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.