Okay then - we have an ICD-10 implementation date: Oct. 1, 2014. It has taken 19 years for the industry to get this close to what is actually a fairly modest goal - upgrade a classification system used extensively in healthcare for reimbursement transactions, quality initiatives, epidemiological tracking and clinical research from the thirty-year-old ICD-9-CM to the latest completed version, ICD-10-CM/PCS.
Even by government standards, the rate of progress has been a crawl. For some, the crawl has taken them by surprise and so they are not ready. Still others have the idea that rather than crawling toward a well-known goal we should leap straight to a completely different goal. Points for creativity, but what about reality? The path to ICD-10 was anything but straight. To leap to a new and "better" goal, would we humans unanimously abandon all politics? Would we forego the need for public hearings and stakeholder input? Would we get there with "effective immediately" federal regulations? What about misrepresentation and spin?
Take the idea that ICD-10 will be the straw that breaks the back of physician practices nationwide. Examples of obscure cause of injury codes in ICD-10 are cited to "prove" this point. Implying that the existence of a code for injury caused by a macaw bite renders ICD-10 coding more difficult is about as valid as saying the existence of some obscure gourmet cooking implement in the far corner of your neighborhood superstore renders you incapable of shopping. But the tactic works - the idea catches on, and soon ICD-10 is called an untenable burden.
Physicians I have spoken to who have actually cracked the book and looked at ICD-10 codes in their area of specialty are not at all intimidated by the change. Having the perspective of real information gained with their own eyes, they see that ICD-10 is not such a big deal.
Is it a change? Yes, but it need not be a crippling change. Its effect on individual physicians in private practice is not by itself a major disruption. Whatever low-tech or high-tech method is now used to get ICD-9 diagnosis codes assigned to a patient encounter, the same method will work for ICD-10. If you are in the process of switching to an EHR, the fact that the system will switch to ICD-10 codes in a couple of years will be a comparatively minor part of the transition.
ICD-10 is a long overdue upgrade and regular upgrades to any system that facilitates the exchange of data should be considered normal and expected. So why not wait for ICD-11, an upgrade that promises to be even better? You've got to walk before you run.
Like all cliches, this one is a cliche for a reason - because we seem to need to be reminded of the simplest things over and over. This industry has been crawling toward ICD-10 for nearly two decades. It needs to stand up and walk before it can hope to run. There are some grand visions for healthcare reform in this country, and many of them aspire to use the power of electronic health records to make the U.S. healthcare system smarter and better, and to help it stay solvent. Superb. Let's do it. Let's get an electronic health record in place everywhere, and let's use the latest completed version of the ICD classification system until the industry has proven it is capable of moving to something more sophisticated.
Nobody has gotten a sweet deal in this compromise. The organizations that have spent considerable time and money preparing for a 2013 implementation date will lose a hefty chunk of that time and money in re-work. The organizations that have not started to prepare have to get going, and the later implementation date does not change the nature of their task. So it would be perfectly accurate in this situation to say that nobody lost and nobody won. Game over, and now there is some work to do. Let's put politics behind us, change into our sensible shoes and take this next step together, shall we?
Rhonda Butler is a senior clinical research analyst with 3M Health Information Systems.