Hospitals struggle with switch to ICD-10

By Bernie Monegain
11:27 AM

Code set has been available for 23 years

SALT LAKE CITY – As if upgrading the nation’s ICD-9 code set for diseases and treatment to ICD-10, with its many thousands more codes, were not enough of a challenge for health information managers at hospitals and health systems across the country, now there’s this: ICD-11 is not far behind.

That’s the message T. Bedirhan Üstün, MD, delivered to a packed and nervous audience at the 83rd Annual AHIMA Convention last month. The deadline for ICD-10 conversion is Oct. 1 2013. That will be followed by ICD-11 in 2015.

With most of the audience made up of health information managers, many of them overwhelmed with the prospect of HIPAA 5010 and ICD-10, Üstün’s message, though couched with humor, was anything but soothing.

Üstün works for the World Health Organization, where he is the team coordinator of classifications, terminologies and standards. His team is developing ICD-11 – which he prefers to call ICD-2015, figuring it will help stave off procrastination when it comes to uptake.

It will have taken the United States 23 years from the time ICD-10 was ready for use until the anticipated October 2013 deadline to adopt the new code system.

Ustun promised ICD-11 would be markedly better than ICD-10 – but also that there is no way the United States could skip right over to ICD-11 now that other countries have employed it for years – and many U.S. healthcare organizations are under way to conversion, though not yet ready.

Jim Jacobs, senior vice president, product management and health information management, at QuadraMed, which provides technology and services to help organizations make the transition, says the bulk of the company’s 800 plus customers, fall in the "absolute beginning” category.

They have HIPAA 5010, meaningful use and many other projects under way, he said. "It’s a lot of pressure, a lot of things. If they wait to the last minute, there’s not an Easy Button."

Tina Carey, director of HIM at Moses Taylor Hospital, a 200 plus-bed facility in Scranton, Pa., who was in the audience, said “We’re not ready.”

“The biggest challenge is time and money,” she said. “We have to do so many other things – there are so many things to change. We’ll need meetings with physicians. It will require lots of training, re-education and physician cooperation."

As Lynne Thomas Gordon, CEO of AHIMA’s 63,000-member organization, sees it, not being ready for ICD-10 is not an option. If providers don’t convert to ICD-10, “they’re not going to get paid,” she said.

ICD-10, Üstün told his audience "is written on the wall (he queued up a slide of a brick wall on which ICD-10 was written) and we cannot take it back.

"This is a huge change and most countries, most managers and most professions are not ready for this change," said Üstün. "You will suffer more, I tell you. I will have ICD-11 ready for you by 2015."
To avoid the 23-year uptake experienced for ICD-10, Ustun, a psychiatrist, said he preferred everyone look at ICD-11 as ICD-2015 -- the better to stay on track.

“Let us not call it ICD-11; let us call it ICD-2015, he said.

ICD-11 would be much more streamlined than ICD-10, yet much more effective. Among the problems with ICD-10, he said, the coding system is used in only 117 of 193 countries, it has limited Web presence, and it does not interoperate with electronic health records. ICD-11, he said, would be built on an Internet platform, with digital curation and wiki-enabled collaboration.

After 2015, coding will be much more automatic, Üstün told the audience.

“It’s like Windows or Mac,” he said. “Your software will be automatically updated.” Why is this this so important? “It’s not just about costs; it’s about saving lives.”

Meanwhile, he urged the audience to plunge into ICD-10 work. “ICD-10 is inevitable,” he said. “Do it as effectively as possible.”