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.


In their book, "The New CIO Leader," Marianne Broadbent and Ellen Kitzis give us several good ideas to address many of the challenges we face today.
Though not specific to health care, they point to these precepts:

  1. Lead, don't just manage.
  2. Understand the fundamentals of your environment.
  3. Weave business and IT strategy together.

These particular precepts have never been more pertinent than in today's health care environment, where IT has taken its place at the table as a trusted partner, leader and participant in the strategic initiatives we are all grappling with: accountable care, meaningful use, payment reform, patient-centered medical home, patient- and family-centered care, and, of course, our favorite subject du jour — ICD-10.

When I took over as CIO here in Little Rock last April, I had already begun to evaluate the technology platform, the organization that I had inherited and the multitude of challenges that I now faced. The platform itself was clearly going to be the biggest challenge. We are currently a best of breed application environment, supplemented by a plethora of "home-grown" bolt-on products. We have at least one of every major vendor's application offerings on the market today.

ICD-10 has been likened to a number of different things. One of those comparisons is to a jigsaw puzzle. Our platform is more like a jigsaw puzzle for which you have lost the top of the box that shows what the picture should look like.

I am convinced, based on the complexity and fragility of the platform we created, that we probably don't even know what we don't know. I know that when we begin to peel back this Pogo-like (we have met the enemy and he is us) onion of technology we created, we will find things that multiple hands created, some of whom are no longer in this organization. It worries me at so many levels.

In my case, there is no question that a detailed analysis, likely with external resources and expertise assistance, will be required not only for ICD-10, but to figure out what needs to be done to prepare us for the drastic changes coming our way in health care. The good news is the organization has agreed to move forward with a replacement strategy with a single enterprise vendor. We are rapidly moving through the planning process, having now selected that new platform.

Even if the government decides to postpone the implementation — as Secretary Sebelius suggested last month — it should in no way give us a sense of relief that we now have more time to do what needs to be done. All of us will need every moment of the day to change hardware, upgrade software and train our providers and coding staff in the new code sets coming our way. We cannot possibly train enough or test enough to get us to a place of complete comfort. Whether you already have an enterprise system, a best of breed, somewhere in between or somewhere on the path, we must continue to take the approach that my colleague Stephen Stewart mentioned in the first blog of the series — The British are indeed coming.

As it concerns the precepts I mentioned earlier, we in IT leadership must help our organizations forge the path to this New World through the strategic but judicious deployment of technology. In my case, that New World not only includes the clinical enterprise and the research enterprise, but also educating the new physicians, nurses, pharmacists and a multitude of allied health professionals regarding the impact that ICD-10 will have on them.

As the only academic medical center in Arkansas, I have the unique opportunity to bring the value of technology across a significant platform. And as someone whose roots in Arkansas go back to 1850, demonstrated by the picture in my office of my maternal grandmother standing with her family in the cotton fields of Independence County at the turn of the 20th century, it gives me particular personal and professional satisfaction to be involved in the improvement of health for population at a statewide level.

Is ICD-10 a challenge? Clearly. An opportunity to choose your attitude, as my colleague Albert Oriol pointed out? Absolutely. But reforming our health system, whether through ICD-10 or any of the other initiatives we face, is the challenge of our generation. In the words of Thomas Paine, it is most definitely time to "Lead, follow, or get out the way."

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