Monday, June 17, 2013

All Is Not Well in the HIT Space


Several upcoming deadlines are on the horizon that will impact operations of providers, hospitals, and intermediaries.

HHS has a fairly cavalier attitude about the changes mandated by Obamacare. Some of these issues are very serious and not to be taken lightly. For providers the impact will be major in terms of operations, ability to bill correctly and the liklihood for substantial expenses to convert ICD Coding from ICD-9 to ICD-10.

HHS and the ACA have set arbitrary and unrealistic deadlines for these changes.  Inexplicably Farzad Mostashari, who thus far has done an exemplary job planning, educating and implementing the changes cast upon us by the Affordable Care Act.   Farzad Mostashari, MD, is the National Coordinator for Health Information Technology. In this role, he oversees the Office of the National Coordinator for Health Information Technology (ONC), a division of the United States Department of Health and Human Services. He joined ONC in July 2009 and was appointed national coordinator in April 2011.

Farzad Mostashari, MD, the national coordinator for healthcare IT, asserted today there would be no extension of the deadline for switching from the ICD-9 medical coding system to ICD-10. The deadline for conversion would remain Oct. 1, 2014. 

Converting from the old ICD-9 diagnostic coding to ICD-10 is much more complex than adding or changing a few codes. The ICD codes are deeply embedded in provider actions and insurance company process. Most providers will be unable to accept ICD 10 codes as of the original deadline of October 2013, so the original deadline was pushed back 12 months until October 2014.

However even at that date most providers and/or insurers will have to use a dual system of legacy ICD 9 and ICD 10.

The consulting firm Deloitte’s White Paper elaborates in detail about the process of the conversion, the expense, and complex inter-relationship of HIT systems, including Electronic Medical Records, and coding. Switching to ICD 10 involves much more than adding codes (the increase is about 7,000 in ICD 9 to over 40,000 codes.


The lofty goal is worthwhile and obtainable. The process is well explained and oulined in this chart.


Mostashari is on the ‘firing line’ from both side s of the table for other issues as well.

Today in the third of three hearings held by subcommittees of the House Energy and Commerce Committee, Farzad Mostashari, National Coordinator for Health Information Technology reassured a congressional panel that health IT interoperability will take some dramatic leaps forward within the next two years.

Michael Burgess, MD (R-TX) vice-chairman of the House Subcommittee on Oversight and Investigation, questioned the sluggishness of interoperability.

“We do hear about this a lot,” Burgess said. “Even anecdotally, hospital systems in the same city, that have the same operating system aren’t talking to each other.”

“You’re the head, why don’t you fix that?,” he asked Mostshari. “Why don’t you just make that happen?” Was this a rhetorical question ?

This statement reveals the lack of understanding by congress how our health system operates and the complexity and workings of daily operations by hospitals and providers.  This type of political grandstanding serves no productive purpose, especially when all the principals  had mulitple reform deadlines given to them in an arbitrary fashion by HHS.

It also points out the misguided perception that throwing money at  issues is not the entire solution and also that ‘haste makes waste’  It appears that Congress learns slowly.


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