“This is just the beginning of the shakeout … there is an asset bubble in electronic health records and health IT,” said Dr. David Brailer, founder and CEO of Health Evolution Partners and former head of the Office of the National Coordinator for Health Information Technology.
“The data suggests that it is likely we’ll see a sizable reduction in the number of EHR vendors listed for 2014 edition certification,” predicted Steven Posnack, director of federal policy, and Dustin Charles, a public health analyst, on the ONC’s September 13 blog post
Now to the question: “ICD when?” Mandated for October 2014, ICD-10 is expected to be one of the most complex and expensive changes healthcare has faced in decades. Look, for example, at this simple numerical comparison prepared by the American Medical Association.
|
ICD-9 |
ICD-10 |
|
| Codes |
~13,000 |
~68,000 |
| Characters |
3-5 |
3-7 |
| Pressure Ulcer Ankle |
707.21 |
L89.501 |
Clinicians are now going to have to provide more specifics on their ICD coding. With the pressure ulcer example below, you can see the increased level of specificity that will be required for reimbursement.
Example for pressure ulcer with ICD 10 changes in bold:
|
ICD-9-CM |
ICD-10-CM |
|
|
Specificity is very helpful in understanding patient condition and care. But how does the system support requirements and usage? Does it just layer the work on the clinician to point and click away? There is no way ICD-10 can create extra time in the day. Physicians, already showing a dramatic despondence with regard to career satisfaction, may start heading for the exits in larger numbers. Emergency physician shortage, anyone?
The ACP survey is ongoing. The 2014 surveys will show which systems dealt effectively with clinician questions and which did not. Even before survey results are published, clinicians may provide answers themselves by replacing their work-creating EHRs with systems that actually ease the burden.
In my estimation, we have all the predictive evidence we need. Meaningful Use 2014 is a tipping point and ICD-10 will only tip the whole project further. This is EHR survival of the fittest. Did you choose a survivor or, better yet, a thriver? If not, the real usability and accessible Meaningful Use data available from systems designed with clinician and patient in mind can help you find a better way.
This post orginially appeared at the Medsphere blog.
