SNOMED was so important to healthcare's switch from ICD-9  to ICD-10 medical coding, ONC Chief Farzad Mostashari, MD says, that he was willing to support the one-year delay to achieve the necessary crosswalks. This system of nomenclature can lay the groundwork and foundation for much better, more granular clinical documentation, he said.

Mostashari spoke with Healthcare IT News Senior Editor Diana Manos June 17 at the HIMSS Media ICD-10 Forum in National Harbor, Md.  With his typical candor and energy, Mostashari commented on several healthcare IT issues and about ICD-10 – the focus of the forum and the topic of the keynote talk he had delivered earlier in the day. Yes, he was wearing his signature bow tie.

Q. How did you get so passionate about healthcare IT?
A. I went to the school of public health first, thinking I was going to help populations and do international work, and then my Dad got sick. He was in the hospital and I thought – my gosh, this laying on of hands, that is something really powerful – and, so I went to med school. There’s an indispensible role of healthcare in easing suffering. Information and information tools help us apply the best care to an individual based on everything we’ve learned and to have that individual encounter contribute to the greater knowledge. That tension [between] the many and the one is very personal to me.

Q. You mentioned SNOMED this morning in your keynote. Can you explain a little more about the importance of the connection between SNOMED and ICD-10?
A. SNOMED was one of the factors for me in supporting the one-year delay in ICD-10. It can lay the groundwork and foundation for much better, more granular clinical documentation and data collection that could then be used if providers and vendors take advantage of it. It could be used to ease the path to ICD-10, so we’re not dealing in ICD-10 with the same darn ICD-9 codes through a silhouette, because if we do that, we’ve added no value.

Q. How is ONC helping providers to use SNOMED in the transition to ICD-10?
A. The first thing we realized we had to do, two years ago, was there has to be a crosswalk. So, out of our teeny tiny ONC budget we helped support the National Library of Medicine in developing that crosswalk. It’s an openly available resource to everybody and we’d like to see more  people use it, fill in the gaps and help make it better over time. But this is one, where the market should work, because there’s money to be made making ICD-10 transition easier for docs. We’re laying out the tools, and the market needs to pick them up.

Q. Can you elaborate on how vendors could help with the ICD-10 transition?
A. We have a fundamental belief at ONC and the administration that the power of American innovation and entrepreneurship is undefeatable and we’ve got to tap into that to solve our toughest problems, including healthcare costs and quality. This is an opportunity for companies to do good, by doing well. 

Q. Do you have in mind the kinds of things they could come up with?
A. Anything that eases the burden on frontline clinicians for documentation and coding. Something that acts in a smart way to use the totality of clinical information and help move away from the scenario of expecting a clinician to keep in mind thousands of potential codes that they could apply to a case, maybe suggest to them three to five codes. Those are the kinds of tools I’m thinking of and I’m sure the market will think of many more.

Q. What would you say to a practice manager who is beginning to panic at the thought of ICD-10?
A. On this one, I’m telling you guys, don’t wait until the last minute. You have an opportunity now to start with a new system and when you make that purchasing decision, don’t just pick the product based on the features and the functionality, make it based on the company. Do they treat their customers well? Are they transparent? Do they have good business practices? Regional extension centers can help you with the process of picking a vendor.

Q. What is your reaction to the Code of Conduct recently released by the EHR Association?
A. I think it hasn’t gotten enough ink in terms of how significant it can be. It’s one of those things where the more people who rely on it and the more attention it gets the more powerful it becomes. I really do applaud the industry for having stepped up.

Q. How disruptive do you think ICD-10 will truly be to meaningful use?

A: Frankly, I don’t see ICD-10 as disrupting progress toward meaningful use. If anything, I’m seeing that if we can get the synergy going that I talked about – people seeing if I have a meaningful use certified EHR, if I have clinical documentation, then it’s easier for me to get to ICD-10, then that’s another reason for me to move forward on the clinical side.

Q. Some hospitals and doctors are reporting frustration with the meaningful use audit process. What would you say right now to somebody who is experiencing those difficulties?

A. This is something that our CMS colleagues have a great deal of experience with. This isn’t the first time a payment program has been audited. I think that over time, the experience has been that things do smooth out, that people begin to understand what the auditors expect and the auditors get a better feeling for what the real risk areas are and they are able to better target their audits and then to offer clarification.

Q. ONC recently announced CMS has paid $14.7 billion in EHR incentives so far. It’s been reported that the federal government originally estimated it would spend around $20 billion in incentives. Obviously, it is going to go over that. Do you see that becoming a problem?
A. I think sometimes people use the amount paid as a sign of the progress we’re making, and I don’t think it’s a good metric. The mark of success isn’t the amount of dollars paid out. The mark of success is how many providers and hospitals have achieved the standards for meaningful use and have earned these added payments.

Q. What would you say to a physician who has decided it’s just not worth the trouble to try for meaningful use?
A. I’d say that it’s a voluntary program and I hope that you’d participate. But, you shouldn’t look at this as a program that’s in isolation to the other things that are happening in healthcare, which are an increasing focus on population health management, care coordination and patient engagement. I would say, don’t think `do I do this program to get the check or not?” Think, `is this in line with patient-centered care and is it where I want to be?’ –  and everything will work out.

[See also these related stories: Mostashari: No more ICD-10 extensions; Expert says prepare now for ICD-10; and, Mostashari calls on vendors to `play fair.']