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 series, three leading CIOs share their experiences on ICD-10 implementation, physician engagement, productivity, payer readiness and more. The blogs run on the first Wednesday of every month.


"So let's see if I've got this right. You're requiring me to use the EMR in new and multiple ways in order to comply with meaningful use, you're changing my compensation model through accountable care, you're reducing my Medicare payment over time, and now you want to continue making me less efficient by requiring me to be more specific in my documentation in order to get any reimbursement at all. Did I get that right?"

There is probably no time in the history of medicine where physicians are less enthusiastic about change than today. And why not? The pace of change over the last few years and the expected changes that are on the horizon are almost overwhelming. As a CIO, I have heard from my own colleagues that it is all just too much, and they are considering getting out of health care altogether. Personally, I see this as one of the most exciting and opportunistic times that I have ever experienced in my career. But I do understand the sentiments of those who feel like they are looking down the barrel of a gun.

In my own case, the problem is exacerbated by the fact that we are kicking off a wholesale replacement of our clinical and financial systems across the enterprise, and for that reason alone the next two years will be some of the most tumultuous years the organization has ever known. So in the midst of all this change, both external and self-imposed, how do we engage the physicians in order to get them to the table?

Undoubtedly, it is the physicians on whom much or most of the change is being laid. And in the case of ICD-10, it is the physician and his or her documentation that is the key to a successful implementation. So the challenge will be twofold: how do we create a value proposition that is attractive to the average physician and how do we leverage that attraction to increase buy-in and participation?

Let's face it. ICD-9 is way past its prime. It's almost 35 years old. It doesn't contain enough detail to analyze diseases properly, to get paid accurately, and it is out of capacity to address any new codes or the last 30 years of medical knowledge. But trying to make the argument with physicians that the United States is behind the rest of the world or that ICD-9 codes are inadequate is not going to get you very far. So focus on the positive aspects of the change. We are going to get more appropriate payment for the level of service we provide. We are going to get the kind of detail that will be needed for the management of accountable care. We're going to get better clinical quality and outcome data. We are going to get better research and clinical trial data. We are going to have a richer data set for disease and population analysis. But at the end of the day, we're also going to have comply with ICD-10 to keep our doors open.

We should also talk about potential tools that can be brought to the table to assist physicians in the documentation. Many of us are already using speech recognition and natural language processing to assist us in this regard. Computer-assisted coding also uses NLP to increase the efficiency of medical record review.

Before we get started with all that, however, there is one first step that should not be missed. You absolutely have to address any current problem in your clinical documentation process. Every organization has physicians whose documentation is problematic in supporting the current coding structure. If you do not have a proactive clinical documentation improvement program you need to start one now. Imagine the nightmare that comes with the tenfold increase in the number of codes from 9 to 10. If you don't have the documentation to back up the former, you'll never recover you get to the latter.

So where can physicians best be utilized in the transition? I believe that physician involvement in ICD-10 should be similar to their involvement in our clinical transformation project that I referenced earlier. We have set the expectation that there are roles for physician at every level of governance.

From the executive steering committee down to the super users, there are specific slots allocated that only physicians can fill. Whether it's creating the training requirements and curriculum, creating and monitoring the metrics by which compliance will be determined or even acting as specialty-specific super users for their colleagues, it is an organizational expectation from the highest levels that physician will step up, own, and manage their piece of the pie.

As my colleagues as stated in previous blogs, ICD-10 is not an option. If they want to continue to provide care and get paid for it, physicians have to step up to the plate. The potential for a significantly better platform for health care delivery, research and education is there. We will need everyone at the party to make it successful.

David L. Miller is vice chancellor and chief information officer at the University of Arkansas for Medical Sciences, an academic health sciences center.