ICD-10, meaningful use and baby barcodes

One year has passed since DOTmed Business News’ interview with HIMSS President and CEO H. Stephen Lieber. At the time, Lieber was gearing up to celebrate the society’s 50th anniversary. Today, the party plans are old news and intense efforts are underway to keep health informatics advancing at a steady clip. Lieber took time to provide an update on some initiatives he talked about last year and revealed some new plans for HIMSS.

DMBN: So a lot has happened since last year, what are the updates? What are the current challenges in the IT sector?

Lieber: The move from ICD-9 to ICD-10 which, needs to happen by Oct. 1 2013, is one of the key challenges. The United States is the last among industrialized nations to make the move to ICD-10 and in fact, Europe and other parts of the world are already starting to adopt ICD-11. The change will mean the granularity of describing the interrelation between patient and physician will increase by about a factor of 10.

DMBN: Will this be a major challenge again when or if we move to ICD-11?

Lieber: The big change is from nine to 10. That’s because every health care encounter currently captured is described in say, 40,000 codes. With the move up, it’s exploded to maybe 300,000. It’s a complete change to the coding structure of health care treatment services, so that means virtually every system that touches a patient has to be modified. From a practitioner side, they have to learn a new set of codes. So it’s also a workflow change and technology programming change.

DMBN: Is the move a benefit or a burden?

Lieber: The fair answer is it’s a mix – the reality is there’s so much going on right now, it’s viewed as a burden. We’re going through the work necessary to meet meaningful use process. It’s unfair to say it’s a paperwork exercise, because there’s so much on people’s plates over the next few months.
I’m hearing the challenge within the IT departments of care delivery organizations being able to tackle this along with other IT projects.

DMBN: Speaking of other IT projects, how are we faring with meeting meaningful use? Has there been a substantial improvement with facilities meeting requirements since we spoke last year?

Lieber: Well, it’s up from zero a year ago, so yes, that’s significant. You have roughly 2,700 to 2,800 hospitals who have registered for the Medicare and/or Medicaid EHR incentive programs. You’re over the halfway point in terms of the 5,000 U.S. hospitals that can register. 1,200 to 1,300 already are qualified and receiving payments.

Today, as we look at our EMR adoption model we see hospitals that scored at a stage 4 level or above. It’s a level of IT adoption that somewhat equates to meaningful use – if you’re at a stage 4 you probably have the tools needed to qualify. Now, there are many details and specific requirements of usage that qualify, but five years ago, less than five percent of hospitals were at that level. Now, it’s about 30 percent at that level. About 46 percent are at stage 3 – so they’re moving up to be on the verge of going into that level of IT adoption where they’ll meet the needs of meaningful use.

We have to recognize some people are saying that 55 percent registered seems like a low number, but you have to understand where they came from. If we were in a technologically advanced sector like finance for example, that should raise a lot of questions. But health care wasn’t at that level of technology and until the regulations and requirements were issued a little over a year ago, nobody knew what it took to qualify for meaningful use. In recognizing that for a couple of years, people were aiming at a target that wasn’t defined and once it was, the strides made since, I think it’s a very reasonable performance report.

DMBN: Are facilities scrambling to get the technology updated?

Lieber: They’re working on it. There is a couple of years’ window at the beginning for hospitals to qualify and receive the full funding and we’re not at the end of that window so nobody is losing anything by not having met the requirements yet. So, just like ICD-10 it’s a process that takes time – you don’t call up GeekSquad, have them load it and be off and running. It’s a long effort to get to the point of qualifying for Stage 1 meaningful use. I think what you’ll see a year, year and a half from now is a leveling off and people at that point working toward avoiding the penalty phase in 2015 rather than scrambling for incentives which start to decrease. As I said though, we see it is good progress now.

DMBN: Are all these upcoming IT issues increasing the recognition of HIMSS?

Lieber: Absolutely. If you look at metrics – whether attendance at the conference or other programs, or page views on the web site we’re at a time when there’s a tremendous amount of focus on informatics. So as a result, recognition has grown not only in the U.S. but worldwide – we’ve been in Europe, Asia and the Middle East for at least seven years.

DMBN: What type of advice do you offer to those contacting the society about choosing a management system?

Lieber: To be sure the system they have in place or will have in place will address their perceived future needs. So there isn’t any one answer for anyone and different products have different strengths for one type of organization versus another — an academic center will have very different technology needs than a very small, rural, critical access hospital would.

DMBN: In last year’s interview, you pointed out that grocery stores have been more advanced with barcode technology than hospitals for about 30 years. I know barcodes are in extensive use for hospitals in the newborn wing, but have things changed elsewhere?

Lieber: Barcodes are common in that area — you can’t ask a baby his name. But, beyond that, I think the technology was adopted very quickly there because hospitals looked at places where the risk assessment showed a problem. There aren’t many other ways of ensuring identity in that case unless you keep fingerprints and keep checking fingerprints, so it makes sense that it’s common there. But, when you think about the administration of medication in a hospital, it happens how many times a day? Well, making sure that the right drug is going to the right patient in the right dosage at the right time has four major opportunities for human error. But, it’s not one of the places where hospital organizations universally have identified that risk and have adopted barcode strategies. So it’s a technology that has found its application in very logical places but is still lacking in others.

Bringing the wrong baby home, although less common, may get more attention from the press, but in terms of patient impact and cost, medication error is a far higher liability.

DMBN: Are medical schools at the forefront for IT to properly train students that they’re matriculating?

Lieber: Very much so. Your academic medical centers are generally speaking, among your larger institutions, generally your best endowed in terms of contributions and reserves. They’re the ones with the resources historically able to invest in technology, so as a result, academic medical centers have as their mission not only to treat patients but to train doctors. So the doctors coming out are expecting to find that technology in places they will work. That’s going to be a factor in recruitment, which is a competitive aspect of the industry. They are coming out with knowledge and experience using good technology tools.

A high technology – high performing organization is going to be an attractive place for younger clinicians to work. A facility that isn’t at that level of technology faces a negative in terms of recruitment.