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At CIO Forum, Orlando Health Describes ICD-10 Challenges

February 20, 2011
by David Raths
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With all the focus on meeting meaningful use requirements, it’s always valuable to get a reminder that another huge project looms for hospital IT executives: the conversion to ICD-10 codes.

Speaking at a roundtable event at the CHIME/HIMSS CIO Forum in Orlando on Feb. 20, Sharon Addison, senior project manager for ICD-10 at Orlando Health, said the cost and impact of ICD10 would far exceed the Y2K conversion. “This is the highest risk project we have undertaken in terms of impact to cash flow,” she said. The complexity level of the coding could triple the amount of time it takes to get paid, according to Orlando Health.

ICD-10 coding, a federal requirement, will allow for far greater detail in classifying diseases by increasing the 17,000 codes in ICD-9 to 155,000. The transition has the potential to improve disease management efforts and quality data reporting.

Although the ICD-10 conversion doesn’t officially take place until October 2013, eight-hospital Orlando Health has taken a very aggressive approach to developing a project management infrastructure. The key sponsors are Rick Schooler, vice president and CIO, and Keith Eggert, vice president of revenue management. A project steering committee has 23 members, and a total of 70 managers are involved in the multimillion-dollar project.

“Some people think it is just a systems project or a coding project,” Addison said. “It is not. It affects systems but also policies and processes, education, training and communications.”

She said Orlando Health has determined that about 70 of its software applications will require changes, and some systems may be replaced altogether. It has sent out a survey to software vendors to ask how they will approach the change, and many have not responded because they don’t yet know what their strategy will be.

The coding changes will also require changes to hundreds of custom reports and interfaces between applications.

The retraining of coders, physicians, other clinicians and data users is a “massive effort,” Addison said. The new structure requires coders to have much more anatomical and epidemiological knowledge. “Some coders are leaving the occupation because they don’t want to deal with it,” she added. “That speaks volumes about the level of complexity involved.”

By building a strong ICD-10 project team, Orlando Health may be in better shape than many other hospitals and health systems. In a February 2010 survey of 37 healthcare executives by Falls Church, Va.-based consulting firm Noblis, 48 percent of respondents were either unsure or believe that their organization is not on course to successfully prepare for the implementation of ICD-10.