May 26, 2011

ICD-10 and Meaningful Use: Undefined Partners in Healthcare Reform

By

ED. NOTE: This is the final installment in a two part series that explores the relationship between Meaningful Use and ICD-10.

Linda Kloss, former CEO of AHIMA, captured the trajectory of the healthcare industry perfectly when she said: “The last decade was about information technology. The coming decade will be about information management.” We are undergoing a paradigm shift in the way health information is collected, stored, calculated and reported. Both ICD-10 and “meaningful use” of electronic health records are integral to this transformation.

 

The transition to ICD-10 is not a self-contained effort. Categorizing and isolating ICD-10 as a coding, IT or revenue cycle project independent of clinical department buy-in and support constricts the governance of such a massive effort within an organization (Glatthorn, 2011). This transition is a multidimensional strategic effort that affects many stakeholders.

The Impact of ICD-10

According to one estimate, ICD-10 will impact 38 percent of all business processes, 47 percent of all IT systems and numerous types of business associates, including EHR vendors (Zenner & Naugle, 2009).

Competing Initiatives?

Despite the common goals and objectives, these two projects for the most part have been viewed as distinct. The Health Information Management Systems Society conducted an “Industry Readiness Survey” in December 2010 to assess the progress of the ICD-10 transition to date. A key finding was that a full 70 percent of respondents identified meaningful use as a project competing with ICD-10. Both meaningful use and ICD-10 implementation significantly impact an organization’s technical applications and business processes, so it is important that providers synchronize the modifications that affect both projects and thus avoid duplication of effort.

Improving Clinical Documentation

Framing the ICD-10 transition within the context of meaningful use provides organizations an opportunity to engage in the process of improving their clinical documentation. Meaningful use and ICD-10 require clinical staff to document clinical information in structured and discrete formats.


 

Structured data provides the foundation for EHR applications such as clinical decision support, also enabling interoperability and the electronic exchange of information (AHIMA CDI Toolkit, 2010).

Meaningful use will require standardized collection of unique data elements for achieving a variety of measures. The Final Rule for Stage 1 of meaningful use specifies that organizations must use ICD-9 or SNOMED, but it is clear that ICD-10 will become a requirement after Oct. 1, 2013 – no matter what stage of meaningful use for a particular organization.

Perhaps the most important overlapping component of ICD-10 and meaningful use is the increased focus on structured clinical documentation, which has been a major challenge for the healthcare industry.

In fact, the level of structured provider documentation required to achieve meaningful use has been dubbed the “hidden requirement.” For example, simply meeting the functional requirements for data capture in Stage 1 meaningful use will cover only 35 percent of the unique data elements needed for the 15 required quality measures. Of the remaining required data elements, which likely represent the greatest challenge to receiving incentive payments, approximately 29 percent are derived from structured physician documentation (Metzger, Ames & Rhoads, 2009).

The “hidden requirement” is an appropriate title to illustrate the daunting challenge confronting the industry. According to HIMSS Analytics, as of end of year 2010, only 3.2 percent of hospitals have fully implemented physician documentation within the EHR. The numbers are similar on the outpatient side. In a 2009 survey of office-based physicians, 3.3 percent reported using a fully functional electronic health record system that would meet the functional requirements of meaningful use (Hsiao et al., 2010).

The goals and objectives of both meaningful use and ICD-10 are based on the availability of discrete data needed to support automated reporting and analysis, thereby representing a system that facilitates continuous care and process improvement within healthcare organizations. As meaningful use becomes more stringent with each subsequent stage, ICD-10 will prove invaluable for data collection and reporting (Mitchell, 2010).

Healthcare delivery historically has been disjointed somewhat, with the work segmented into silos. This pending transition to ICD-10 and meaningful use provide a unique opportunity to cross the interdisciplinary communication chasm that often is so wide within many organizations. While it may be easier to plow forward on these initiatives without collaboration, the long-term benefit of working together, particularly on topics related to improved clinical documentation, far outweighs the cost.

One of the greatest challenges in the interim will be for organizations to remember to be inclusive, remain calm and plan well!


 

 

About the Authors

Brooke Palkie, MA, RHIA is an Assistant Professor for the Department of Healthcare Informatics and Information Management at the College of St. Scholastica. In her current role as faculty, Brooke is responsible for successfully transitioning the coding and classifications curriculum to ICD-10. Additionally, Brooke is involved with a HRSA grant funded research effort to implement a rural health technology project focused to improve healthcare quality and reduce costs.

Ryan Sandefer, MA, CPHIT, currently serves as project manager of a series of rural EHR implementation and optimization initiatives for the Center for Healthcare Innovation at the College of St. Scholastica in Duluth, Minn. The projects have included the implementation and study of a variety of health information technologies in rural facilities, representing an effort to optimize their use of EHR systems.

 

 

References:

American Health Information Management Association (AHIMA) (2010). Clinical Documentation Improvement (CDI) Toolkit. Retrieved 4/24/2011: http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047236.pdf

Dingle, John & Gary Keast. Mayo Clinic PowerPoint Presentation: HIMSS11 Creating Opportunities of Hope: Organizational Opportunities for ICD10 and meaningful Use. Retrieved: 4/20/2011: http://www.himssconference.org/docs/sphandouts/ICD8.pdf

Glatthorn, John (2001). ICD-10 Transition Planning: Evaluating Your Organization's Mindset. HCPro Just Coding. Retrieved 4/24/2011: http://blogs.hcpro.com/icd-10/2011/03/icd-10-transition-planning-evaluating-your-organization%E2%80%99s-mindset/

HIMSS (Healthcare Information and Management Systems Society) ICD-10/5010 Industry Readiness Survey: Retrieved 4/24/2011:http://www.himss.org/content/files/ProviderReadinessSurveyDecember2010.pdf

Hsiao, Chun-Ju, Hing, Esther, Socey, Thomas C., and Bill Cai (2010). Electronic Medical Record/Electron Health Record Systems of Office-based Physicians: Unites States, 2009 and Preliminary 2010 State Estimates. Centers for Disease Control and Prevention. Retrieved 4/24/2011: http://www.cdc.gov/nchs/data/hestat/emr_ehr_09/emr_ehr_09.htm

Infosys. ICD-10 & MU: Partners in Healthcare Reform. Retrieved 4/20/2001: http://www.infosys.com/offerings/industries/healthcare/Pages/ICD-10-meaningful-use.aspx

Metzger, Jane, Ames, Melissa. and Rhoads, Jared. (2010). Hospital quality reporting: The hidden requirements of meaningful use. Computer Sciences Corporation. Retrieved 4/20/2011: www.csc.com.

Mitchell, Robert N. (2010) The Connection Between Meaningful Use and ICD-10. For the Record. Retrieved 4/20/201: http://www.fortherecordmag.com/archives/120610p20.shtml

Wierz, Chris, Johnson, Kerry (2001). Premier & HIMSS presentation: Implementing ICD-10 Lessons learned from Canada. Retrieved 4/20/2011 http://www.premierinc.com/advisorlive/Presentations/advisorlive033110-ICD10.pdf

Zenner, Pat and Andrew Naugle (2009). Milliman Webinar Series: ICD-10 Critical Success Factors. Retrieved 4/24/2011: http://publications.milliman.com/publications/podcasts/multimedia/icd-10-slides.pdf

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Brooke Palkie, MA, RHIA

Brooke Palkie, MA, RHIA is an Assistant Professor for the Department of Healthcare Informatics and Information Management at the College of St. Scholastica. In her current role as faculty, Brooke is responsible for successfully transitioning the coding and classifications curriculum to ICD-10. Additionally, Brooke is involved with a HRSA grant funded research effort to implement a rural health technology project focused to improve healthcare quality and reduce costs.