CIOs see vendor compliance as hurdle to successful ICD-10 conversion

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A majority of healthcare IT executives report they have not heard from IT vendors about plans to comply with the new ICD-10 code sets, and the related updated X12 standard, Version 5010 and NCPDP D.0 for HIPAA-related transaction standards, according to a recent survey of hospital chief information officers (CIOs), conducted by the College of Healthcare Information Management Executives (CHIME).

The survey also found that many respondents are concerned about the amount of time that they will have to test transactions with business partners and how those tests will be paid for. In August 2008, the Department of Health and Human Services (HHS) proposed regulations that would set an April 1, 2010, deadline for using the 5010 transaction sets, and an October 1, 2011, deadline for using the new ICD-10 codes.

CIOs said that the proposed changes will enable more accurate coding for patients’ diagnoses, improving the accuracy of reimbursement and providing other benefits to the industry, including improved patient care. At the same time, CIOs are concerned their organizations will be rushed into preparing for this transition, the survey revealed.

“The implementation date for the 5010 code set will come due in about a year, and the scheduled implementation date for the ICD-10 will be here before we know it,” said Gretchen Tegethoff, CIO of George Washington University Hospital in Washington, D.C., and co-chair of CHIME’s Advocacy Leadership Team. “The greater the rush to implement, the greater the cost, and the industry is already under financial pressure because of the current economic crisis.”

CHIME said it is uncertain whether HHS will stick to the deadlines, as some industry trade groups have asked for longer timelines to enable full testing and training in the new code sets.

Some 72 hospital CIOs responded to the CHIME survey in November 2008. Of those, 60 percent said their healthcare IT vendors had not alerted them to the proposed new regulations and timelines for ICD-10/5010 implementations.

The survey also found that CIOs are unaware whether ICD-10 upgrades from vendors will cost them additional money. Approximately 72 percent of CIOs said they did not know if their vendors would include ICD-10 in annual software upgrades, and 53 percent of CIOs were unaware if the changes would be covered by “federal and state” clauses in their contracts, which generally leave vendors responsible for government-related software updates.

About 55 percent of CIOs surveyed said that they expected that vendor readiness and cooperation would be one of the top hurdles in achieving compliance with the new code and transaction sets. Second on the list was short- and long-term budgeting for the transition, mentioned by 45 percent of respondents.

Many CIOs said that their operating budgets for 2009 already are set, and any work required to transition to the new codes will have to come out of previously budgeted spending.

CIOs said other significant hurdles in making the transition would be the impact on the organization’s staff and provider communities (42 percent) and the need to implement education and awareness programs (35 percent).

Survey respondents said their immediate short-term action steps for implementing ICD-10/5010 include coordinating and communicating with all necessary vendors (51 percent); establishing an interdisciplinary or interdepartmental task force to develop a plan of action 41 percent); and developing educational or awareness programs (35 percent). Other actions planned by CIOs include estimating work force staffing and training required for the conversion; identifying crosswalks between the current ICD-9-CM system and ICD-10; cataloging quality reporting initiatives; and identifying testing mechanisms.