HL7 v2.x
During the last few years I’ve had some key conversations with many hospital executives and healthcare IT professionals, among them: CEOs, CIOs, CMIOs, COOs, architects, strategists, etc. Most of the conversations have been around the topic of how to get the data required for being or becoming an effective ACO, or simply a provider highly conscientious of the well-being of their cared ones even beyond the walls of their facilities. Some of these providers weren’t aware of the ACO conversations since they didn’t participate in the CMS roundtables but they understood that the healthcare model had to drastically change.
Chad Johnson from the HL7 Standards blog reached out to interview me for his “5 Hot Topics in Healthcare Interoperability” post. It resulted in an outstanding article.
The Outrageous, the Outraged and the Courageous: Another Attempt to Halt the Healthcare IT Evolution
The Outrageous
On February 2nd 2011 the American Medical Association wrote to the Secretary of the U.S. Department of Health and Human Services, Kathleen Sebelius, to urge her to immediately halt the Health Insurance Portability and Accountability Act (HIPAA) mandate to implement ICD-10.
The AMA wasn’t only asking to immediately halt an endeavor that had officially started on January 16, 2009, over three years ago, when HHS published one of several final rules but they are also asking to re-evaluate the penalty program timelines related to Meaningful Use (MU) of Electronic Health Records, e-Prescribing and Physician Quality Reporting System (PQRS).
I would have been more amenable to read something like “reassess the timeline or extend the timeline due to significant concerns of our constituent members” but to immediately halt the program? Could someone please explain to me why we should halt any national Healthcare IT project?
They should have asked to immediately halt incentive payments as well! Why? Because we, the U.S. taxpayers, are actually paying physicians across the entire United States to implement and meaningfully use an Electronic Health Record system to keep our health data in a digital format that can be easily and safely transmitted between myriad providers and so that we, as patients, can have access to it as well. It’s not financial aid from the government that is paying for the Meaningful Use of Electronic Health Records but it’s us the People of the United States that are paying for it.
From what I also understood by reading between lines they want to be paid to implement ICD-10. Sorry docs, us rabbits are running out of carrots! Under the same reasons why shouldn’t we go ahead and pay for their mobile tablets as well because in my opinion it would abide to the same logic?
The AMA claims the difficulty of transitioning from the ICD-9 13,000 diagnosis codes to the ICD-10 68,000 diagnosis codes. Maybe the five-fold arithmetic expression raises eyebrows to some but the truth is that the scarce 13,000 codes used by ICD-9 have created an undecipherable conundrum of clinical data throughout several decades. Most clinicians and clerical staff would choose a diagnosis code based on the expected reimbursement amount and not on the actual clinical diagnosis and how could this be considered sane in a scientific realm? A lot of healthcare data used in claims processing is absolutely unauditable. It’s actually a toss and start over rather than a transition. We don’t want to deal with the cluster of conundrums created by all the garbage that has gone into the databases since garbage in=garbage out (GIGO).
AMA is clear to state that it’s not just a technology project and that’s because they are well aware that the Health IT technologists can solve the problem and I know this because I am a Health IT technologist and I know there is no technical impediment to solving the ICD-9 to ICD-10 transition. There may be semantic interoperability issues in the conversion but that can happen with any transition from any coding system to another.
Another outrageous event was the unclear response by the acting CMS Administrator, Marilyn Tavenner, who on Tuesday, February 14th indicated to the reporters that the CMS will re-examine the time-frame. Further exacerbation came along when the Secretary of HHS announced the intent to delay the ICD-10 compliance date on February 16th. Responding so quickly to pressure from one letter seems like a sign of weakness from a leader.
The Outraged
Many of us are outraged. Many of us stood mostly silently and briefly tweeting 140 characters at a time what we were thinking in protest to the unfolding of the ICD-10 debacle. Most of us were expecting the HHS Secretary to adopt a strong position defending the interests of her Constituents, We the Patients of the United States of America. What was perceived was that there is some extra-caution due to the re-election climate in the air, there is fear to uphold the interests of the Constituents.
Many of us are outraged as citizens, tax-payers, patients or relatives of seriously-ill patients. We should be since it’s our hard-earned money going to waste. We have never had an opportunity to transform our wasteful healthcare system as the one we are living today. We don’t want to miss this opportunity since it may take decades before it could happen again.
We are outraged because it’s always the same story. Powerful groups of healthcare in the US will claim many reasons they have to not implement technology. They’ll claim too much work, workflow disruption, physician <-> patient intrusion, not enough reimbursement, no incentives, etc …
But the truth is that many have made great strides in ICD-10 conversions so who is the AMA actually advocating for?
Continuing the use of ICD-9 is continuing to put the lives of many at risk. Who is responsible for the deaths or injuries caused by improper coding?
I wanted to write this blog before but I was also waiting for some other organizations with muscle to cry-out loud and they finally did. I call these groups “The Courageous”.
The Courageous
When I first read The American Health Information Management Association’s (AHIMA) request to urge HHS to move forward with ICD-10 plans and to not delay the compliance date I finally felt relief from my outrage.
HIMSS also raised their voice and recommends not delaying the ICD-10 implementation.
There is too much to lose here. Meaningful Use stages 2 and 3 depend on quality data and ICD-9 does not fulfill this requirement.
Many will start speaking up in defense of the ICD-10 transition and hopefully HHS will listen to our shouts.
Readers, we are paying for the transformation of the U.S. healthcare system out of our pockets. Don’t let special interest groups steal this opportunity from us.
Courageous, raise your voices!
