July 24, 2012

What you should do with this “gift of time”? Use it to review workflows and processes

By Beth Parker, RHIT, CCS, CRCR

The postponement of the ICD-10 implementation date has given us the gift of time—time to review additional workflow and processes. The mandated conversion from ICD-9 to ICD-10 will require changes to most facility information technology (IT) systems and will have significant impacts on business processes and the people within these facilities. This conversion will also necessitate reviewing and updating reports and other downstream data uses at all levels of the organization.

In order to perform this review and identify the issues at hand, it will be helpful to perform an ICD-10 impact assessment.  The first phase of this analysis is intended to identify what people and what processes will be affected by the transition to ICD-10, as well as to determine the degree of impact.

Choose Your Team and Assess Your Processes

Who do you want to participate in the assessment? Identifying and meeting these individuals to explain the process will ensure better results.  After this initial meeting, put together tools (such as a spreadsheet) that will allow for easy data entry and information sharing.  This tool (s) should include questions based on processes that each group performs on a regular basis with the ultimate goal, and the first step, being to determine the business process impact.

During this process, ask the following questions:

  • Do you identify, document, or review patient diagnoses and/or procedures?  If so, do you assign codes to this information?  If your answer is “yes,” then:
    • Describe the associated workflows.
    • Identify the tools and references used to capture the codes.
    • What other internal areas and departments are impacted by this work?
    • Would you rank the impact to your daily activities as high, medium, low, or none?
    • If there is any impact to your daily work processes, describe it here.
    • What dependencies (existing systems, planned projects, lack of staffing, budgetary restrictions) need to be considered as part of this transition?

Evaluate Effect on Staff

A key step for those in management and training is to identify those staff members who will be impacted by ICD coding in their daily work. To determine the issues at hand, ask the following questions:

  • What is the impact by job type?  For example, what retraining, recertification, and workflow changes need to be accomplished?
  • Describe in detail the training needs of each individual.  It is best to assess (test) and interview all of the highly impacted individuals to ascertain their learning styles and needs.  Although we all know physicians, the C-suite (i.e., CEO, CFO, and CIO) and coders have different needs, we cannot forget about the other individuals impacted by this change (IT, non-coder health information management, ancillary staff, billing department, etc.).
  • What training materials and/or policies and procedures will need to be written and/or updated?
  • How will training be delivered?  Will each individual be trained separately based on their specific learning styles and educational needs?
  • Who will the trainer be, and what are the associated timelines?
  • What is the budget for staffing and tools?
  • What will be done to counteract the training time and learning curve of the coding staff?  Will you outsource the current coding?  Will you offer overtime pay?

Pull It All Together

When all questions have been answered and documentation has been obtained, it is time to put all this information into play.  The first step is to design flowcharts that demonstrate the processes and the impact on these processes.  A “before and after” picture may work well to help with the next step, which is writing a gap analysis—defined by Wikipedia as a “technique for determining the steps to be taken when moving from the current state to a desired future-state.”

After this crucial step, begin to write associated policies and procedures to compensate for this gap.  While writing these, keep in mind the impact on the associated staff, and determine productivity and workflow requirements to help pinpoint budgetary needs.

Last but not least, write up a plan to define all of the information you have obtained, and implement the plan.

About the Author

Beth Parker is Vice President Clinical Division - HIM for MedLearn Publishing, a division of Panacea Healthcare Solutions, St. Paul, MN.

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Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.