Monday, January 30, 2012

Update on the BIDMC ICD10 Project

I've written extensively about the challenge of implementing ICD10 and my belief that the billions of dollars required to implement it will not improve quality, safety, or efficiency.

I've spoken to many people at HHS, CMS and the White House about the need to rethink the ICD10 timeline, deferring it until after Meaningful Use Stage 3  which enables us to focus on improving our clinical documentation and adopt  SNOMED-CT  to capture structured signs and symptoms.

However, I've been told that the Affordable Care Act (ACA) includes cost savings from reduction in healthcare costs/fraud/abuse that require the implementation of ICD10.  Thus, it's not likely going to be delayed.

At Beth Israel Deaconess, we're moving forward, assuming that ICD10 must be implemented by October 1, 2013.     We held our kickoff meeting in June, hired external resources to create a project management office, and hired subject matter expert consultants to assist with the gap analysis, project plan and budget.

Today, I'm posting two resources for the benefit of other organizations planning their ICD-10 projects.

The first is the RFA we used to hire a consulting partner.   In our case, we elected to create a single unified project for the academic medical center, community hospitals, physician organization, faculty practice, and owned community practice.   We felt that creating one project for all the stakeholders would reduce costs while eliminating redundancy and aligning resources.

The second is the letter we sent to all our stakeholders, asking them to create an inventory of the software applications and processes that incorporate ICD9 and need to support ICD10.

In the next few weeks, we'll complete our detailed project plan, budgets, staffing model, and timeline.    I'll share as much as I can as soon as it is available.

ICD-10 is a costly project that will have no benefits and if we're truly successful, the best we can hope for is that no one will be too upset that we implemented it.

Given a project with this many negatives (here's the AMA letter to Speaker of the House John  Boehner), the least I can do is share everything we're implementing in the hopes that others will benefit from our experience.


Neha said...

Hello Dr. Halamka,

I truly enjoy reading your posts as they are so insightful and honest! I am so sorry to hear about your wife but she has been in my prayers and I hope the best for her.

I realize the problems associated with ICD-10, however I was under the impression that with more granularity with ICD-10s, it would be easier to track patients problems and create analytics? Or is that a bit far for now?

Lori S said...

Hello Dr. Halamka,

Thank you for your informative posts!

Would you be willing to also share the template, for inventorying workflows and activities impacted by ICD-10, that you reference in the letter to stakeholders?

Thank you.

Andy Wiesenthal said...

John--certainly those systems that purely store, send, or receive ICD need remediation, and I share your opinion that this will only have cost and produce no benefit. What about taking the opportunity to convert your clinical systems to SNOMED-CT as a reference terminology, with table-based mappings to ICD-9 and ICD-10 in the background and your choice of interface terminology (CMT, IMO)? You train your clinical users to something that makes more sense than ICD, it supports diagnosis, problem list, procedures, organisms, meds,etc. If it isn't good enough, then BIDMC can become an active part of the community that improves it, and it is a universally available, free, public good. I know, I'm biased.
Andy W.

Rebecca W said...

Hello John,

I am currently serving as Consulting director of ICD-10 for a healthcare organization, and I can tell you that I share your concerns regarding cost and revenue impact. One additional point worth making, I believe, is that HIT vendor readiness is an imperative to a successful deployment of ICD-10 within organizations. Unfortunately, it seems many vendors are waiting until clients "pull the fire alarm" to act and avidly prepare for this large and obviously impactful initiative ahead. I would advise all healthcare organizations out there to contact their vendors NOW for a status updates on ICD-10 readiness.

Thank you for your posts, as always, and your family remains in my prayers.

Anonymous said...

Dr Halamka -

I appreciate your posts and share your concerns regarding ICD-10. As I look into the future I see that we will exhaust ourselves implementing a 30 year old coding system that will be obsolete within the next 5 years. Perhaps we should have done this 25 years ago, but having made a mistake then doesn't mean that we need make a second now.

How about joining the AMA and the multiple State Medical Societies that are trying to find a better alternative? As we learned from the recently outcry over SOPA, if we all join together, even ICD-10 can be stopped

A concerned CMIO in Dallas, Texas