Hospital CIO Stephen Stewart: Don't bet your career on an ICD-10 reprieve

Stephen Stewart, CIO of Henry County Health Center in Mount Pleasant, Iowa, says his organization isn't waiting around to see if the Centers for Medicare & Medicaid Services really will delay the October 2013 deadline for converting to the ICD-10 coding system--and he urges his colleagues not to count on it, either.

Despite word today from acting CMS Administrator Marilyn Tavenner that CMS will "re-examine" the ICD-10 conversion timeline, taking a wait-and-see approach is too risky, he says. 

Stewart will be one of four Health IT experts on FierceHealthIT's exclusive ICD-10 preparedness panel at this year's HIMSS conference in Las Vegas: "ICD-10 Readiness for Hospital Leaders." (The breakfast panel requires special registration and takes place on Wednesday, Feb. 22 from 7 to 8:30 a.m.)

He'll be joined on the panel by CHIME chair Drexel DeFord, senior vice president and CIO at Seattle Children's Hospital & Research Institute; Carole A. McEwan, ICD-10 migration project manager at SSM Health Care; and Roy Foster, director of regulatory compliance practice at Cerner.

FHIT: Some healthcare leaders are banking on the fact that ICD-10 deadline will be pushed back--or that the whole thing will just go away. Do you think that's a smart move?

Stewart: It's an interesting year. What happens in November 2012 is probably the key as to whether this goes forward. But I'm not even sure a Republican in the White House is a substantive enough change to take ICD-10 off the table altogether. It would take radical change in Washington and significant legislative changes.

I suppose it's politically possible, but my advice to any colleague would be "don't bet your life on it--don't bet your career on it." As pilots say, don't give up runway you can't get back. The time between now and November is time that you can be getting prepared, but if you let those months slip away you can't get them back. 

We've talked about it in our organization and we've agreed it's certainly not a gamble we want to take. If we put forth the planning efforts and the work that we're putting into it now we think we're in pretty good shape. It's going to come to pass sometime. What we've done up to this point and time will not be 100 percent wasted effort.

FHIT: Where should healthcare organizations be right now in order to prepare for the conversion to ICD-10--regardless of whether or not the final deadline is extended?

Stewart: The biggest short-term problem is creating the awareness among providers and getting them on board to help us provide the information that they're going to have to provide. And there is no way in my mind that, at least initially, it won't be a time sink for the providers, and obviously time is the one thing that they guard most jealously.

I'm cautiously optimistic that they will respond. It's working through the challenge of creating the awareness and recognition that this, too, must be done. So rather than continuing to resist it, let's figure out how to make it go smoothly to the best of our ability.

At least at my organization, this is a lot like Y2K. You're taking a fundamental data element that's part of almost everything you do, the diagnosis codes, and you are changing its structure. So you've got to look at everything. First of all, do you have the room to store it; and then secondly what do all of your underlying applications to with that stored information and will it be able to operate under the new values?

That's not nearly as daunting a task for me as it is for a larger organization. We had about 40 applications that use the codes. Walk through all your applications: Where are your business partners, what are they doing? Identify your potential problem spots and create a strategy to deal with them--that's the first thing the CIO has to do.

FHIT: How does an ICD-10 implementation project compare in scope and importance to, say, launching an EMR system?

Stewart: It is not as obviously visible on the same scale as an EMR is. But underneath it could be every bit as big if done poorly. Because it could grind the whole thing to a halt. You could have the best EMR in the world, but if you can't code a claim to get it out the door and get some reimbursement it could stop the world.

One of the problems with ICD-10 is that it's not very glamorous. It's kind of like watching paint dry. But you're changing the color of your room and you're going to change it from black to white and you're going to watch some paint dry while you're in the process. If you don't go through that, you'll never get the color change.

It's also a lot like 5010. For those who did their homework early and worked the problem there was an impact but it wasn't the end of the world. Others who didn't do it are struggling now. And I think the same thing's going to happen with ICD-10.

For more information and to register for the FierceHealthIT breakfast panel, "ICD-10 Readiness for Hospital Leaders," on Feb. 22 at the HIMSS conference in Las Vegas, visit the event website.  

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