13 comments on “The Outrageous, the Outraged and the Courageous: Another Attempt to Halt the Healthcare IT Evolution

  1. I completely agree that action should be taken. I would encourage brief letters to your members of Congress and the President. This is a debacle.

    Or maybe try to educate the AMA about what ICD-10 actually is since its leadership does not seem to have even a basic grasp. The fact that ICD-10 helps so many electronic and quality initiatives right now, or as pointed out above, are, in fact, required to achieve them, appears totally lost an organization clearly terrified of computers. It’s ironic that a profession that embraces technology for improving care can’t see that this is technology that improves care.

    • Hi Darren,

      I can understand AMA’s concern about some of their constituents (e.g., rural physicians, solo practitioners, small practices) and I also understand that the sum of these can be quite large.

      What I didn’t understand is why, AMA as a group that has a strong political influence, is in my opinion irresponsibly requesting a halt. They should have requested an evaluation of an extension or some type of assistance for the less fortunate physician population.

      There are many healthcare organizations that are making leaps and bounds in ICD-10 implementations and there are others that are just starting to do it, for example, the Beth Israel Deaconess which John Halamka, a notorious Harvard CIO and blogger, has kindly volunteered to share their project implementation strategy: http://geekdoctor.blogspot.com/2012/01/update-on-bidmc-icd10-project.html

      I’m concerned about how this latter group type, the ones who are hesitantly initiating ICD-10 projects, will react to the ambiguity of the responses by CMS. They may halt endeavors that could easily be executed in the next year and a half until there is clarity. This will certainly create ripple effects on other projects that are depending on quality coding.

      With great power, wealth and influence comes great responsibility. Taking advantage of the political weather of this year’s elections is not responsible.

      We all have to guard this Health IT revolution because our efforts and money poured into it since 2009 can go to waste in a blink.

      Regards,

      Michael

      • I have less understanding than you about the AMA’s concerns. The reason professional societies exist is to help their constituents further their mission. Clearly the methods to the end are up to the organization. Instead of being constructive, the AMA chooses to be obstructive. Unlike the AMA, I’ve seen how other local and specialty organizations developed low cost programs to help their members face the changes. http://mcod.us/y9AERU

        Why are there almost no resources on the AMA’s website for ICD-10 when they have letters dating back to the 2003 in their advocacy section? http://mcod.us/xZR0Cy It’s fascinating to read them since the AMA actually was successful in getting ICD-10 implementation deadlines moved to October 1, 2013.

        Worst, though, is the seeming lack of understanding about the ICD-10 system. ICD-9 is so broken right now due to its age and the lack of remaining codes that it simply cannot capture diagnostic information based on today’s medical science. In a great article, Rhonda Butler at 3M discusses the misinformation about ICD-10. http://mcod.us/zauM7s Comparing the codes sets almost exclusively by number of codes is silly at best and disingenous at the worst. From the time that I’ve spent developing search tools for ICD-10-CM, I have every belief that an unseasoned coder (or, heaven forbid, a doctor) would actually be more successful at finding the right diagnosis codes using ICD-10-CM than ICD-9-CM. Also, for John Lynn, here is a recent post on my blog discussing the positive impacts of ICD-10-CM on patient care. http://mcod.us/yBVDgb

        My guess is the real reason to be against ICD-10 is the coding system’s ability to start to measure quality outcomes. The AMA would rather keep Medicare fee-for-service, a payment method that is meaningless to patients. We know that more spending does not make people healthier.

        I completely agree that this disruption could have terrible ripple effects, undermining implemetation efforts and possibly negating technology investments. I strongly believe there is no other way forward than through ICD-10, and I hope no one deprioritizes it at this time. How wonderful would it be to actually have ICD-10 ready systems when it is actually time to educate coders and providers for the transition? And you can move on to other efforts once you are done.

        Finally, if you want to be courageous, call your Congresspeople and the President. Get your institutions and professional associations to call or draft letters. Better, set up time to meet with your Congresspeople, especially when they are home. You have as much to say on the topic as the AMA (actually I’m sure you have volumes more!), and our leaders should hear about this disruption.

        Thanks for a great blog!

  2. I must admit that I was surprised by this delay. I wrote a post about the delay: http://www.emrthoughts.com/2012/02/17/thoughts-on-icd-10-delay/

    Although, one thing I talked with people about at HIMSS was “What are the true benefits to using ICD-10?”

    I’ve read story after story about ICD-10 (including this post) and so far I’ve only seen people giving general lip service to the basic idea that more specifically quantified data will somehow have a benefit to the healthcare system. Darren in the comment above says, “The fact that ICD-10 helps so many electronic and quality initiatives right now, or as pointed out above, are, in fact, required to achieve them”

    What are the electronic and quality initiatives to which he speaks? What are the true benefits that we’ll get if we go to ICD-10? I have seen enough of these examples.

    We could also look at this same question another way. The rest of the world has been using ICD-10 for a lot longer than us. What have been the benefits that the rest of the world has seen from their use of ICD-10 that we haven’t seen in the US since we’re still on ICD-9?

    I’m not trying to say that there aren’t benefits. I’m just saying if there are, then why aren’t we hearing more stories with concrete examples of the benefits? If there are, I’d love to see them and make them more widely known.

    • John,

      What you are asking for is reasonable and fair.

      I will post, in a future blog, examples of why migrating to ICD-10 has beneficial clinical quality outcomes other than the intended reimbursement aspect of it which has been the main purpose of implementing it here in the United States.

      But in essence a deep specificity would eliminate the erroneous coding accompanied by bulk documentation to justify the claim to be reimbursed.

      Achieving semantic interoperability with erroneous coding is impossible. I’ve been in aggregation projects where abstracting information from HL7 messages was futile because no one in the healthcare organization seemed to understand what was contained in them.

      This will be a very lively topic for months to come. I look forward to your participation in the discussions.

      Best regards,

      Michael

    • John, I came here to post the same exact thing. I hear folks, like AHIMA, stating ICD-10 is a great benefit to quality. But I cannot cite a single instance where that is the case. Nor, can I state a single time where the limitations of ICD-9 has prevented us from moving forward with any single quality initiative in our 15 hospitals. I am looking forward to seeing some real-world examples.

  3. As a health care consumer, I want four things from ANY national health effort: prompt access to needed care, predictable costs, good care outcomes with minimal risk of errors, and steady improvements in public health. An accurate and complete clinical vocabulary is necessary to meeting all of those objectives.

    While it can be argued that proceeding to ICD-11, with its SNOMED alignment, would be even better than ICD-10, that’s in the future. We should have already been on IDC-10. Every day that we are not is another day that access, cost, outcomes & errors, and public health is diminished.

    HHS has sacrificed its health mission to a loud-mouthed lobby in an election year.

    I dislike being a sacrificial animal.

    • Glen,

      Your comment is spot on and it is in alignment with everyone I’ve corresponded with regarding the same subject.

      The concern regarding ICD-11 is that it is still in consulting and commenting phase and it will not be official until 2015. Considering that ICD-10 took several decades to be considered in the US it raises concerns on how quick will ICD-11 be mainstream to start adopting.

      And HHS, after harnessing trust, with their ambiguous position after the AMA letter have outraged the entire Health IT, and a significant amount of the healthcare, communities.

      If the Courageous are loud enough I doubt we will end up being sacrificial animals.

      Best regards,

      Michael

  4. Michael,

    This is not the time to slow down. When discussions were underway about delaying Meaningful Use Stage 2, I would discouraged by that suggested approach. As you point out, this is an incentive program. Patients are embracing personal health care technology, which will create a wave that physicians, clinicians, and provider organizations will need to join or be washed over with the transformation.

    We need to move health care forward in our country; there is no other option.

    Thanks for raising the call to action!

    Jon

  5. Healthcare organizations are looking at ways to combine more sophisticated uses of health IT and clinical care to achieve better health outcomes and improve health system performance. The delay will hinder the progress being made, but lets hope the $3.3 billion for information technology will speed up the process.

  6. Pingback: Are you “Fed” up? | Perficient Healthcare IT Solutions Blog

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