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Dr. Halamka Riffs on ICD-10, Stages 2 and 3

May 13, 2014
by Gabriel Perna
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John Halamka, M.D., CIO of Beth Israel Deaconess Medical Center

The outspoken John Halamka, M.D. fired off a number of comments on the major policy issues affecting healthcare IT leaders, specifically meaningful use and ICD-10, at the iHT2 Health IT Summit in Boston. 

Halamka, the CIO of Beth Israel Deaconess Medical Center in Boston, shared some strong words against the ICD-10 delay in his keynote address at the event. He said that pretty much every hospital was ready for the transition and that the government probably could have gotten it over with. The delay of the ICD-10 transition was passed as part of congressional legislation in April, and the Centers for Medicare and Medicaid Services (CMS) is proposing that the new deadline be Oct. 1, 2015. 
In Massachusetts, Halamka said many are continuing on the path from before, as if the Oct. 1, 2014 date wasn't altered. He said these people plan on finishing end-to-end testing of ICD-10 in the interim and be as done as much as they could be with the coding transition until Oct. 1, 2015. 
Earlier in the keynote, Halamka focused on the 19 meaningful use Stage 3 proposed recommendations. In total, he said that of the 19, 80 percent of them have some sort of workflow, vendor burden, or standards readiness issue. Halamka went over each of the recommendations and examined some of the possible issues with each specific one. 
For the visit summary requirement, Halamka said that proposal states the information can only be actionable and relevant for patients. He noted that this was kind of hard to develop because the words "actionable" and "relevant" are hard to discern.
"I don't know about you, but I don't know what actionable and relevant means. How does CCHIT or other certification bodies assess whether it's actionable and relevant. You can't measure this stuff," Halamka said. 
In regards to the proposal that would connect EHRs with any arbitrary public health registry, Halamka said that with the way the proposal is currently worded, it would probably be impossible for providers to achieve the mandate. Instead, he recommended that the EHR could support one registry as proof of concept.
For the Stage 3 proposal that would connect the EHR with patient-generated data, Halamka says that generally he believes this type of information is useful and there are lots of reasons to gather it. However, he notes that standards and workflow still have to evolve. On Stage 3 secure messaging proposed requirements, Halamka pleaded with federal regulators to not prescribe workflow for provider organizations. 
This echoed one of his overall themes of the keynote. He said that he is trying to get the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) to not be overly specific in what technology providers must adopt. Instead, he would like them to focus more on outcomes. 
In the beginning of his speech, Halamka made some harrowing predictions for the Stage 2 attestation rate. He said that 80 percent of hospitals would fail to successfully attest to Stage 2 of meaningful use within the allotted time, and that there would be mass applications for hardship exemptions. He also predicted that many provider organizations would see the millions of dollars worth of investments, compared to the thousands of dollars the provider organizations get in stimulus incentives, and opt out of the program. 
"I love the program, love the ideas. It's too much, too soon," Halamka said.