Health IT Certification: Implementing ICD-10 and SNOMED-CT in the United States

Transcription

1 Certification Commission for Healthcare Information Technology Health IT Certification: Implementing ICD-10 and SNOMED-CT in the United States Alisa Ray, Executive Director, CCHIT FPS-Health, Food Chain Safety and Environment ProRec-BE June 18, 2009 Brussels, Belgium

2 Topics Background of US certification Status of ICD-10 and SNOMED-CT in US Impact of certification in US 2009 Slide 2 June 18, 2009

3 Background

4 Mission and Goals Mission: Accelerate the adoption of robust, interoperable health IT by creating an efficient, credible certification process. Goals: Reduce the risks of investing in health IT Facilitate interoperability of health IT Unlock adoption incentives and regulatory relief Protect the privacy of health information 2009 Slide 4 June 18, 2009

5 Historical Milestones Sept 2004 CCHIT founded by AHIMA, HIMSS, NAHIT June 2005 Eight more organizations contribute funding Oct 2005 Awarded 3-year $7.5M HHS/ONC contract May 2006 Ambulatory EHR certification launched Oct 2006 Federal recognition as Certifying Body Jan 2007 CCHIT becomes independent, nonprofit organization Aug 2007 Inpatient EHR certification launched July - Oct 2008 HIE certification launched; began expansion to new populations and medical specialties and care settings Feb 2009 American Recovery and Reinvestment Act (ARRA) 2009 Slide 5 June 18, 2009

6 What Lies Ahead for CCHIT? ARRA/HITECH offers up to $34B in Medicare/Medicaid incentives Incentives keyed to meaningful use of certified EHR technology The Federal health IT focus has now shifted away from process and toward outcomes Certification will change significantly to align with this new focus 2009 Slide 6 June 18, 2009

7 Certification Commission for Healthcare Information Technology Status of ICD-10 and SNOMED-CT

8 Current Status in the US of ICD-10 and SNOMED-CT Few US providers use SNOMED on a regular basis, therefore few US EHR vendors support it ICD-10 implementation is not required in US until 2013 Will it be delayed again? New, X is a prerequisite administrative transaction under the American Recovery and Reinvestment Act (ARRA) Business case for change is not urgent; providers are early on the adoption curve Significant amount of work to implement ICD-10 Not just on IT side Workforce training and operations impact is substantial 2009 Slide 8 June 18, 2009

9 Interoperability Roadmap: How fast should CCHIT go? Patient Summary Transport Medications & Allergies Problem List CCD XDS RXNORM, UNI SNOMED Must Balance Impact on provider workflow Data required for interoperability Burden to vendors Proposed for 2010: Structured SNOMED-CT encoded problem list mapped to ICD9-CM 2009 Slide 9 June 18, 2009

10 Challenges Presented to CCHIT Will this require double entry of both ICD9-CM diagnosis and SNOMED problems on system screens? Solved not in the user interface, rather map unique concepts behind the scenes Is this feasible? Some are doing it with a subset now US Veterans Administration/Kaiser Permanente problem subset is 3,000, representing 90% of problems used by most physicians daily; endorsed by Health Information Technology Standards Panel 2009 Slide 10 June 18, 2009

11 Challenges Presented to CCHIT Won t this require an expensive lexicon intermediary? Government has a role: National Library of Medicine funding could make one SNOMED/ICD encoded problem list Distribute as Open Source Why not just wait for ICD-10 in 2013? Implementing both ICD-10 and SNOMED CT simultaneously won t be easier ICD-9 is not granular enough; we can implement better problem lists and enhance interoperability now 2009 Slide 11 June 18, 2009

12 Impact of Certification in the US

13 Acceptance by Providers Endorsement: AAFP AAP ACP ACC ACEP ACOG AHA AMA MGMA Physician s Foundations Impact Surveys: 72% of physicians believe published certification standards have an impact on EHR adoption 1 66% of CIOs are aware of certification; 55% of them plan to require it in their purchase decisions 2 1 MGH Institute for Health Policy, George Washington University and RTI, A National Survey of Health Record Keeping among Physicians & Group Practices in the United States, preliminary data report to AHIC, Jan Survey conducted by HIMSS Analytics, March 2007; 2008 survey is pending 2009 Slide 13 June 18, 2009

14 EHR Marketplace Remains Diverse and Competitive Annual Revenue of Ambulatory EHR Vendors Practice Sizes Served by Vendors Applying > $100 million 7% $21-$100 million 9% $11-$20 million 13% N/A 7% < $1 million 25% $1-$10 million 75% 50% 25% 37% >50 Number of Physicians in Practice Certification has created a level playing field upon which a wide diversity of vendors compete (>200 products) Revenue and Size data from application data of certified Ambulatory EHR 08 vendors as of March 2009; N=77; response rate 100% 2009 Slide 14 June 18, 2009

15 Success will take time... Policy Drivers Provider Decisions Technology Uptake IT-Enabled Care Transformation 2009 Slide 15 June 18, 2009

16 Summing Up CCHIT has developed a trusted, fully operational certifying organization with substantial impact in the US CCHIT faces continuing challenges in supporting US implementation of both ICD-10 and SNOMED-CT Federal actions have put health IT on the US national healthcare and health reform stage CCHIT will remain flexible and responsive as US federal health IT initiatives emerge and grow 2009 Slide 16 June 18, 2009

17 Thank You! Q & A For more information: