Editor's note: H&HN Daily, in partnership with the College of Healthcare Information Management Executives, is pleased to present ICD-10 In Real Time. In this 12-month series, three leading CIOs share their experiences on ICD-10 implementation, physician engagement, productivity, payer readiness and more. The blogs run on the first Wednesday of every month.


Last month, the Centers for Medicare and Medicaid Services proposed a one-year delay for ICD-10 to October 1, 2014. Reactions have varied. Some are extremely disappointed that CMS didn't propose to wait until the much anticipated 2015 release of ICD-11, which is said to harmonize ICD codes with SNOMED, and would likely mean an implementation somewhere between 2018 and 2020. Others are equally disappointed that CMS is proposing a delay at all to anything beyond enforcement, as the delay not only takes the wind out of current project sails and has the potential to extend costs, but it generates other schedule conflicts with such things as IT system upgrades and deployments in preparation for Meaningful Use Stage 2 efforts.

I, for one, am reasonably satisfied that providers, payers and our system vendors face less uncertainty as to what is to be done by when, so we can recast our plans and get on with our transition efforts. Granted, content with the status quo is not my cup of tea, and I come at it with an attitude of, "Don't leave for tomorrow what you can do today." There is much work to be done still, even for those of us who started a while back. The extra year offers both the potential to parse the work effort more effectively so that we can reduce the use of costly external resources previously required by a very tight timeframe, as well as an opportunity for more thorough testing, which, given the industry's collective experience with 5010, is very advisable.

Given the anticipated implementation costs, many still question the value of the transition to ICD-10, but researchers generally — and epidemiological, disease management and outcomes researchers specifically — tend to see the value in the more granular code sets.

(For those suffering insomnia and interested in multiple view points regarding the value of ICD-10, I recommend reading the RAND Corp's Technical Report on The Cost and Benefits of Moving to the ICD-10 Code Sets, Milliman's ICD-10 Savings: Who Will Be the Winners and Chute et al's There Are Important Reasons For Delaying Implementation Of The New ICD-10 Coding System).

The additional granularity of ICD-10 offers great potential to advance epidemiological and outcomes injury and trauma research by enabling the classification of the nature and location of injuries, their cause and treatment. There are plenty of examples in the literature, but one that is dear to those of us in children's health is the improved ability to capture incidents of suspected domestic violence and child abuse (see Cohn et al's A comparison of ICD-10-CM and ICD-9-CM for Capturing Domestic Violence). Of course, the value will be dependent on the quality of the data captured upfront, which emphasizes the importance improving clinical documentation. Efforts along that front must be tied into an organization's overall ICD-10 strategy.

Interestingly enough, when surveyed about their preparation for the transition to the new code set, individual researchers don't seem to be worried. Many assume that central repositories will be converted/cross-walked, making it all transparent to them. Others work on shorter-term projects and expect some semblance of a clean-cut transition a la "finish Project A using ICD-9 and start Project B using ICD-10." Some just don't want what might be perceived as "corporate IT" messing with their data; and still others have paid no attention and believe this is someone else's problem altogether and that it will not affect them.

One organization's experience after a not-too-successful pass at a survey to inventory departmental and investigator-owned research datasets and applications containing diagnostic and procedure codes has led the project leadership to attempt, as a next step, the use of automated discovery tools to alert the owners of the data sets that they might be sitting on a data analysis challenge. This effort might have the added benefit of accelerating conversations about data stewardship and data governance with the research community, and promises to be both interesting and enlightening.

My guess is that health care organizations with sizeable research programs will benefit from the extra year to ensure their research outfits are as well prepared as their clinical and billing operations.

Albert Oriol is chief information officer at Rady Children's Hospital San Diego. He's a regular contributor to H&HN Daily's ICD-10 series.