Way back, when we were still struggling to run a successful birthing practice called Athena Women’s Health, I shared a dank, cramped house in San Diego with Jonathan Bush, my brother Todd, and the other athenahealth co-founders. I slept on a mattress on the floor with a 30-pound tower computer as a headboard and for months would wake up every day, roll out of bed, and write code. Line by line, I built rules around medical billing claims so providers could get paid faster and more accurately for delivering care. Down the road at the clinic, the providers were consumed with weightier challenges, like lowering the C-section rate and reducing NICU days. It struck me then, and still does, that we had landed on a fair and smart division of labor. Providers would focus on delivering care and we’d invent technology and services to wick away the paperwork and hassles, and get the caregivers paid for doing the right thing.
To my mind, that is the fundamental social contract — or it should be — behind the $31 billion health IT (HIT) industry that’s grown up around US caregivers. Which is why news of the vote to once again delay the ICD-10 transition is disappointing, and symptomatic of an ongoing breach of that contract by technology vendors. Whether the adoption of an already two-decades-old coding system is going to meaningfully transform care is certainly up for debate. But as a proxy for the HIT industry’s ability to handle change on behalf of providers, the latest ICD-10 delay is a troubling canary in the coal mine.
Over the last five years, the government has spent more than $20 billion of taxpayer money to install electronic health record (EHR) technologies, many of which cannot implement a change in diagnosis codes that the rest of the world implemented years ago—in some nations, more than a decade ago. ICD-10 readiness for providers is about much more than the availability of mere technical functionality; it’s about having the support necessary to successfully achieve ICD-10 compliance, which includes things like training and business processes. That the government felt compelled to delay the ICD-10 transition reflects not a failure of health care providers, but a failing health information technology industry that’s unable to support providers in navigating change.
Health care providers need and deserve technology partners that will step up and do what it takes to ensure their success in meeting the complex demands of our changing health care system: from the ICD-10 transition to the Meaningful Use program, from the transition to risk-based payments to the demands of care coordination. The government needs to stop subsidizing dysfunction by accommodating technology vendors that, time and time again, leave providers high and dry.
In recent years, caregivers have been asked to do backflips to absorb huge changes to their practices, their approach to care, and the ways they get paid. If health care providers are ever to achieve the ambitious triple aim around cost, quality, and the patient experience, they’re going to need technology partners that can move beyond excuses to keep up their end of the bargain.