ICD-10 Implementation Contention – Only 55 Hospitals in the U.S. Are at Stage Seven for Electronic Health Records

ICD-10 implementations have competition for resources within hospitals.  According to HIMSS Analytics, Stage seven healthcare organizations support the true sharing and use of patient data that ultimately improves process performance, quality of care, and patient safety.   While this is a laudable achievement, only 55 hospitals have made this goal and many are part of the Kaiser health system.

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Industry Timelines

Health care reform implementation timeline from Kaiser Family Foundation

Achieving meaningful use of electronic health records (a term used interchangeably with electronic medical record) has caused resource contention with the implementation of other standards such as the move to the new medical coding standard ICD-10 and the electronic data interchange standard HIPAA 5010.   ICD-10 includes revised diagnosis codes as well as procedure codes that would then populate future electronic health record systems.  ICD 10 steering committees at many hospitals are just starting to meet, despite the fact that the WEDI / NCHICA timeline of best practices for implementation suggested health care providers should have started the move from ICD9 to ICD10 a year ago.    ICD-10 has its own process and IT impacts which are distinct from EMR / EHR but that tend to overlap.

Full, paperless EHR implementation is an important foundation for enabling Accountable Care Organizations, and enabling usable Health Information Exchanges.  Ten percent (10%) of hospitals support Computerized Physician Order Entry (CPOE) and over seventy percent (70%) have not moved beyond stage three.  The fact that such a small percentage of health care providers have achieved this level provides some insight into the challenges with ICD 10 which is a complete overhaul of the diagnosis and procedure coding system.

In Stage 7, the hospital is truly paperless.

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HIMSS Electronic Medical Record Adoption Phases
Phases of EMR adoption - source HIMSS Analytics

Clinical information can be readily shared …with all entities within health information exchange networks (i.e. other hospitals, ambulatory clinics, sub-acute environments, employers, payers and patients). This stage allows … the true sharing and use of health and wellness information by consumers and providers alike,” according to HIMSS Analytics.

The co-mingling of these initiatives does have one large impact on quality measures for health care.  ICD-10 is expected to increase the complexity of quality measures ten-fold.  No similar set of Stages have been published for ICD-10, only a roadmap to compliance.  In fact,  ICD-10 compliance has been described as a “single event” for all HIPAA Covered Entities, with no trial run to ensure that the health care system will be in compliance.

As October 1, 2013 looms ever closer, the Wall Street Journal has labeled ICD-10 “the ‘Y2K’ problem in health care.”   As 2011 plays out, ICD-10 implementations should gain momentum.  In a few months the U.S. Health and Human Services department will have more visibility into the level of compliance expected and we look forward to seeing the new survey data.[/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]

Michael F. Arrigo

Michael Arrigo, an expert witness, and healthcare executive, brings four decades of experience in the software, financial services, and healthcare industries. In 2000, Mr. Arrigo founded No World Borders, a healthcare data, regulations, and economics firm with clients in the pharmaceutical, medical device, hospital, surgical center, physician group, diagnostic imaging, genetic testing, health I.T., and health insurance markets. His expertise spans the federal health programs Medicare and Medicaid and private insurance. He advises Medicare Advantage Organizations that provide health insurance under Part C of the Medicare Act. Mr. Arrigo serves as an expert witness regarding medical coding and billing, fraud damages, and electronic health record software for the U.S. Department of Justice. He has valued well over $1 billion in medical billings in personal injury liens, malpractice, and insurance fraud cases. The U.S. Court of Appeals considered Mr. Arrigo's opinion regarding loss amounts, vacating, and remanding sentencing in a fraud case. Mr. Arrigo provides expertise in the Medicare Secondary Payer Act, Medicare LCDs, anti-trust litigation, medical intellectual property and trade secrets, HIPAA privacy, health care electronic claim data Standards, physician compensation, Anti-Kickback Statute, Stark law, the Affordable Care Act, False Claims Act, and the ARRA HITECH Act. Arrigo advises investors on merger and acquisition (M&A) diligence in the healthcare industry on transactions cumulatively valued at over $1 billion. Mr. Arrigo spent over ten years in Silicon Valley software firms in roles from Product Manager to CEO. He was product manager for a leading-edge database technology joint venture that became commercialized as Microsoft SQL Server, Vice President of Marketing for a software company when it grew from under $2 million in revenue to a $50 million acquisition by a company now merged into Cincom Systems, hired by private equity investors to serve as Vice President of Marketing for a secure email software company until its acquisition and multi $million investor exit by a company now merged into Axway Software S.A. (Euronext: AXW.PA), and CEO of one of the first cloud-based billing software companies, licensing its technology to Citrix Systems (NASDAQ: CTXS). Later, before entering the healthcare industry, he joined Fortune 500 company Fidelity National Financial (NYSE: FNF) as a Vice President, overseeing eCommerce solutions for the mortgage banking industry. While serving as a Vice President at Fortune 500 company First American Financial (NYSE: FAF), he oversaw eCommerce and regulatory compliance technology initiatives for the top ten mortgage banks and led the Sarbanes Oxley Act Section 302 internal controls I.T. audit for the company, supporting Section 404 of the Sarbanes Oxley Act. Mr. Arrigo earned his Bachelor of Science in Business Administration from the University of Southern California. Before that, he studied computer science, statistics, and economics at the University of California, Irvine. His post-graduate studies include biomedical ethics at Harvard Medical School, biomedical informatics at Stanford Medical School, blockchain and crypto-economics at the Massachusetts Institute of Technology, and training as a Certified Professional Medical Auditor (CPMA). Mr. Arrigo is qualified to serve as a director due to his experience in healthcare data, regulations, and economics, his leadership roles in software and financial services public companies, and his healthcare M&A diligence and public company regulatory experience. Mr. Arrigo is quoted in The Wall Street Journal, Fortune Magazine, Kaiser Health News, Consumer Affairs, National Public Radio (NPR), NBC News Houston, USA Today / Milwaukee Journal Sentinel, Medical Economics, Capitol ForumThe Daily Beast, the Lund Report, Inside Higher Ed, New England Psychologist, and other press and media outlets. He authored a peer-reviewed article regarding clinical documentation quality to support accurate medical coding, billing, and good patient care, published by Healthcare Financial Management Association (HFMA) and published in Healthcare I.T. News. Mr. Arrigo serves as a member of the board of directors of a publicly traded company in the healthcare and data analytics industry, where his duties include: member, audit committee; chair, compensation committee; member, special committee.

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