CIOs Prepare for Sweeping Changes in Switch to New Coding System

Concerned about the pending announcement of deadlines to use ICD-10 code sets and related transaction sets, healthcare IT executives are undertaking collaborative efforts to prepare for the switch, but concern is growing about unbudgeted expenses, staff time and training needed to make the transition.

A recent survey of hospital CIOs conducted by the College of Healthcare Information Management Executives (CHIME) shows that a majority haven’t heard from their IT vendors about their plans for updating products to comply with the new ICD-10 code sets, and the related updated X12 standard, Version 5010 and NCPDP D.0 for HIPAA-related transaction standards.

The survey also found that many respondents are concerned about the amount of time they will have to test transactions with business partners and how those tests will be paid for. In August, the Department of Health and Human Services proposed regulations that would set an April 1, 2010, deadline for using the 5010 transaction sets, and an October 1, 2011, deadline for using the new ICD-10 codes.

CIOs believe the proposed changes will enable more accurate coding for patients’ diagnoses, improving the accuracy of reimbursement and providing other benefits to the industry, including improved patient care. At the same time, CIOs are concerned their organizations will be rushed into preparing for this transition.

“The implementation date for the 5010 code set will come due in about a year, and the scheduled implementation date for the ICD-10 will be here before we know it,” said Gretchen Tegethoff, CIO of George Washington University Hospital, Washington, D.C., and co-chair of CHIME’s Advocacy Leadership Team. “The greater the rush to implement, the greater the cost, and the industry is already under financial pressure because of the current economic crisis in the country.”

It’s not certain whether HHS will stick to those deadlines, which were announced this past summer, as some industry trade groups have asked for longer timelines to enable full testing and training in the new code sets.

Some 72 hospital CIOs responded to the CHIME survey in November. Of those, 60 percent said their HIT vendors had not alerted them to the proposed new regulations and timelines for ICD-10/5010 implementations.

“Outreach efforts to vendors are under way, with the objective of encouraging development of education materials for CIO technical use as well as briefing senior management,” said Sharon Canner, director of advocacy at CHIME. Canner added that other preparatory steps include the formation of an ICD-10 industry work group and coordination among hospital and health IT organizations.

The survey also found that CIOs don’t know whether ICD-10 upgrades from vendors will cost them additional money. Some 72 percent of CIOs said they didn’t know if their vendors would include ICD-10 in annual software upgrades, and 53 percent of CIOs didn’t know if the changes would be covered by “federal and state” clauses in their contracts, which generally leave vendors responsible for government-related software updates.

Some 55 percent of CIOs surveyed by CHIME said they expected that vendor readiness and cooperation would be one of the top hurdles in achieving compliance with the new code and transaction sets. Second on the list was short- and long-term budgeting for the transition, mentioned by 45 percent of respondents.

Many CIOs said their operating budgets for 2009 already are set, and any work required to transition to the new codes will have to come out of previously budgeted spending.

CIOs said other significant hurdles in making the transition would be the impact on the organization’s staff and provider communities (42 percent) and the need to implement education and awareness programs (35 percent).

Survey respondents said their immediate short-term action steps for implementing ICD-10/5010 include coordinating and communicating with all necessary vendors (51 percent); establishing an interdisciplinary or interdepartmental task force to develop a plan of action 41 percent); and developing educational or awareness programs (35 percent). Other actions planned by CIOs include estimating workforce staffing and training required for the conversion; identifying crosswalks between the current ICD-9-CM system and ICD-10; cataloging quality reporting initiatives; and identifying testing mechanisms.

CIOs also cite the extent of testing that will be required to ensure a smooth transition. The respondents said the shift will require extensive internal testing and coordinated testing between business partners and physician practices with which hospitals interact.

ICD-10 Full Survey Results (December 2008)

About CHIME
The College of Healthcare Information Management Executives (CHIME) was formed with the dual objectives of serving the professional development needs of healthcare CIOs and advocating the more effective use of information management within healthcare. CHIME's events and activities were designed to reflect that purpose, including CIO-oriented surveys, education programs, and networking activities. With membership of over 1,300 CIOs, CHIME has established itself as the premier organization serving the needs of healthcare CIOs. CHIME's educational initiatives are supported by the CHIME Foundation, a group of 67 providers of healthcare IS products and services. To learn more about CHIME and the CHIME Foundation, see www.cio-chime.org.

UPDATED: 12/23/2008 5:38:33 PM