Five trends that will shape ICD-10 implementation in 2012

Carl Natale
by Carl Natale

I hate making predictions. Especially when they're about the future.

But since I listed the top stories of 2011 and how they affected ICD-10 implementation, I need to explain their implications in 2012.

First, I'm sticking to the world of healthcare. These are two, easy predictions to make. Next comes three predictions from fields outside of healthcare. They explain how events and non-healthcare professionals are going to impact how we work with ICD-10 coding and healthcare in general.

Here are five trends that will affect how the ICD-10 transition will progress:

ICD-10 is the new stimulus

More healthcare information technology (HIT) vendors will offer ICD-10 compliant upgrades and products. It's easy to see an increase in the systems that not only accept the new codes but attempt to make documentation, medical coding and workflow easier and more efficient. Big money will be on the line here.

Also look for more medical coders to get ICD-10 training and certification. They will become trainers and consultants who will help healthcare organizations through their ICD-10 transitions. Of course that will create more demand (on top of the increased demand) for medical coders to replace them. Which means they will have someone to train. It's going to be a strong job creator.

HIPAA 5010 becomes the new Canada

Canada's transition to ICD-10-CA is seen as a test case for what we can expect to happen in the United States. Of course the systems are different. But there were enough mistakes made that we can use as teachable moments.

The same with HIPAA 5010 implementation. We will find out next month how the healthcare industry can handle new mandates. Costs will be tallied and mistakes will be discussed for a year-long post mortem. Those observations will be used as lessons to refine ICD-10 implementation plans.

How things go could add pressure on the Centers for Medicare and Medicaid  Services (CMS) to create a grace period or soften the Oct. 1, 2013, deadline someway.

Personally, I will write at least three columns about what we learned from HIPAA 5010 that can help implement ICD-10 coding.

What happens in Washington, stays in chaos

There is a perfect storm brewing politically:

I don't think you will see a Republican nominee for president promising to kill ICD-10 implementation. It's too boring of a subject to debate. I don't even think it's going to be a question in Tavenner's confirmation hearings.

But if Republicans get a chance to change ObamaCare, a repeal of ICD-10 legislation might be slipped in there. It doesn't matter that ICD-10 codes aren't a part of Obama's healthcare reform. Congress could put anything in new legislation. And that's where the lobbying efforts of the AMA could pay off.

Or ICD-10 could become a bargaining chip in Tavenner's nomination process. The administration may agree to delay enforcement if hearings don't go well or Congress threatens funding cuts. It

But ICD-10 coding is being positioned as a tool for cutting healthcare costs (after the initial investment) and fraud. That's an idea that appeals to Republicans as long as no one associates it with healthcare rationing.

ICD-10 proponents are going to have to get better at simplifying and humanizing their arguments. "Granularity!" makes a lousy rallying cry.

So I'm going to weasel out of an actual prediction of whether ICD-10 coding will survive this year. (Although I give it a good chance of making it.) But there will be a fight that will take a lot of energy and money.

'Siri, what's the ICD-10 code for a sprained ankle?'

HIT vendors have been working on natural language processing (NLP) for years. It can help turn clinicians' dictation into electronic health records (EHRs) that help medical coders be more productive and help physicians improve patient care.

Apple's Siri feature in the iPhone 4S shows it has been working on NLP also. Add Google to the list. It's been working on NLP too. Expect an Android version of Siri to hit smartphones this year.

While asking your phone for a weather report or directions to the nearest deli are far cries from diagnosing a patient, the technology will take a giant leap in accuracy and use this year. So don't be surprised when doctors ask for the same features in their EHRs that they have in their iPhones.

HIT vendors to learn about disruptive innovation the hard way

If you think I'm nuts for comparing the iPhone to EHR systems with NLP, wait until you read this story about two teenagers who rigged a Microsoft Xbox Kinect to diagnose a person's gait. Cassie Cain explains to NPR what they programmed an Xbox - the same game console you can buy at Walmart - to do:

"So, for our project, because we were interested in the way that people are walking, so we tracked the hip, the knee and the ankle and, just by tracking those three points, we were able to find the knee angle, which is really useful for therapists and clinicians and prosthetists when not only fitting prosthetics, but also helping people with therapy and rehabilitation."

The high school students also said there are stereo cameras costing about $2,000 that are used in medical practices. Maybe this Xbox hack is inadequate compared to what's being used in healthcare but I bet it's close to being comparable. And if these kids got this far, it won't take long for engineers to get there.

This is just an example of how amazing the technology is in our homes. Combine that with my NLP/Siri prediction, and you have the stage set for a new breed of HIT products that are less expensive and more available. There will be concerns and debates over safety and reliability. But the new products will be good enough to do the job safely. If not, they will be good enough to force a traditional HIT vendor or two to adapt their products and pricing.

It's called disruptive innovation. If you're a HIT vendor, you're not going to like it. And you're going to have a lot of good reasons why it won't work. But in the end, it's going to be the doctors - the same ones complaining about the costs of ICD-10 transition - that decide whether it works or not.