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Is ICD-10 a Quality Initiative?

August 27, 2010
by David Raths
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Innovators Will Use ICD-10 to Further Their Business Models and Clinical Capabilities


As health providers prepare to make the transition to ICD-10 and HIPAA 5010, they are taking a hard look at who, within their organizations, will lead the efforts. Whoever takes the lead will be deciding on a key question: Will the transition be an opportunity for quality improvement?

An interesting paradox surrounds the efforts to motivate hospitals and physician practices to get moving on the transition to HIPAA 5010 and ICD-10 codes. Much like the period before the Y2K conversion or HIPAA's introduction, analysts and consultants have largely succeeded in convincing providers of the magnitude of the challenge. Yet despite this heightened awareness, very few organizations have made progress on ICD-10, and some CIOs are getting nervous about it.

“We started this process more than a year ago, and we are not nearly as far along as I thought we would be,” says Bill Spooner, CIO of San Diego, Calif.-based Sharp HealthCare, a five-campus, 2,000-bed system.


Most people who work in health IT don't need another primer on the specifics of the challenge. Healthcare Informatics published one just last December under the headline “Wait at Your Own Risk.”

Bill Spooner
Bill Spooner

CIOs know that ICD-10 coding, a federal requirement by Oct. 1, 2013, will allow for far greater detail in classifying diseases by increasing the 17,000 codes in ICD-9 to 155,000. The transition has the potential to improve disease management efforts and quality data reporting.

Health IT and finance executives also recognize that the switch will require investments in training, changes to legacy systems, and testing with partners, vendors and payers. In addition, it will necessitate a technological “crosswalk” between ICD-9 and the new ICD-10 codes to ensure system compatibility during the transition timeframe.

The real questions now involve who within the organization will lead the effort, and will it be seen in the context of an innovative quality improvement program or treated as a matter of regulatory compliance only. What are teams that got started early working on now?

Sharp's ICD-10 team has 10 members led by an IT project manager, with the chief financial officer of one of Sharp's hospitals as an executive sponsor. “My team is facilitating it, so I guess we are taking the ball on this,” Spooner says, “but we haven't turned up the fire on it yet.”

The first thing the Sharp ICD-10 team did was try to create an inventory of the type of employee training that will be necessary and a survey of its business partners. “Our main software vendors seem on top of it, and could give us specifics about their roll-out plan,” Spooner says, “but some small vendors seem less prepared. And the answers from health plans were less than satisfying,” he adds. “Some are changing their software, while others are doing some kind of tricky software plan to convert the codes back to ICD-9, which may undermine the whole purpose.”

Sharp is in the minority in having its CIO's office taking charge of the effort. A February 2010 survey of 37 healthcare executives by Falls Church, Va.-based consulting firm Noblis found that CFOs are leading 52 percent of project teams while CIOs are leading 15 percent.

Getting Ready for ICD-10

Who has responsibility for ICD-10 in your organization?

Source: February 2010 Noblis Insights Panel survey of 37 healthcare executives.
Source: February 2010 Noblis Insights Panel survey of 37 healthcare executives.

Mary Anne Leach
Mary Anne Leach