Editor's note: H&HN Daily, in partnership with the College of Healthcare Information Management Executives, is pleased to present "ICD-10 In Real Time." In this 12-month blog series, three leading CIOs share their experiences on ICD-10 implementation, physician engagement, productivity, payer readiness and more. The blog will run on the first Wednesday of every month.

I had the great pleasure of working with a CNO who, before retiring recently, shared some valuable information and insight with me. She always said, "If you want us nurses to get it, you have to ride the halls like Paul Revere and keep reminding us that the British are coming. It doesn't matter if it is by land or sea; we need to know they are coming. We are so involved with our patients that we have a hard time seeing what is coming at us, and we need people like you to tell us, over and over."

That advice has served me well over the years, but never as much as when I was awakened to the looming deadline of ICD-10. I remember sitting in a presentation about ICD-10 at the 2010 CHIME Fall Forum. At that time, I knew this thing was coming, but I really did not understand what it meant or its magnitude. Figured I had a lot of time, so why worry? The proverbial plate was already filled with such things as ARRA, meaningful use and attestation. It was a sunrise session, 7 a.m. as I recall, and as I sat there, terror began to seep into my consciousness. This was much bigger than I had ever dreamt and we had done little to prepare.

When I returned to the hospital, I went to our capable HIM director and she got it. She knew the magnitude of the task. Together we quickly assessed our technologies and partners therein. We were reassured about our capabilities — both ours and that of our partners — but that reassurance didn't last long. We were struck with the fact that this issue was not going to be resolved with technical readiness or wizardry, for that matter. This was a people issue, an awareness issue. This was a change in the way we did just about everything. Everyone was focused on meaningful use and quality improvement, so it's not as though our plates were empty.

Then I remembered the words of my CNO: "The British are coming!" It became obvious that we needed to begin a campaign to create an awareness that would mobilize the organization. My strategy was clear: Make everyone aware that this big thing was coming that would change our lives forever, was not likely to be delayed and we needed to begin preparations. So, we started telling the story to everyone at every opportunity: leadership; board of trustees; medical staff; clinical staff; operational staff. Literally, every constituency in the organization needed to know and understand. While many tried to deny it, by repeating the message time and again, it eventually sank in.

After building awareness, we grew our team to assemble a plan and strategy. That plan is on solid footing today, but continues to evolve. Technology and training are huge components of our plan, but creating the sense of urgency in our medical staff is paramount to our efforts. We work on that every day.

My advice: If you have not started, you are behind but not lost. Begin now. Figure out what it really means, which is that everything changes, and build the awareness first. When your colleagues realize what is coming, they will rally to the cause, just as those of us in health care always do.

Beyond awareness, there must be action. For us, that means preparing and double-checking all systems that utilize codes. Much like the Y2K gap analysis, so is ICD-10. Everything has to be checked and inventoried. If it uses codes, it needs to be ready.

Most important for us was building a test scenario that allowed us to get rolling when our first payer was ready. Eat the elephant one bite at a time, not cut the dog's tail off an inch at a time. Focus on the positive and get ready.

We are just beginning to get interest from the medical staff. By repeating the message over and over, we have been able to create an initial awareness so that they now realize this is not just a coder problem, but they, too, are impacted in the way they work.

At this juncture, I really do not know exactly how everything will play out for us, but I am much more comfortable today than I was a year ago. Terror has not yet become complete confidence, but I now believe we can do it. So, we keep at it — refining plans now that the inventory is complete; but the rubber meets the road when we begin to train the organization. Stay tuned, that piece will be interesting and coming in another blog.

Stephen M. Stewart is CIO of Henry County Health Center, a critical access hospital in southwest Iowa. He is a regular contributor to H&HN Daily's ICD-10 series.