—85%, 90% of provider organizations, particularly hospitals, say they are ready. So it's now a matter of executing. I think there is going to continue to be a lot of handwringing, but we're there. We're ready. Let's do it.”

Dr. Deborah Peel, founder of Patient Privacy Rights Foundation, a privacy advocacy organization:

“I think it's a nightmare. You know, we were going from 25,000 codes to 250,000 codes. Do you think that is going to help me as a doctor in the office take better care of you? No! It's another plot of the insurance industry.”

Dr. William Bria, chief medical officer, Dataskill, and president of the Association of Medical Directors of Information Systems:

“Oh, we'll have to, it seems, if we would like to be paid for what we do. ICD-10 provides the dual edge of much greater complexity in terms of the documentation, feeding a much higher resolution number, a code, as the submission for billing and for many other purposes occurs. The notion of physicians, again, reassessing their documentation, the completeness of the information and how it actually reflects accurately the code that comes up is now a new educational process that we need to go through.”

George Hickman, executive vice president and chief information officer at Albany (N.Y.) Medical Center and chairman of the College of Healthcare Information Management Executives:

“I think we have got a ways to go yet. We are about 16 months out. The way I do the math is this. I think about what has to happen with, say, a go-live of October 2014. To go live, in other words, to pull the trigger and have all these systems cooperating means you need to sort of back up three months from that and have everything frozen so that you are doing all sorts integration testing to assure these many, many systems (cooperate)—in our case, over 70, plus all the clearinghouses and government agencies and electronic data interchanges and so on. So, the deadline isn't really October, the deadline is probably three months before.”

Dr. Karen DeSalvo, New Orleans health commissioner:

“It's been something we have talked about for a long time about when we are going to convert and how disruptive that is going to be to the existing systems. I don't want to minimize it, but certainly in Y2K we had a lot of concerns that didn't come to fruition, and I think that people developing systems are probably pretty smart. What would be terrific is if we could figure out a way in this country that we could disentangle all of the structure that ICD-9 artificially puts on the doctor-patient relationship and allow doctors to practice medicine within the framework of regulation and oversight. But one of the things that we've done in New Orleans is use what we call population capitation. Pay me as a doctor to take care of a population of patients with some rules, but not have to go to that level where we are so encumbered by the documentation, etcetera, that we are spending more energy trying to code better instead of just taking care of patients. … It would be great if we'd get really creative and rethink the classification of people's diseases.”

Dr. Charles Jaffe, CEO of the standards development organization Health Level Seven:

“I think as we move forward, it is critical that our documentation more accurately reflect the decisions and the processes that the caregivers define. I think, unfortunately, the language that we use is antedated to a time when we knew less about healthcare and the pathogenesis of disease. I think ICD-11 and the future of this structured data really depends on the involvement of all of the stakeholders. Unfortunately, there are strange coalitions that are delaying the implementation of ICD-10. I fear that our goals won't be enhanced by a carrot and will largely be stick-based. And I think it is unfortunate, but the critical issue is the rest of the world has moved to ICD-10, and we are not doing a good job playing catch-up.”