Some Thoughts on X12 5010 and ICD-10

The ICD-10 code set has 200,000 codes, almost 10 times the 24,000 codes in the ICD-9 code set. Providers and payers will need to completely redesign their business processes and systems to handle these hundreds of thousands of new codes. Before the transition to ICD-10 can begin, industry must move to the next generation of HIPAA transactions (version 5010) because the current version (4010) will not work with ICD-10. Version 5010 is a major re-write of the HIPAA transaction standards, with more than 850 individual changes.

The Department of Health and Human Services recently proposed rules to implement 5010 by April 2010 and ICD-10 by October 2011. This may appear to be a staggered implementation of these daunting initiatives but in reality, it is not quite that easy. There is no debate as to whether or not 5010 must be implemented prior to conversion to ICD-10 as the expanded diagnosis codes cannot be worked into the standard HIPAA transactions until the appropriate fields have been expanded. The question becomes, is 18 months enough time to have the standard transactions modified, tested, and implemented prior to moving to the enhanced code set? Many think that the timeline is not realistic.

Preparing for 5010 and ICD-10 can hardly be classified under regular system maintenance and operations. Carrying the hefty estimated price tag of $10-20 million, preparing for these changes really falls into to the category of major system modification. As such, many States will be asking for contracted help to perform this work. The feds have hinted that they will pay enhanced (90%) funding for the 5010/ICD-10 work; qualifying for this funding will require an APD and then either a contract modification or an RFP. If a State were to begin today by writing and submitting a planning APD to explain to the feds their approach and plans for 5010/ICD-10 compliance, it would likely be a full year before the final implementation APD and contract mod were approved. If an RFP is involved, add 6-8 months for the award process. On this schedule, work would not even begin until late 2009/early 2010, hardly in time to meet the first deadline of April 2010.

The National Committee for Vital and Health Statistics--an advisory body to HHS—made a recommendation to implement HIPAA 5010 first followed by ICD-10. If the NCVHS process were followed and started now, the soonest ICD-10 could be completed is late 2013, this seems like a more realistic timeframe.

Another consideration is the provider side of the equation. A key lesson learned from HIPAA is that provider education and outreach is critical to ensure providers are aware of the changes that must be made and adequate time is given to make those changes. Providers are looking at a vastly expanded set of options for assigning diagnosis codes. This means that they all must be trained in the awareness and use of the codes and many practice management systems will need to be enhanced, or likely replaced in order to comply with use of the expanded codes. Will this occur on schedule currently presented for payer system compliance? Probably not. The enhancements for 5010 and ICD-10 are not “backward compatible” and so we are looking at the potential for crippling claims backlogs, inaccurate and delayed payments, and an inability to detect fraud and abuse. Is the accelerated timeline worth all of this?

The MITA community needs to give some serious thought into how MITA fits with these two initiatives. How can resources be integrated in such a way that states are moving toward both HIPAA II and MITA compliance in a combined effort? Can MITA business services at level three maturity be built as 5010/ICD-10 compliant? It doesn’t seem practical to keep MITA and HIPAA II as separate activities; there must be a way to kill two birds with one stone here.

Thoughts?

HL7 MITA Project Pics Added

Click on the slide show at the top of the MITA Matters homepage to see a few pictures of the HL7 MITA Project group during a meeting at MMIS 2008 in Nashville. Sent by a friend of the blog, thanks!

MITA Governance Update

I have it on good authority that Chairpersons have been selected for both the MITA Technical Architecture Review Boards (TARB) and MITA Information Architecture Review Board (IARB). This is good news because these boards are one the critical path to establishing a fully-fledged MITA repository, populated with approved artifacts from each of the three architectures.

Among the TARB’s initial tasks will be a review of the Technical Function Templates that are being completed by the MITA Technical Architecture Committee (TAC). The IARB first official act is likely to be a review of the HL7 MITA Project’s MITA Development Methodology document. It will be interesting to see where these documents are posted once they are approved. I have not heard anything regarding an update to CMS plans for a new repository site. Currently, approved MITA Business Architecture documents can be found here: http://hl7projects.hl7.nscee.edu/docman/?group_id=40.

HL7 MITA Project Meeting Announcement

The HL7 MITA Project will be holding a teleconference meeting tomorrow aftern0on from 2:30 pm - 4:00 pm EDT. Anyone with an interest in the MITA Information Architecture is welcome to attend the meeting. This group meets every Thursday afternoon.

Meeting Title: HL7 MITA Project

Date & Time: Weekly, Thursday
11:30 PT, 12:30 Mtn, 1:30 CT, 2:30 ET

Join Link: https://ahcccs.ilinc.com/join/kfrxpt
Dial In Number: 770-657-9270
Participant PIN: 451256

Meeting Agenda:

1. Call to order

2. Establish/determine minute taker

3. Review Agenda

4. Approve call minutes for 09/04/2008

5. Working Group Updates/Changes
Ø Introduce Roger Todd, our MITA Project, Project Manager
Ø Discuss sub-workgroups

6. HL7 V3 Ballot Reconciliation
http://www.hl7.org/v3ballot/html/welcome/environment/index.htm
See screen print following agenda for additional reference

6. Review Deliverables for next call
Internal Updates and Com
Respond to Provider
Circle back, final check on all sub-phases

7. Agenda for next call, October 09, 2008

NHIN Goes Live, Sort Of

The emerging Nationwide Health Information Network (NHIN) was put through its paces today as live operations were demonstrated before a large audience at the Health and Human Services Department and via a Webcast.

The demonstration involved records created for the test but stored in actual health systems. The exercise showed that a health care provider could easily use a Web browser to obtain basic records on a patient stored by another health care system.

“I think you have to admit that this is really cool,” said one of the participants, Dr. Robert White of the New Mexico Health Information Collaborative. “This is kind of like having a magic decoder ring in health care.” …

... Using a variety of Web interfaces and authentication schemes, representatives of more than a dozen health care organizations showed how they could locate a record, retrieve it, and view important information such as the patient’s medications, diagnoses, allergies, laboratory test results and recent treatments.

Find the full article here: http://www.govhealthit.com/online/news/350589-1.html?GHITNL=yes

Creationism and Coffee

In the beginning God created coffee,

And God tasted the coffee, and it was good.

Thus began the second day…

Okay, perhaps not exactly Biblical in proportion, but a damned necessary evil in my book. I stayed up waaaay past my bed time last night to watch my beloved Ravens lose to their arch-rivals, the Steelers, 23-20 in an overtime nail biter. Now, I am left to pick up the pieces of my shattered dreams and this steaming hot cup of Columbian black gold, my Medellin Mistress, is the only comfort I have. As I ponder the thought of work today on the morning after the night before, I am convinced that God did indeed create coffee. There is no way that the Supreme Being toiled endlessly and creatively for six days without a few cups of joe.

If there was no coffee, the World would have never been created; it’s as simple as that. In fact, Pope Clement VIII officially baptized coffee in the late 1500's in recognition of its divine powers. The centuries that followed this frequently overlooked event have brought us wonderful discoveries and technological advances. The same human race that needed thousands of years to invent the wheel has laid the foundation for all the modern sciences in a matter of a few hundred years. Isaac Newton developed the basis of modern Calculus and the Law of Gravity in the 1660's - exactly around the time coffee became widespread in England - coincidence my friends? I think not!

And so it is back to the arms my Caffeine Countess I go and then on to face the big scary world of Medicaid IT!

One Stop Provider Enrollment

Received word that the PECOS One-Stop-Shop Medicare & Medicaid Provider Enrollment Discussion Board is being shut down effective 9/29/2008.

It sounds like the concept of the One Stop Shop is being revisited and perhaps even re-designed. I do not have stats on how many states were participating in the discussion board but I know that there was limited interest in participating in the solution as it was presented at the two workshops earlier this year. It would be great if MITA could be more of a consideration in the solution going forward. Anyone with more information on where OSS is headed please feel free to comment.

State Alliance for eHealth

The State Alliance for eHealth, co-chaired by the governors of Tennessee and Vermont and sponsored by the National Governor’s Association (NGA), has released their first annual report and recommendations on Medicaid and e-Health. The State Alliance is supported by an advisory committee composed of representatives from both the public and private sectors who provide technical expertise on critical issues related to electronic HIE.

The report is broken down into 4 sections: An Executive Summary, Challenges to the Exchange of Electronic Health Information, Recommendations from the Alliance, and a Conclusion. Here are the six recommendations found in the report to help States further the adoption and use of HIT and electronic HIE:

1. Provide leadership and support for e-health efforts in each state;
2. Address privacy and security;
3. Promote the use of standards-based, interoperable technology; (MITA)
4. Streamline the licensure process to enable cross-state e-health;
5. Engage consumers to use HIT in managing their health and health care; and
6. Develop workforce capacity to support electronic HIE efforts.

On page 42 of the report, The Alliance recommends that states (governors) provide Medicaid with the technical resources necessary to implement MITA and related HIT/HIE activities. This report is a good read if you have 20 minutes or so. The full report can be found here:

http://www.nga.org/Files/pdf/0809EHEALTHREPORT.PDF

Reflections on 2008 MMIS

Hats off to NESCO and the group of MMIS 2008 Conference volunteers - (the “blue shirts”) that acted as registrars, porters, tour guides, nurses, dance instructors, and presentation aides-de-camp - these good folks put on an excellent MMIS conference in Nashville this year!

Over 870 people attended the conference this year, which took place at the Gaylord Opryland Resort just outside of the city of Nashville. The facility was cavernous, covering something along the lines of 90 acres, much of that enclosed under a big glass bubble. The resort itself was a bit eclectic in its design, looking and feeling as if Salvador Dali had taken the Jungle Cruise from Disney World, Bourbon Street from New Orleans, and the set of Gone with the Wind and connected them all together (sort of) with winding and distorted passageways. It was actually a nice location, just a bit difficult to navigate at times. After saying farewell to the sun before descending below 10,000 feet on Sunday afternoon on the approach to Nashville, I did not see the big orange ball again until sometime on Tuesday evening. I overheard one of the Gaylord employees making reference to someone as a “bubble rat”; by Thursday afternoon, I felt that I fit the bill.

Back to the conference – it was terrific! There were over 40 breakout sessions, excluding the vendor tracks, that spanned MITA, new technologies, MMIS operations and HIT/HIE plus a couple of good plenary sessions. I found the MITA sessions that I attended to be relatively superficial but helpful just the same. I also “hopped” (new conference term) a few of the new technology and HIE sessions; these I found to be very informative and very interesting. **Mikey Tip: One should not attend these conferences with the primary intent of getting information from the breakouts sessions; the breakout sessions are good, but not really the major reason for attending in my opinion. Rather, attend the MMIS conference to meet and network with others in our industry - so many smart people in one place at the same time, you need to take advantage of that opportunity!

Some highlights for me included the PSTG TAC session (as I was not aware of just how much progress is being made on the MITA Technical Architecture), the panel of States that related their MITA SS-A experiences, hearing about the progress that is being made by the HL7 MITA project team, and the demos of various HIE and EHR products being either under development or available for use.

I thought that the meals were good and discovered again that breakfast and lunch provide great opportunities to meet and chat with others. This was probably when I spent the most time talking with folks from State Medicaid Agencies. Again, smart and competent – having the opportunity to share experiences and information with folks in similar situations across the fruited plain is one of the biggest benefits to attending this event.

I thought that the vendor area was well organized and the participating vendors were, for the most part, professional and courteous. This is the first year that I managed to visit every vendor booth and I can say that it was well worth the time. It occurred to me that for years I have viewed vendors as either cunning competitors or shady salespersons, never stopping to think that they could actually be real people with real families, interesting backgrounds and yes, feelings! I think I made a few new friends this year by shedding the burden of that stereotype and actually engaging in some real conversations. Perhaps another tip for attendees next year, don’t be afraid to dig a little below the surface, you will probably be pleasantly surprised.

With each succeeding year that I attend this conference, I get more of a feeling that although we come from private sector, state government, federal government, wherever – we are more of a community than exists in most other industries; I was actually a little sad boarding the bus on Thursday afternoon and leaving my Medicaid family. Thanks again to Nancy and her crew and to all of the vendors and presenters, this conference was well worth the price of admission.

Okay, enough of the gushy stuff – I’m going to watch a Chuck Norris movie now and crush a few beer cans on my head…Egad man, I’m going softy in my old age…

Well, Maybe This Time....

We're back....again

Rusty, dusty, out of blogging practice but willing to try once again to open up a dialogue within the MITA community.

Last year at this time, the MITA Matters blog was averaging around 100 visitors per day but only one or two comments a week = lame. There is lots of good MITA stuff happening about which to blog, but Mikey needs to feel the love :-)

Open for business - ideas for post topics welcomed...questions encouraged...email or comment here.

We're back

After a long sabatical, Mikey is back and MITA blogging once again and I have news from friends at the HL7 work group meeting in San Antonio.

The good news is that it looks like the MITA Information Architecture is going to get a well-needed boost from the newly-formed HL7 MITA Project work group!

Day one at the work group meeting was spent getting oriented with the HL7 process and procedures and members of the group getting to know each other. The HL7 MITA project is a step child of the HL7 Financial Management (FM) group and they have provided solid support for the HL7 MITA Project team.

The HL7 MITA Project is a nice mix of State folks and representatives from the vendor community and CMS even sent a few government types down there to make sure that the project team didn't have too much fun. Day 2 was spent learning about the relationship of HL7 to MITA and a discussion about how MITA will benefit from the work that has already been done within HL7 in terms of the Reference Information Model (RIM).

The emphasis of day three was on business cases, the RIM and how to model MITA business services. Tomorrow, day 4 will be focused on planning and how work on the MITA Information Model will progress over the next 3 months. Some good websites to check out, related to today's activities include the following:

http://hl7projects.hl7.nscee.edu/projects/mita/

http://mita.wikispaces.com/

The takeaway so far from this work group meeting seems to be that there are many very smart people who believe strongly in the concept of interoperability and are willing to graciously lend thier time and talent to the MITA effort. If you think that MITA is a fad or a flash in the pan, perhaps you should think again...