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.
It's been said that ICD-10 is this decade's Y2K for health care IT. We could only wish it were so. Not that there aren't similarities. Just like those days leading up to the new millennium, we have to modify myriad applications that we rely on to process, generate and store mission-critical codes — data structures, interfaces, reports, decision support rules, you name it! If it handles a diagnostic or procedure code, you'll have to touch it. Unlike Y2K, however, the effort isn't relegated to the IT back office. This time, massive education will be required of IT's customers along the revenue cycle, which, let's not forget, begins with clinical documentation. Billers, coders, physicians and other clinicians, researchers, analysts, report writers — it's a long list of people affected by this change.
By now, in most organizations, someone has managed to capture the attention of the CIO and/or the CFO and between the two, the topic has been introduced to the rest of the executive team. With less than two years before we are required to utilize the new codes, most organizations have established multidisciplinary steering committees that involve revenue cycle, medical staff and other clinicians, HIM, IT and quality representatives. If you still need help getting attention in the C-suite or elsewhere, here's a little factoid that my colleague Adrienne Edens, vice president and CIO at St. Luke's Health System in Boise, Idaho, brought to my attention a couple of years ago: The AHA produces executive briefings on key topics, typically geared for CEOs. The executive briefing on ICD-10 is 44 pages long.
IT shops have begun working with key systems vendors to assess their state of readiness to comply with ICD-10, their ability to meet parallel processing needs, etc. Analysts, developers, clinical informaticists and report writers are busy preparing upgrades, updating interfaces and rewriting reports. Everyone is focused on the big EHR and billing applications, but let's not forget about smaller systems — such as ancillary apps supporting laboratory or radiology departments, or revenue cycle add-ons to support claim scrubbing or pre-authorization functions — that store or process diagnostic and procedure codes. They will need upgrading, replacing or a robust interface effort.
Many of us in academic institutions also are beginning to realize the magnitude of the submerged part of the iceberg. Hundreds, if not thousands, of researchers have built and depend on all kind of databases that store some sort of diagnostic or procedure code to conduct their research. For better or worse, most research projects will not stop on October 1, 2013, which means we will need to ensure researchers are attuned to the organizationwide ICD-10 effort and that our remediation plans incorporate their needs.
Revenue cycle executives are working with payers and intermediaries, and treasury is figuring out contingency strategies for dealing with likely impacts in cash as both providers and payers navigate the few months post-transition. HIM has moved beyond the initial shock of having to adapt to a tenfold increase in diagnostic and procedure codes and, by now, departments have identified certified trainers and have begun executing their plan to train coders. Front-runners have assessed — and some have even implemented — computer-assisted coding (CAC) programs that are expected to provide efficiencies and help coders regain the anticipated productivity losses caused by the introduction of ICD-10. It's early on and, for CAC, the proof is still in the pudding.
All this will be meaningless without the proper, more-detailed clinical documentation. That is why many of us initiated clinical documentation improvement programs as we kicked off our ICD-10 efforts. With the leadership of influential physicians, these programs helped us to identify and address potential documentation gaps. I anticipate that these types of programs will be as critical, if not more, to our efforts to maintain coder productivity as the implementation of CAC solutions.
As multipronged project implementation efforts continue, one last note from one organization's experience: We began our approach to ICD-10 with the assistance of outside experts. They helped us get up-to speed quickly and forced us to focus at a time when we were in the midst of several other mission critical initiatives — deploying our inpatient EHR, opening new facilities, etc.
Without a doubt, ICD-10, like Y2K, has the potential to be a consultant's heaven. Without downplaying the value that these outside experts brought to us early on, it didn't take long to realize that we needed to be judicious in our use of expensive external resources, first because our payer mix doesn't afford us many luxuries. Every dollar is precious, and external experts would have to deliver three to four times the productivity of our own staff to make it worthwhile. And second, because it is clear that many of the issues that need addressing are both organizationwide and organization-specific. We understood that the knowledge gained from this effort is something that will help us not only become ICD-10-compliant but, most importantly, will help us identify and tackle other improvement opportunities so that we can remain competitive as health care reform advances. We wouldn't want that knowledge to walk out the door after this particular project comes to port.
All in all, it will be an interesting couple of years ahead. Timing isn't the best, but it never is. We all face a number of other competing priorities, but as one of my mentors used to say, we get to choose our attitude. We can come out strong and try to have fun while we tackle this challenge, or we can be passive and brace for the storm. Call me a control freak, but I'd rather get the pieces we can control in order.
Albert Oriol is chief information officer at Rady Children's Hospital San Diego. He's a regular contributor to H&HN Daily's ICD-10 series.