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Themes and Lessons from AHIMA 2011

October 19, 2011
by Joe Bormel
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Three issues are competing for attention: MU, EHRs, and ICD-10

Themes and Lessons from AHIMA 2011

As promised (link), I’m here to share a few of the major messages that resonated during this convention. So without further ado, here are my notes, grouped by subject area. I'll try to share the names of the presenters where I can, since the presentations and audio are available to AHIMA members. If you have trouble accessing a reference, ask your organization's AHIMA member; if they attended the conference, they have the same access that I used. In some cases, the AHIMA staff has posted videos of presentations on the organization’s YouTube channel. I love social media, don't you?

Meaningful Use

This would seem to be the place to start, given the immediacy of MU. The topic came up in the majority of presentations. Providers said that three issues compete for resources and attention, MU, the EHR, and ICD-10. We have a tendency to forget or fail to see the common management and change management components, since all three are concerned with improving information capture and the quality of that information for overlapping purposes. That said, the managers and directors involved often have very independent perspectives, needs, and budgets.

I highly recommend an article, " Meaningful Use - Notes From the Journey," by Chris Dimick, JAHIMA October 2011. Dimick covers "results so far," including that early attesters greatly exceeded the MU requirements thresholds. Probably not surprising is that those organizations that were underway when the program was announced do better than those starting cold. Apparently those shrink wrapped, pre-packaged, slam-them-in approaches haven't delivered attestations. Dimick addresses real world challenges like reproducing records for patients. He notes that current provider workflows often don't support this since the chart isn't ready when the patient should be able to leave. All-in-all, this nine-page article is a wonderful framing of where we are today as an industry with MU. Articles from Bonnie Cassidy (link) and Lynn Thomas Gordon (link, page 23) are also highly recommended.


- ICD-10 will be an economic battleground between the payers and providers, despite the public posturing that the move will be revenue neutral. Providers and Payers who don't arm themselves with retrospective and concurrent (i.e. dual coding) skills, data, and modeling will leave money on the table, as well as overpay or be overpaid. One healthcare delivery organization has already spent 30,000 hours on ICD-10, between training, analysis, and outside review of its operational plan.

- Creating a code in ICD-10 will often require information that is either not captured today, or captured today utilizing language that is not allowed in ICD-10. For example, if a code requires indication of laterality such as a limb bone fracture, i.e. right, left, both, or unspecified, a code cannot be determined without that information. It was noted by several speakers that, if the "unspecified" code is used, some payers will deny the claim. For more on this, I recommend Lynn Kosegi/NLP, “The Silver Bullet” presentation ( link).

- The revenue opportunities and risks with the move to ICD-10 dwarf the MU incentive dollars by one or two orders of magnitude. Every organization with its eyes open has its best and brightest people managing this risk. See my notes section on competing initiatives.

Competing Initiatives

- Life within hospitals is especially chaotic these days. I just touched on MU and ICD-10 transitions, each of which present distinct challenges. What can quickly get lost is that the hospital EHR roll-outs, both inpatient and community, were in progress over a seven to ten-year period before MU and ICD-10 were contemplated. Although there are synergies, such as improving physician documentation and CPOE related ordering practices, there are plenty of cases where sub-projects compete for resources, create incompatible deadline issues, and expose “single-threadedness” or bottleneck performance limits.




Thanks for the update. I've been waiting for this since I was unable to attend.

I have two questions for you. First, has anyone or any organizaion yet determined, once a hospital has made an ICD-10 transition plan, how long it actually takes, on average, to actually become ICD-10 ready? I presume it would depend somewhat on the size of the organization.

Second, did you receive any solid data about what percentage or number of hospitals have actually formulated a plan, and what percentage or number have actually implemented a transition plan. The various studies I've read to date differ greatly.


Thanks for your comment. Based on what I've heard, executing a transition plan is going to depend on resources and number of systems that have to be touched. Most organizations who talk about their surveys are surprised. Becoming ICD-10 ready work depends in part on how fragmented an enterprise is in terms of systems, HIM staffing/training, source systems and the nature of the clinicians originating the documentation. To your point, the larger the organization, the more touch points that need to be addressed.

A lot of the talk at AHIMA was around dual-coding as well as retrospective analysis to inform the ICD-10 conversion strategy in an agile (and Agile for that matter) manner. Those seem to be two of the critical core steps to prepare for ICD-10 in a manner that is competent. Which brings me to your second question. In the preliminary surveys presented, it was the minority of organizations that had completed much less implemented a transition plan. I suspect that it is the conservative appraisal. I would expect that all HIM managers have drafted a budget, training plan and some projects. The "minority" status reflects that the plans aren't approved, or funded. And, as outlined in the competing initiatives section above, poorly ranked against more immediate projects and programs.

Thanks for your question.