By Jason Miller
Executive Editor
Federal News Radio

Every hospital and medical facility that does business with the Center for Medicaid and Medicare services must begin using new diagnosis codes by the end of fiscal 2013. This group includes the Department of Health and Human Service’s Indian Health Service (IHS).

Howard Hays, the acting IHS chief information officer and director of the office of information technology, said the move to version 10 of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) is the agency’s the most important short-term priority.

“This is a huge transition that requires updating most of our electronic information systems—both the clinical and business office applications–as well as training across the country for clinicians, billers and coders who need to become aware of knowledgeable in the new coding system,” Hays said.

ICD-10 is the code set used to describe health diagnosis and conditions anytime a provider sees a patient. The U.S. has been using version 9 for the last few decades, while the rest of the world transitioned to ICD-10. The Centers for Medicare and Medicaid set a 2013 deadline for all entities that bill Medicaid and Medicare for services to use ICD-10.

“It’s a huge effort because the ICD-10 code set is conceptually quite different than ICD-9. There is an order of magnitude more codes on ICD-10 side and there is a lot more granularity to the codes so clinicians have to know how to document in a way that the coders can select the right codes from the documentation so the bills will be accurate, not be rejected and will be paid,” he said. “It’s a transition that involves both information systems as well business practices throughout any health care enterprise.”

Hays said IHS will have to modify the data tables to use the new code-sets and account for the increased number of codes. The agency also will have to develop new programming interfaces for applications that pull information from the databases.

IHS will have some help in transitioning to the new code set. Hays said many of the agency’s systems are similar to those the Veterans Affairs Department’s VISTA system.

“We are working closely with the VA on this process,” he said. “We are making sure our decisions are consistent with one another. The fact that the VA is working on this will help us a lot in simplifying the amount of programming that will need to be done.”

The health service borrows heavily from VA’s VistA system for its Resource and Patient Management System (RPMS)—IHS’s electronic health records system.

“I’m confident we will be able to do it,” Hays said. “We have a good understanding of where we need to go. It’s just getting the work done, getting the testing done and getting the updates released to the field in a timely way for them to be trained and begin using them by October 2013.

Hays said most of the development work will take place in 2012 and testing and release management in first part of 2013 so there is plenty of time for field training.

Along with the move to ICD-10, Hays said IHS is working closely with VA, the Defense Department and the Department of Health and Human Services on interoperability of health IT systems.

Hays said the RPMS is the first government system to meet the definition of meaningful use under Stage 1 as set by HHS. HHS states on its website that meaningful use must “show [providers are] using certified EHR technology in ways that can be measured significantly in quality and in quantity.” Under Stage 1, providers must meet 20 of 25 core objectives such as maintaining an active medication list electronically, recording all demographic information, recording all vital health information and many others.

IHS also is working with DoD, the Coast Guard and tribal nations on telemedicine. Hays said about 300 communities in Alaska benefit from telehealth technologies.

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