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1. Electronic Health Records
and ICD-10 Status Update
Richard Gartee
© Richard Gartee, 2012 - All Rights Reserved

2. ICD-10
• Scheduled for October 2013
• Postponed to October 2014
• Perhaps later…

3. US Department of Health and Human Services
• “The change in the compliance date is intended to give covered
healthcare providers and other covered entities more time to
prepare and fully test their systems to ensure a smooth and
coordinated transition by all covered entities.”

4. Might ICD-10 be delayed further?
• Problem is not just coders, computer systems must change.
o Outdated claim systems are programmed specifically for ICD-9-CM.
• After Oct. 1, 2014, medical practices will still use CPT (not ICD-10-
PCS) to code for physician services in their offices.
• Precedent of HIPAA Implementation Delays.
o HIPAA was made law in 1996.
o Was not implemented until 2001.
o Transactions and Uniform identifiers were phased in even later.
o Two transactions and a uniform identifier still pending 16 years later.

5. Background
• Health Information
Technology for Economic and
Clinical Health (HITECH) Act.
• Law to promote widespread
adoption of EHR in 10 year
timeframe.

6. Office of National Coordinator (ONC)
for Health Information Technology
• ONC created framework for strategic action.
• CMS specified objectives and clinical quality measures to determine
meaningful use.
• To qualify:
• Eligible health care providers must adopt and meaningfully use a
“certified” EHR.
• Meaningful use requirements ensure EHR is actually used.

7. Providers that use a
certified EHR prior to
2015 are eligible for
incentives.
After 2015, Medicare
will begin to administer
financial penalties for
non-EHR providers.

8. Results
More than 120,000 eligible health care
professionals and more than 3,300
hospitals have qualified to participate in the
HITECH program and receive incentive
payments since it began in January 2011.
US Department of Health and Human Services
August 23, 2012

9. Stage 1
• Stage 1 meaningful use requirements include core group of
requirements that must be met (see Chapter 1 of textbook.)
• For Eligible Professionals (EPs), there are a total of 25 meaningful
use objectives.
• For Hospitals, there are a total of 24 meaningful use objectives.

10. Stage 2 Goals
• More coordination of care
• Reduced medical errors
• Eliminate duplicate screenings
and tests
• Greater patient engagement in
their own care

11. Stage 2
• Stage 2 seeks to expand the meaningful use of certified EHR
technology.
• Increases health information exchange between providers.
• Promotes patient engagement by giving patients secure online
access to their health information.
• Stage 2 requirements begin in 2014 (instead of 2013.)

12. Timeline
Stage 3
Stage 1 Stage 2
2016-
2011-2013 2014-2015
beyond
Stage 1 Stage 2 Stage 3
In effect today Rules issued Rules TBD

13. Stage 2
• Stage 2 includes most Stage 1 core objectives except two that were
changed:
• A more robust “transitions of care” replaces “exchange of key clinical
information.”
• “Provide patients with an electronic copy of their health
information” was replaced by the core objective “electronic/online
access.”

14. Patient Engagement
• Adds two new objectives:
o Providing patients online access to health information.
o Secure messaging between patient and provider.
• Access to clinical information electronically promotes patient
engagement.
• Requires patients to take specific actions in order for a provider to
achieve meaningful use.
o At least 5% of patients must participate to qualify provider.

15. Electronic Exchange of Summary of Care Documents
• To spur provider commitment to electronic exchange:
o Provider must send a summary of care record for more than 50%
of transitions of care and referrals.
• More than 10 percent of these must be electronically
transmitted.
• To foster electronic exchange outside established vendor and
organization networks:
o Requires at least one instance of exchange with a provider using
EHR technology designed by a different EHR vendor.

16. Increased Clinical Quality Measures Reporting
• Stage 2 Clinical Quality Measures (CQM) that must be reported:
• Eligible Providers increased from 6 to 9 (out of 64 measures.)
• Eligible Hospitals increased from 15 to 16 (out of 29 measures.)
• In addition, all providers must select from at least 3 of the following:
o Patient and Family Engagement.
o Patient Safety.
o Care Coordination.
o Population and Public Health.
o Efficient Use of Healthcare Resources.
o Clinical Processes/Effectiveness.

17. Changes to Reporting
• Allows physician groups to report meaningful use in a
batch, submiting information for all of their EPs in one
file.
• Allows hospital based EPs who own and support their
own EHR to qualify and receive incentive payments.
• Allows Children’s Hospitals (who do not bill Medicare) to
participate.

18. Looking Ahead
• Stage 1 continues through 2013.
• Stage 2 begins 2014.
• Stage 3 requirements will not be finalized
until later.
• Stage 3 will not go into effect before
2016.

19. Instructor Take-away
• Gartee EHR books are very up-to-date!
• Chapter 11 exercises on patient portal are 2 years ahead of Stage 2.
• Update to Instructor’s Resources section of the website listed inside
the cover of Gartee EHR books will include:
o Summary of CMS Stage 2 Final Rule (handout.)
o Additional PowerPoint for Chapter 1.
o Updated answer key for test question on ICD-10 implementation
date.