CIOs and HIM directors are laying the groundwork for the ICD-10 transition by performing critical risk assessments, beginning training programs for clinicians and coders, and figuring out what all this is going to cost.
Last October, Stephen Stewart, the CIO of Henry County Health Center, got a major wakeup call after he attended an ICD-10 sunrise session at the College of Healthcare Information Management Executives (CHIME) Fall Forum, which emphasized that the compliance deadline was quickly advancing. Before then, his 74-bed hospital in Mount Pleasant, Iowa, had, as he puts it, been “plodding along” on creating an ICD-10 plan, but after hearing the session, he sprang into action and called his health information management (HIM) director to start the ball rolling on a plan to tackle this multi-faceted project.
If your organization has been hearing similar calls to action, you're not alone. IT leaders and HIM professionals across the country are pursuing parallel paths that will eventually dovetail as the Oct. 1, 2013 ICD-10 transition date nears. These two departments will be joining other organizational leadership to work out detailed assessments of what systems will be affected and extensive ICD-10 training, all the while overcoming common challenges including budget, bandwidth, and human resources. As many have asserted, the technical issues of the ICD-10 transition are not that great; it's the training of clinicians and coders that will be the significant obstacle.
Because the ICD-10 transition cuts across all departments, Janice Jacobs, director, regulatory compliance practice at IMA Consulting (Chadds Ford, Pa.), says that every organization might take a different approach, but that, however they approach it, healthcare IT leaders “absolutely, positively have to have an executive steering committee.” At the very least, steering committees need to have representation from IT, revenue cycle, HIM, and clinicians to create a comprehensive communication plan to coordinate software upgrades and training, she advises. Organizations like CentraState Healthcare System, a 282-bed hospital-based organization in Freehold, N.J., and the 562-bed Fletcher Allen Health Care in Burlington, Vt., have gathered together multi-disciplinary taskforces to develop work plans and organize organizational assessments for their ICD-10 journey.
SYSTEMS INVENTORY AND PHYSICIAN DOCUMENTATION
All of the organizational leaders interviewed for this story note that a major component of their work plan has been a complete systems inventory to identify which information systems would be affected by the transition and what hardware and software upgrades would be necessary. “It's amazing when you start looking at the tentacles of ICD-10 and how it really cuts across all parts of your organization: financial, clinical, HIM, IT,” says Chuck Podesta, CIO, Fletcher Allen Health Care. “Depending on what type of systems you have in place, it can be even more challenging from an IT perspective if you're a best of breed versus an integrated shop because you have more systems.”
Many in the industry realize that considerable challenges will arise from physician documentation issues. Stewart acknowledges that physicians, when building problem lists at intake, will be confronted with more choices and clinical vocabulary with ICD-10. His strategy is to advise clinicians to document by their best practices, and HIM will review and correct the codes afterward. Over time, he says, his team will educate physicians on what additional coding they might be missing.
Lahey Clinic, a health system that includes a flagship 317-bed hospital in Burlington, Mass., as part of its clinical documentation improvement program for capturing quality data for benchmarking, did a risk assessment with the help of the St. Paul, Minn.-based 3M a year ago that identified ICD-10-driven documentation requirements for diagnosis codes and procedure codes, as well as what service lines required additional documentation specificity. Three hundred records were reviewed, says Lori Jayne, Lahey Clinic's HIM director and privacy officer, to target subspecialties and diagnosis-related groups (DRGs) that were lacking in documentation for the specific codes for ICD-10 translation.
The risk assessment revealed common threads that were lacking in physician documentation that included identifying the specific diagnosis or procedure involved. Another need that was identified was making sure laterality is documented for the site of joint replacements, cataracts, neoplasms, arthritis/osteoarthritis, hearing loss, and visual loss. Other items noted in the assessment include procedure codes needed in ICD-10 when none was required in ICD-9, and increased specificity needed in ICD-10 for some routine procedures that only had one code in ICD-9, such as for infusions/transfusions. Lahey Clinic will also be focusing on specialties like cardiology, orthopedics, and radiology, where coding guidelines and further training will be given.
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