ICD-10: Learning from an industry's aversion to change

ICD10 Practice Fusion senior medical director Richard Loomis, MD

ICD-10 turned 21 this year. The medical coding system could have been out legally drinking shots of Fireball (F10.129, Alcohol abuse with intoxication) and getting ill-advised tattoos (L81.8, Other specified disorders of pigmentation) while regulators and healthcare organizations continued to debate, delay, and talk about "protecting American doctors" from the change.

There's no turning back now. After years of so much debate and delays, we have proceeded with the monumental transition from ICD-9 to ICD-10.

There's much discussion about how the change will unfold. Will it be a non-event, similar to Y2K with all parties being well prepared, or will it be another healthcare.gov fiasco? Now that ICD-10 is finally here, it's time to look back at lessons we can learn and apply to future healthcare change. Was it the infrastructure of our health IT system or the scope of the coding change that caused such concern and delay?

Two steps forward
(R62.50, Unspecified lack of expected normal physiological development)

The October 1 switch to ICD-10 should be heralded as a tremendous (if overdue) step forward for healthcare in the U.S. After at least three different delays in the deadline, we're now catching up to the rest of the world in using this expanded, modern coding system. With five times more diagnosis codes, ICD-10 brings with it substantial clinical benefits for physicians -- providing accurate and complete information to assist with transitions of care, patient treatment, and public health reporting.

So why did it take us so long to get ICD-10?

(Y93.C, Activities involving computer technology and electronic devices)

When ICD-10 was first launched back in 1994, HIPAA wasn't a thing and less than 10 percent of U.S. medical facilities were using an electronic health record (EHR) system. For decades, that adoption rate stayed low as the health IT sector offered only expensive, difficult, and bulky options to physicians. 

According to Black Book Market Research, seven out of 10 small medical practices are now using a cloud-EHR system in their practice. Instead of software upgrades that come with a stack of CD-ROMs (or worse, 3.5" floppy disks) and a suited consultant, hospitals and medical clinics on the cloud are able to receive updates to their EHR systems in real time. 

Create a system for change
(F43.23, Adjustment disorder with mixed anxiety and depressed mood)

Despite big gains in cloud-based EHR systems, costs for medical practices to make the ICD-10 upgrade remained surprisingly high. The American Medical Association (AMA) estimated small practices would spend as much as $60,000 just to upgrade their software from ICD-9 to ICD-10. This cost does not correlate with the true overhead of an EHR landscape that is increasingly web-based, where vendors can easily make regulatory changes to their systems. When paired with other training and payment disruption costs, this created a financial situation difficult for community medicine providers to manage.

About that promised surprising recommendation
Cloud or not, all electronic health record vendors should be required to provide upgrades to meet regulatory change at no cost to physician users. Complying with new e-prescribing, Meaningful Use, or medical coding regulations should be made as easy as possible, supported by regulators and vendors together. Community medical practices especially should not have to pay for the innovation that our healthcare sector needs.

As we move forward as a community, we need to ensure that healthcare IT vendors are creating an environment where changes like ICD-10 don't need to take 21 years to be implemented. Regulatory change is happening faster than ever, and our health IT infrastructure needs to be made more adaptable. The continuing shift to cloud-based systems is a giant step in the right direction. A regulation making upgrades to meet new health system mandates more affordable for EHR users would help, too.

Richard Loomis, MD, is senior medical director at Practice Fusion, where he leads health informatics and medical affairs.