August 2, 2012

Olympic-Size Tips from International ICD-10 Implementers


Workers in the healthcare industries of other countries have lived through the implementation of an ICD-10 system and so can we. That’s the gist of the advice from three professionals—one from England, one from Australia, and one from the United States who worked in Palestine—who helped to implement the new system in those countries. The three were panelists on Talk-Ten-Tuesday, the live, 30-minute Internet radio broadcast heard on July 31, 2012.


The following healthcare professionals shared their insights and observations about planning and implementing the system:

  • Sue Eve-Jones, clinical coding consultant, as well as co-founder, director and member of the Professional Association of Clinical Coders in the United Kingdom
  • Barbara Godbey Miller, vice president of HIM client development for QuadraMed
  • Alfred Papallo, managing director for Eurofield Information Solutions, Sydney, Australia

Across the Pond

England made the switch to ICD-10 in April 1995, after three years of preparation that included updating systems. According to Eve-Jones, the real push came in 1994 when coders began their training.

She explained that when the country’s Department of Health made a decision to implement ICD-10, England didn’t have a coding qualification. “People who worked in coding were part of medical records normally. Because they didn’t have any professional qualifications, the caliber of coders varied.” Many were long-term coders who could assign the code, but couldn’t tell you the rules governing its assignment. As Eve-Jones says, “We needed to develop a new set of rules and a training program around the discipline.”

Switching to ICD-10 was a “major transition” because the country hadn’t implemented the system in increments and updates the way we do in the United States. “We used the same version of I-9 for many years and, then, bang, we switched to I-10,” said Eve-Jones. Since the April 30, 1995, implementation date, England has used version 4 of the ICD-10, and now they are undergoing the transition to an update.

The fact that the concepts and rules have moved in the classification is an issue, she says. From her point of view, a key tip during the transition is to realize that “people have habits to break…and cooperation is needed for those who are used to the old way.”

On the West Bank

Barbara Godbey Miller, vice president of health information management (HIM) client development for QuadraMed, worked in Palestine on a project with the National Authorities Ministry of Health, which had $57 million to spend to build a healthcare infrastructure, which was, she said, “broken.”

When it came time to decide whether to proceed with ICD-9 or ICD-10, “We were at a fork in road,” Miller said. “Then we found out that Palestine and the Ministry of Health already was submitting mortality data with I-10,” which made the decision obvious. Because the ICD-10 data file was publicly available in the United States, the decision was made to use our version instead of Australia’s.

However, Miller said, the Ministry of Health couldn’t accommodate the code sets because they had no HIM profession, and the physicians and nurses would be doing it. Healthcare leaders didn’t want them to have an unlimited number of choices, so she pared down the data set, pulling from the primary-care and hospital settings only the patient’s age and sex, diagnosis and procedure performed.

“We’re pretty blessed in having a HIM profession in this country that is dedicated to data integrity and capture it so we can do tracking and trending, something that doesn’t exist in the rest of the world,” said Miller.

Down Under

Meanwhile, thousands of miles away, Papallo, shares that Australia began capturing mortality data with ICD-10 in 1994 with a full transition occurring in 1998 to half of Australia and in 1999 to the remaining half plus New Zealand.

Although development and implementation of the new system has been an “incredible success,” says Papallo, “time was clearly a serious restraint.” For example, ICD-10 education coordinators said they could have used more time for finding and training the required number of coders, develop programs to get clinicians to provide adequate documentation in the medical records so coders could assign codes with minimal effort, and other critical elements of the transition

However, “the biggest challenge turned out to be coordination,” he said. “Each of the Australian states had separate health organizations with separate agendas, and we had to get all of these stakeholders coordinated and cooperating.”


Read 7 times Updated on March 16, 2016
Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for and; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.