Like many hospitals and health systems around the country, ours has been on a physician-buying spree. Whether it’s through direct acquisition, long-term leasing or capital investment, we have created many alternatives for physicians to work with our organization. After three years and approximately 400 new providers, it is time to pay the ICD-10 piper.

As is the case with many health care organizations on the physician-alignment path, we inherited the best and worst of many of those practices. Some had great processes and many had some questionable activities that, as part of a health system, needed to change. What almost all had in common, though, is a legacy electronic health record.

Given the deadline for meaningful use attestation, our organization focused its efforts on getting our practices MU-ready. We shifted those practices still on paper to our enterprise ambulatory EHR and upgraded those inherited EHRs. With that done, we awoke to the fact that some of those legacy practice EHRs were in various states of ICD-10 un-readiness. We found that some needed extensive upgrading, some a little upgrading and, worse, some are not upgradable at all. Depending on the vendor, upgrades entailed database changes, new interfaces and billing workflows, field additions for documentation, new code tables, tables to support transitional dual coding, new configuration programming, and new forms and reports.

While many vendor software upgrades are free, some are not. In the end, nothing is free. Given the growth in data along with new workflows, some vendors require new hardware and increased processing capacity while others require increased storage capacity. The sheer complexity and level of detailed assessment required is, in my opinion, what drove many practices to procrastination and inactivity.

So, they waited; we shouldn’t be surprised. A survey done by clearinghouse vendor Navicure in 2014 noted, “74 percent of respondents have not begun implementing their transition plan …  .” The survey goes on to say that the physician practice state of readiness for ICD-10 “varies widely” and that “practices are confident in their vendors’ abilities despite a lack of communication on updates and/or timing.”

Some practices knew that their EHRs would not be ICD-10-compliant, but now it is our problem. Whether it is a technology upgrade, wholesale system replacement, training or just awareness, this is now something we have to stop and focus on.

An article in the Jan. 8, 2015, issue of Medical Economics notes that many small practices are relying on their EHR vendors, billing services or clearinghouses to absorb the costs of conversion. For many of our newly acquired practices, that reliance now falls to the health system.

For us, this has hit home. We have a fairly well-honed process for bringing new practices on to our ambulatory EHR, but that is going to have to change. We have had to add a new phase to that plan — conversion of practices with non-ICD-10-upgradable EHRs.

For many of these practices the good news is that they are now part of a larger organization. There are resources for coding support, training, EHR replacement and upgrades if available. From a health system perspective, we are asking new questions of potential physician partners, and one of the first is: “How ready are you for ICD-10?”

For additional commentary on the conversion to ICD-10, check out the rest of our blog series, ICD-10: Making Use of the Delay.

Linda Reed, R.N., is vice president, behavioral and integrative medicine, and chief information officer at Atlantic Health, a five-hospital health system based in Morristown, N.J.