Ask Not What ICD-10 Can Do For Healthcare, Ask What Healthcare Can Do With SNOMED and ICD-11
Health IT-related patient safety risks should inspire Congress to create a national patient safety board

It is time for the U.S. to begin implementing health IT smartly

From a national policy perspective, ICD-11 is not found anywhere on the U.S. dial.   Not even a preliminary roadmap to ICD-11 has been proposed.   I believe this to be a serious risk to our nation’s health IT planning efforts, and this risk has been inherent to U.S. health IT planning for decades.   The recent ICD-10 delay magnifies this strategic flaw.   It is time for CMS to take a deep breath, re-evaluate our national strategy, address the unmitigated strategic risks and determine whether any mid-course corrections are needed before deciding on the new ICD-10 implementation date.  It is time for the U.S. to begin implementing health IT smartly.  

What I see right now is the U.S. planning to achieve a short-term tactical goal of getting off antiquated ICD-9 while the rest of the world is focusing on the long-term strategic goal of developing and adopting the new-century ICD-11.   Unless we take action now, we are destined to be in the same predicament in the 2020s when we will be struggling to get off of last century’s ICD-10.   

But the stakes will be much higher in the 2020s.  

Most physicians and hospitals will be using EHRs, health information exchange will be flourishing, SNOMED-CT will be the common vocabulary used by clinicians and big data analysis will be... well, big.  We will be stuck, though, with an ICD-10 taxonomy that was developed before the Internet came into common use.   We will be clamoring for ICD-11 because it was developed in alignment with SNOMED and for other reasons I and others have previously described.  Delays will likely be encountered.  And we will probably be amnesic about how we got into such a predicament.  

To avoid this we need a U.S. roadmap to ICD-11 before deciding when to implement ICD-10.   We need to determine our long-term goals and then align our short-term tactical plans to those goals.   What if ICD-10 is delayed another year?   Would it then be time to leapfrog to ICD-11?    What if the delay is 2 years?   How about 3 years?   Or maybe to meet our long-term goals it is actually time to leapfrog now.   But without establishing long-term goals and developing a proposed roadmap to ICD-11,  we cannot really make an informed decision. 

Yes, we have to get off ICD-9, but not at any and all costs.   I want the U.S. to change health IT planning efforts from one that risks derailment from ostrich-style decisions to one that smartly develops long-term strategic goals and aligns them to tactical plans.  I want us to be a country that leads the world in the use of health IT to improve quality of care and one that smartly plans to optimize health IT use each decade.




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