July 24, 2015

ICD-10: No Turning Back

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It looks like ICD-10 will indeed keep on trucking, with the American Medical Association (AMA) now on board and the Centers for Medicare & Medicaid Services (CMS) recently having made an announcement regarding a transition period. Not only was this important to reassure folks that there would be no turning back with ICD-10, it underscores two additional key points. 

 

First, experience tells us that a transition period for something like this is absolutely necessary. If it often takes years for physicians to adopt new standards of care, it certainly will take time for ICD-10 to become normalized. We also saw this with electronic health record (EHR) implementations, and despite over 85 percent of physicians using an EHR today, 24 percent say it has detracted from quality of care. Additionally, 45 percent of physicians have said that it detracted from efficiency, and 47 percent said it has detracted from patient interaction, according to a 2014 foundation survey of 20,000 physicians.  

Now, keep in mind that these large percentages still reflect a minority of all physicians, and the majority of physicians indeed have realized benefits from EHRs. That said, with ICD-10, this nation cannot afford for such a large minority group of physicians to take on too large a productivity hit after implementation, so a transition period makes a lot of sense.

A transition period also underscores the need for fine-tuning that will start on Oct. 2, 2015. Despite the fits and starts related to the implementation of ICD-10, most physicians will have completed their ICD-10 training at least one month before the first of October.  

In many cases at larger health systems, however, it may still be six or more months. I am not sure when the last time you prepared for an exam was, but you certainly don’t stop studying a month before your score actually counts. If you are a good test taker, you probably would spend that last few weeks taking practice exams and reviewing your own scoring data to identify personal knowledge gaps that you would attempt to close in a highly targeted fashion.  

When studying for a board exam, if you got a question wrong regarding a patient with HIV, you won’t necessarily reread the entire chapter on infectious diseases, though.  

As with any training initiative, your ICD-10 training curriculum must account for a post-implementation phase to close these inevitable specialty-specific (and often individual-specific) gaps that will become apparent during the transition period. With over 80 percent of physicians currently being at or beyond full capacity at work, the post-implementation training phase must be targeted and not wasteful of the physician’s time. In fact, it should be based on at least several weeks of billing data to identify physician-specific knowledge gaps.  

Your training curriculum and system should be capable of delivering targeted training interventions at 3-5 minute increments or less, and it certainly should not include lengthy online courses lasting 30 minutes, 60 minutes, or even longer.  

We physicians, including physicians from the AMA (of which I am a member), just don’t have time for lengthy online courses that are not targeted to our individual needs.  

The American Health Information Management Association (AHIMA) ICD-10 training program for physicians, which I am proud to disclose I helped develop, and the new mobile-only enterprise training app they are about to release, are great examples of systems able to effectively deliver this type of targeted training to physicians based on their own billing data. Embracing these resources will help organizations transition to the most detailed ICD-10 codes before the transition period comes to an end.

 

 

Andres Jimenez, MD

Andres Jemenez, MD, is the founder & CEO of ImplementHIT, a physician and PhD Candidate in adult education, and his company's training software is used by hundreds of hospitals to train physicians on ICD-10 and their EHR.

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