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February 3, 2012

RE: AMA to Congress: Halt ICD-10

By Phyllis Dreading, RHIT

I have been meaning to respond to a lot of articles concerning the ICD-10 conversion and meaningful use in the EHR arena, but I felt it would not necessarily engender any useful outcome. After 40 years in the industry, however, I decided I might have as much of a right as anyone to at least express my opinion, since I was there the day the first PC landed in my department.

Irrespective of the fact that ICD-10 conversion is going to cost the healthcare industry billions of dollars at a time when revenue and patient volumes are shrinking, I am convinced we need to slow down our march toward total automation under meaningful use and ICD-10. Compounding the challenges created by shrinking revenues, government intrusion and oversight of potential areas of fraud or abuse demand more manpower and resources at the provider level in order to monitor and edit claims and documentation – thus raising operational costs.

Recently, for example, hospitals and healthcare providers met the challenge of the new 5010 claim form. It has been devastating to cash flow in innumerable facilities and services in the industry. The software and integrated EHR systems were not ready to handle the new form. Although CMS extended mandatory implementation for 90 days, the cost to the industry already has been very high.

ICD-10 would be beneficial in tracking disease and services throughout the global economy, increasing our ability to zero in on populations with higher incidences of specific conditions and healthcare service issues. However, the direct benefit to the individual patient is minimal, if it exists at all. The cost to our healthcare industry, on the other hand, is astronomical at a time when the economy is in the doldrums and the culture of the healthcare industry is rapidly evolving.

In keeping with that theme, the push to implement EHRs – driven by meaningful use criteria and promises of millions of dollars in reimbursement to providers for meeting the required criteria – is ludicrous in light of the already stressed economy. Having served on the meaningful use task force at our facility, I know we have learned that most current systems are not ready (and will not be ready for some time to come) to optimally handle the documentation required to meet meaningful use requirements. For the most part, current EHR systems are not sophisticated enough to guarantee patient safety and deliver efficient, quality outcomes; bottom line, these systems place the patient at risk for provider error and poorer outcomes.

I applaud all efforts to automate the healthcare delivery system. If done right and thoroughly tested for safety and quality, the efficiencies and return on investment will be immeasurable. But this should not be pushed through just to allow us to say we are “automated” and able to provide health information at the touch of a button! Misdiagnosis, treatment errors and erroneous documentation pose a far-reaching threat to quality healthcare, in my opinion. A sum of $7 million in meaningful use rewards for achieving EHR quality measures and other criteria is not worth the death of, or harm to, one single patient. Without the MU reward potential, many organizations would not be attempting to automate, because a $20 million EHR does not compare to a $20 million rehabilitation center, or new medical laboratory, or new emergency care wing to the hospital.

Well, that is my take on the issue of pushing forward with ICD-10 and meaningful use at this point in U.S. history. I hope we ultimately get to where we want to go, but not at the cost of deaths, maimings or other disastrous outcomes due to systems and processes that are simply not ready to provide for seamless and flawless transfer and dispensation of information to treat patients safely and securely. Although data repositories brimming with gigabytes of health data is a researcher’s nirvana and could allow statisticians to extrapolate theorems and projections light years into the future, the immediate anticipated return on investment in terms of both dollars and patient health is not worth the potential cost.


Phyllis Dreading, RHIT,
Director, Health Information Management


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