Editor's Desk: T.W.I.G. Notes

By Tom Sullivan
10:50 AM

Add the exact cost of ICD-10 to the list of topics not to bring up in polite conversation.

Some folks are saying that the new code sets will cost as much as ten times the original estimates, while others are pointing out that some of the implementation costs might be covered by competing health IT projects.

The latter came to light at the ICD10Watch blog where Carl Natale made mention of one large provider that found up to 60 percent of its ICD-10 implementation costs was already budgeted for in other projects.

Then again, John Halamka writes in his Life as a Healthcare CIO blog post The challenges of ICD-10 implementation, that “the ICD10 final rule estimated the cost as .03% of revenue. For BIDMC [Beth Israel Deaconess Medical Center], that would be about $450,000. Our project budget estimates are about ten times that.”

Offering some help, CMS continued building out its array of ICD-10 resources, this week adding a guidance document for claims that span the implementation date. That’s to say that some health care services will begin on or before September 30, 2013 then carry on into October 1, 2013, meaning portions would need to be coded in ICD-9, others in ICD-10. So providers and payers alike need to brace for that reality.

Senior Editor Chris Anderson, meanwhile, reports on AHIMA survey findings that ICD-10 planning and implementation are picking up speed. It’s worth noting that for just about any project as grand in scale as ICD-10, the chasm between planning and implementation can be as wide as, well, in this case the gap between estimated and actual costs of ICD-10.

And what about your health organization, are ICD-10 costs under the purview of any competing projects? One of those HIT initiatives considered a potential counterbalance to ICD-10 is the meaningful use of EHRs. On that front this week, ONC foretold of a forthcoming pilot to ease patient consent woes via data segmentation within electronic health records. “The goal of this project is to enable the implementation and management of health information disclosure policies originating from a patient’s request, statutory and regulatory authority or organizational disclosure requirements,” national coordinator Farzad Mostashari, MD, wrote in the HealthIT Buzz blog first detailing DSI, otherwise known as the Data Segmentation Initiative.

DSI will likely prove a challenge spanning patient education, politics, and policy, not altogether unlike the joint DoD/VA EHR currently in development, a puzzle of which technology is being recognized as the easiest part. Given the project’s open source and proprietary mingling, the larger question might concern whether or not the agencies can foster an open eco-system that thrives as long as the EHR itself.

Kicking off a twelve-part series, the Oregon Health Network’s 12 best practices for HIT, part 1: Strategy and planning, examines how telehealth and telemedicine are maturing beyond “testing to see if the gadgets work” and becoming about “using technology innovations to enhance the clinical moment, allowing patients to receive continuous care in their home or local community, allowing health care systems to discharge patients to a transition team that will follow their care for the next stage of returning to health.”

Still to come this week: Senior Editor Mary Mosquera reports the latest on the joint DoD/VA EHR news, a common GUI will connect their back-end systems. And yours truly interviews two IBMers about the forces driving healthcare data analytics. Big Blue's Watson supercomputer is included, of course, and there’s more to it – such as how ICD-10’s greater granularity will be one aspect of a new age in which analyzing healthcare data is “a global issue as much as a local issue.”