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Health IT from the CIO’s Chair 4/9/14

April 9, 2014 Darren Dworkin 8 Comments

The views and opinions expressed in this article are mine personally and are not necessarily representative of current or former employers. Objects in the mirror may be closer than they appear. MSRP excludes tax. Starting at price refers to the base model, a more expensive model may be shown.

ICD-WHEN …  But It Is Not Fair!

I have an 11-year-old daughter (I have a nine-year-old daughter too, but she is not part of this post, which ordinarily would be a problem except that HIStalk has a fairly low readership among the nine- to 11-year-old girl demographic, so I’m probably safe just referencing one kid.) My wife and I hear a very common phrase from our 11-year-old, which is, “But it is not fair!” (as you read the line, insert a foot stomp, a hand on the hip, or some exaggerated facial expression.) The good news is I’m told that challenging fairness or having an exaggerated sense of being wronged are normal things for a girl her age.

So why I am raising this?

A couple of weeks ago, our daughter told us the ultimate “But it is not fair!” story at the dinner table. She had a lot of homework and had stayed up late doing it, only to be told by her teacher the next day that since many kids complained, everyone would be given an extra day to complete the assigned work. She had strong feelings that, “But it is not fair!”

Let’s fast-forward to the shocking news we all heard on Thursday, March 27. The House had voted to delay ICD-10. Emails were flying around. Some were forwarded by well-intended people thinking they were breaking the news by passing on various listserv posts. Most were from leaders or team members deeply involved in the ICD-10 project. These emails — while sometimes containing more colorful language – essentially proclaimed, “But it is not fair!”

As I have thought about it, I guess that really is the right phrase to describe our ICD-10 delay situation. The root of the issue is that those organizations that have been preparing and working really hard at ICD-10 and sacrificing other things to get ICD-10 done feel wronged. We studied hard for the test, we made the sacrifices, we checked in with our bosses to be sure this was something we really had to do. Then, without warning, poof! Another delay.

Others feel ICD-10 has not been fair all along. This point of view would say that a break is needed from all the bureaucratic burdens, especially for small hospitals and solo physician offices.

So how do the pros and cons of this all play out?

On the cons side:

  1. Momentum. Many organizations had made room for the project and spent a lot of money to get ready. It will be hard to rally the troops again for the big ICD-10 project now that it has been delayed. ICD-10 with its many delays can officially be called ICD-WHEN? It will be hard  to insist with credibility to physicians and others that we have to aim for a new hard date.
  2. ICD-9 was developed in 1979. That kind of stands on its own. That was 35 years ago. Things have changed, but the ICD codes have not.
  3. Monies have been invested and spent on training. Training, like computer hardware and milk, just don’t age well.
  4. We have transparency problems in healthcare today. Better coding was not going to solve that in itself, but it was going to help.
  5. Better analytics will come from better data. ICD-10 was going to help us get better data.
  6. It will be hard to quantify the opportunity cost of ICD-10. Since we all thought we had to do it, we skipped doing other things. More importantly, our vendors skipped doing other things. I bet folks have an impressive list of opportunities on their to-do lists.
  7. Many of our systems are now in limbo. Code is loaded and tested, but now those systems need to stand down.

On the pros side:

  1. Folks who need the extra time will have it.
  2. Heck, I guess ICD-11 is just around the corner.
  3. I suppose some version of phased go-lives might be possible with systems at larger hospitals on track.
  4. More dual coding data means more testing. It’s hard to say more testing is bad.
  5. With our extra time, we can find more obscure ICD-10 codes and make fun of them, like “V95.43, spacecraft collision injuring occupant.”

I’m disappointed that ICD-10 was delayed, probably equal parts for the delay itself and the way it was delayed. But in the end, I think this one is best summarized by my daughter: “But it is not fair!”

1-29-2014 12-54-46 PM

Darren Dworkin is chief information officer at Cedars-Sinai Health System in Los Angeles, CA. You can reach Darren on LinkedIn or follow him on Twitter.

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Currently there are "8 comments" on this Article:

  1. Darren, your article is the best summary of this sad situation that I’ve seen. You really hit the nail on the head with your list of “cons”, and particularly that it’s going to be very difficult moving forward to point to any new deadline with authority. Having more time for testing is a silver lining, and hopefully that will make the delay worthwhile. All in all, though, I agree with your daughter.

  2. Darren, I enjoyed the post. As a vendor, we also incurred lost opportunity cost since we invested significant time and energy in building out the product to support the challenges of ICD-10 documentation. Having to delay and or post-pone upgrades for various reasons will only necessitate the incursion of cost and resource time next year… all with the cloud hanging over us wondering what legislative bill will have a one-liner inserted to delay again. For an industry under the gun, the collateral impact is not trivial.

    However, my hope is that the industry can take this time to test, educate, test again, implement and improve as we get closer to the next date. If we look at the delay as an opportunity to have a smoother transition for the clinicians and the coders who are impacted by this implementation, then we may in-fact get Lemonade out of the Lemons we were given. Getting to better data is desperately needed, and this is a step on that journey. Thanks for your insights.

  3. Darren,

    Recalliing the day of the vote – yes, emails flying around – LinkedIn was a ‘twitter’ with activity. During a focus group meeting, a couple of CMIOs excused themselves to receive and then spread the urgent word.

    Superb synopsis of the pros and cons. Loss of momentum may be the toughest challenge. Hopefully the folks who need extra time will invest and use it wisely.

  4. So what’s wrong with sticking with your original implementation timeline? As long as you can get the work done on schedule, get the ICD thing put to bed and move on. And if your deliverables cause the schedule to slip you now have calendar room to make those adjustments.

    Your comments on opportunity cost are valid. However when you remove the “cost” part of that equation (by implementing on the original timeline), you are left with “opportunity”. Is that suddenly a bad thing?

    This is what is wrong with so much of the negative commentary about the ICD date extension. If you fear a loss of mission urgency then… stick with the original implementation timeline! As an autonomous organization you are not solely stuck with outside agencies to determine your priorities. You can do that internally as well. So do that.

    The psychology of ICD leads me to think of children and brussel sprouts. The child doesn’t want brussel sprouts and so all kinds of problems mysteriously arise when served those troublesome vegetables. The child is full, the veggies are cold, they need a glass of milk, the dog needs petting, there’s something on TV.

    OK, I get it. ICD isn’t fun. However it’s time to do it and move on to something else. You’ll feel better when it’s done and maybe discover it wasn’t as bad as you feared.

  5. I don’t think it is this simple. Could this “autonomous organization” really go ahead and implement as planned as you suggest? And then what? Aren’t there dependencies such as the recipients of that billing and coding being able to accept it? Wouldn’t this require the organization to support both ICD9 and ICD10? Admittedly, I am not very close to this space, but if this is true, I don’t think maintaining both at the level needed would be viable.

    The brussel sprout story is cute, but I don’t think it applies here.

  6. Re: confused

    Do you not like the brussel sprouts story because it’s not applicable, or because it does not validate your position?

    I know excuse-seeking behaviour and there’s a lot of it going ’round in the ICD space. ICD-10 has been available since 1999. That’s the beginning of 1999 in case you were wondering. My own organization has been running ICD-10 for 9 years now. And it caused chaos and havo… oh wait, no it did not.

    The concern about the US ICD-10 deadline extension seems to me caused by an invalid point of view. It’s caused by the notion that the deadline is in fact a government-mandated delivery date. It’s no such thing. What it is instead is the last acceptable implementation date. Any date prior to that is acceptable too.

    Concerns about code mapping will exist regardless of the organizational go-Live date. That’s just a red herring.

  7. Not at all – I don’t actually have a position on it.
    From my post, “… I am not very close to this space …”

    Just asking some questions. Asking whether what you suggested is viable, because it hasn’t been the impression that I have been given from folks that are in the space.

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