Executives at Catholic Health Initiatives had to roll out new electronic health-record systems across 89 hospitals nationwide while meeting the Oct. 1 federal deadline for implementing the complex new ICD-10 coding system. They knew the two big health information technology tasks couldn't both be done in the time available.
So CHI officials decided to spend millions of dollars remediating outdated “legacy” software programs in some hospitals so that they could run on ICD-10 coding for as many years as it would take to install new EHRs.
That remediation money may have been wasted thanks to Congress' surprise decision to delay the switch from ICD-9 to ICD-10 at least until Oct. 1, 2015, and maybe longer.
“We made decisions 18 months or two years ago that we are going to do certain things and postpone certain things based on having to implement ICD-10,” said Michael O'Rourke, senior vice president and chief information officer at the $11 billion Catholic Health Initiatives system, headquartered in Denver. “Had we known this would be delayed, things would have been different.”
Healthcare providers, insurers and other organizations now will have to wrestle with when they think the government will ultimately push the button on ICD-10 in deciding when they should start—or restart—training their doctors and workers. They also are calculating how much time and money they wasted in training and preparing for this October, since doctors' and coders' memories of the intricate ICD-10 codes will fade fast without daily use.
O'Rourke and many other top healthcare executives around the country met in private conference rooms last week to wring their hands, rewrite timelines and try to divine when the next deadline will be. They have to decide whether to cut back for now on their staffing and IT investment in ICD-10, and when to ramp it back up. Since last week's decision was the third such delay, they are wondering how much stock they should put on the next announced deadline—and how to convince skeptical doctors and staff to go through another round of intensive training.
Come 2015, “what if the government says for some reason, we won't go to ICD-10?” asked Dr. Alistair Erskine, chief clinical informatics officer at the Geisinger Health System in Danville, Pa. “What if we (as a nation) decide we're going to go (straight) to ICD-11? Now we're stuck.”