October 27, 2011

Exclusive to ICD-10monitor: ICD-10 Transition: Lion’s Share of Work Lies Ahead


EDITOR’S NOTE:  CHIME, the College of Healthcare Information Management Executives, is holding its annual CIO Forum in San Antonio. The conference continues today.

San Antonio, TX: Oct. 27, 2011---Even those far along the ICD-10 conversion path worry that they’re going to face difficult challenges ahead.

At a town hall meeting on ICD-10 conversions at the CHIME11 Fall CIO Forum, executives charged with implementing the new coding system in their facilities told attendees about the importance of lining up support for the transition and incorporating multi-disciplinary and executive support.

Rady Children’s Hospital has been working on the ICD-10 transition for more than two years, but executives there realize that the lion’s share of the work lies ahead of them, said Albert Oriol, chief information officer of the organization.

“We’re on the way, but we’re not seeing the finish line by any stretch of the imagination,” said Oriol at the meeting, sponsored by the College of Healthcare Information Management Executives.

Three Sponsors for ICD-10

Rady Children’s ICD-10 initiative has three executive sponsors the chief financial officer who owns the revenue cycle impact, the chief medical officer, because a key impact of the transition will involve a need for substantially improved documentation, and Oriol.

“After doing a gap analysis and needs assessment, the bottom line was documentation,” said Cassi Birnbaum, director of health information and the privacy officer at Rady Children’s. “We were able to engage our physicians, but there are other reasons to shore up our documentation.”

Many healthcare organizations see the ICD-10 transition as posing competition for resources with plans to implement electronic health records. But Rady Children’s sees synergies between the initiatives, Birnbaum said. “Some of the people who we need at the table for ICD-10 are the same individuals who are leading our EMR rollout,” she said.

Synergies at SSM

That’s also true at SSM Health Care, said Carole McEwan, project manager for ICD-10 at the hospital system that operates facilities in four states in the Midwest.  “I report to the CFO of the organization,” she said. “We used the same steering team that our electronic health record rollout was using.”

The CIO must be involved in the ICD-10 transition process, but must realize that he or she needs other key leaders to gain the necessary organization-wide support, McEwan said. “The optimal role for the CIO is he should be a key leader, a key enabler. He needs to co-own the transition, but he or she also needs the clinical and revenue cycle ownership as well.”

Both Rady Children’s and SSM Health Care realize they will need additional human resources in order to successfully make the transition.

“Health information management and HR directors are working to make sure that we have the right number of coders in place,” McEwan said.

More Coders Needed

Having more coders in place will be necessary in order to make up for the expected delays coders will experience in making the transition to the more granular ICD-10 codes. Some estimates suggest that it will take coders 30 percent to 50 percent longer at first.

Rady Children’s is considering the use of automation to assist in the transition, Birnbaum said. Tools such as computer-assisted coding can help with the process, while natural language processing applications also might be useful in the transition.



CIOs also will face concerns as they look to transition existing databases to the new coding system or determine how to translate their information.

“Because we’re an academic institution, we do a lot of research, and we have hundreds of (Microsoft) Access databases that are being used by researchers for projects,” Oriol said. “We’re going to need to tackle that. We’ll have to make a tough decision about getting the information out of those small databases and moving it to a central data warehouse.”

While the transition will be expensive, there’s no choice for healthcare organizations that otherwise will risk losing money if they’re not ready to move to ICD-10 on October 1, 2013. An expected expense is running both ICD-10 and ICD-9 coding systems, which Rady expects to do as long as necessary until its payers are prepared to operate entirely within the new coding system.

About the Author

Fred Bazzoli is CHIME’s senior director of communications. Before coming to CHIME, he was an editor at Healthcare IT News and Health Data Management magazine.

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