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.

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.

Michael F. Arrigo

Michael is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. His vision for the firm is to continue acquisition of skills and technology that support the intersection of clinical data and administrative health data where the eligibility for medically necessary care is determined. He leads a team that provides litigation consulting as well as advisory regarding medical coding, medical billing, medical bill review and HIPAA Privacy and Security best practices for healthcare clients, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, physician compensation, Insurance bad faith, payor-provider disputes, ERISA plan-third-party administrator disputes, third-party liability, and the Medicare Secondary Payer Act (MSPA) MMSEA Section 111 reporting. He uses these skills in disputes regarding the valuation of pharmaceuticals and drug costs and in the review and audit of pain management and opioid prescribers under state Standards and the Controlled Substances Act. He consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises ERISA self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, studies at Harvard Medical School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims). Mr. Arrigo has been interviewed quoted in the Wall Street Journal, New York Times, and National Public Radio, Fortune, KNX 1070 Radio, Kaiser Health News, NBC Television News, The Capitol Forum and other media outlets. See https://www.noworldborders.com/news/ and https://www.noworldborders.com/clients/ for more about the company.

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