Since the stimulus bill was signed into law in February of this year, in effect mandating incentives and penalties for health care providers tied to the meaningful use of electronic health records (EHRs), there has been an explosion of rhetoric around the potential benefits and pitfalls of EHRs; the definition of meaningful use; and ways to translate electronic data into improved quality of care. As the potential for hospitals and physicians to receive Medicare and Medicaid incentive payments in 2011 draws near—and penalties for those not using EHRs loom in 2015—there is no shortage of industry articles, discussion boards, and interest group publications debating when to adopt EHRs, how to adopt EHRs, and whether or not the financial incentives are worth the investment. Though EHRs are certainly a topic of concern for all providers, it appears two other important initiatives have been overshadowed by the debate—the transition to ICD10 codes and the upgrade to HIPAA 5010 transactions.
Undoubtedly, our country is moving in the direction of an electronic medical system. This involves several key initiatives, a few of which are approaching before the 2015 deadline for EHR implementation. By 2012, all providers must be using HIPAA 5010 transactions, and by October 1, 2013, providers must transition from ICD9 to ICD10 codes. The transition from HIPAA 4010A1 to HIPAA 5010 transactions will necessitate physicians’ offices and institutions evaluating and amending many individual electronic data interchange standards. Since the adoption of 4010 standards almost ten years ago, providers have voiced hundreds of complaints, many of which have been addressed in the 5010 version. The 5010 version also adds, removes, and improves content to make it more usable; supports ICD10 codes; and has improved instructions to make implementation of standards more intuitive. Similarly, the transition from ICD9 to ICD10 coding will require technical and workflow reengineering. Under ICD10, the number of diagnoses codes will increase from 13,000 to 68,000, and the number of procedure codes will increase from 3,000 to 87,000. These additions will allow providers more granular and detailed descriptions of diagnoses and treatments but will also require more extensive collection of data elements.
The interdependence of HIPAA 5010, ICD10, and EHRs should not be overlooked. All three initiatives will require strategic planning, workflow reengineering, and appropriate budgeting. Furthermore, the initiatives all use similar technical resources, which are already in short supply and high demand. As highlighted in the first meeting of the federal Health Information Technology Standards Committee by Anne Castro, chief design architect of BlueCross BlueShield of South Carolina, a roadmap must be created for these changes to occur concurrently, and they must not be looked at solely in isolation.
As hospitals and physicians continue to think about EHR implementation, they would be well served to consider it in the larger context of necessary HIPAA 5010 and ICD10 transitions.
References:
Bechtel, Don, Version 5010 HIPAA Upgrade, Presentation for NCVHS Subcommittee on Standards and Security, 30 July 2007.
Mainkar, Abhay and Barbour, Robert, Surviving the Perfect Storm-Coordinating Major IT Initiatives, Presentation for Coordinating EHR Incentives with HIPAA and Other Major HIT Initiatives, 13 May 2009.
Melamed, Dennis, Presentation for Coordinating EHR Incentives with HIPAA and Other Major HIT Initiatives, 13 May 2009.
Nachimson, Stanley, Presentation for Coordinating EHR Incentives with HIPAA and Other Major HIT Initiatives, 13 May 2009.