According to surveys conducted by HIMSS and WEDI, many organizations are behind schedule in planning for the transition, which is going to smack against any number of clinical, billing and reporting information systems. However, those who have jumped head-first into planning for the transition do share common lessons. High-level executive sponsorship of the effort is a given.
And many are realizing just how expansive the impact of ICD-10 actually is. Because of the scope of the remediation and training work involved, organizations need to become extremely methodical in their management of the transition, laying out systems inventories, remediation plans, budget estimates and labor allocations. Some are already calculating the impact of a major productivity decrease, certainly on the part of coders, and likely on the part of the physicians, who will be asked to document to an unprecedented level of detail about what they do and why. And while ICD-10 offers the tantalizing prospect of creating a much more accurate portrayal of clinical work, some organizations, particularly health plans, are taking a go-slow approach in capitalizing on the specificity.
The starting point, experts say, is establishing high-ranking executive sponsorship of the ICD-10 effort. "You need an enterprisewide governance structure to manage the change," says Mark Avery, an I.T. and management consultant with PricewaterhouseCoopers. "ICD-10 is not just a compliance event. It's a compliance event with enterprise impact. "
That's the exactly the approach taken by Orlando (Fla.) Health, a nine-hospital delivery system that began its ICD-10 transition last fall. Orlando Health has established an executive project steering committee whose sponsors are the CIO and vice president of revenue management. The team has nearly two dozen members, comprising senior or upper level management from a host of departments, including health information management, physician practices, and quality improvement, says Beth Patino, chief of I.S. projects and administration.
A key player is Sharon Addison, who serves as ICD-10 project manager and leader of the project steering committee. Her 14 years of project management experience are paying off, she says. "You need the ability to set the project up, run the project, execute the project and know the right things to do," she says. "My 14 years are serving me well right now. The effort is calling me to task on everything I thought of and on things I didn't think of. ICD-10 is not a tech project, it's not a coding project, it's a project that impacts the entire organization."
In an effort to understand the organization's culture and the eventual scope of work required, Addison devoted two months interviewing department leaders. She then devised a game plan for the organization, laying out the broad scope of what needed to be done and who should do it. Her analysis divides work into four big areas: systems and applications; education; policy and process; and communication. Each of those areas, in turn, has a workgroup-comprising some eight to 12 people, Patino says-which is tackling chores specific to the area.
It's a smart approach, says Avery the consultant. He says the first order of ICD-10 business should be analysis of existing coding with ICD-9, followed by an inventory of applications used in support. Understanding how ICD-9 is used gives "some indication of the where the complexity lies for change in a given organization," he says.
Orlando Health is underway with both efforts. "We have to identify all systems and applications that need to be changed or remediated," says Addison. "It's a critical component, because we will need upgrades in functionality and then think about the training that comes in behind that." Currently, Orlando Health has identified 72 applications that will need upgrades. "Even though the vendors are looking at ICD-10, we want no stone left unturned, so we analyzed the effort from the application level," adds Patino.
The actual number of affected applications could be in the hundreds for larger academic medical centers, says Avery, the consultant. "It depends on the level of centralization and the number of enterprise apps."
Sisters of Mercy Health System, whose 24 hospitals sprawl four Midwestern states, is facing a large inventory of applications upended by ICD-10. Its remediation work began last year, marked by the formation of a executive steering committee, whose membership has expanded to include more physicians as the project drives on, says Sheri Beekman, vice president of revenue cycle. "We have spent a lot of time of system inventory," she says. "You think you know the scope, but the steering committee has pointed out other reporting systems" impacted by ICD-10, she says.
Getting underway
Sisters of Mercy began its work by identifying systems needing remediation for HIPAA 5010, the forthcoming claims format that will uphold ICD-10, and come on line next January. "More than 60 systems need to be upgraded or replaced for 5010 alone," says Beekman.
Last year, the health system did an initial inventory of systems affected by ICD-10. The results yielded a portrait of the daunting challenge awaiting the organization. Some 250 information systems showed up on the inventory. "We have several dozen vendors in play," says Beekman, rattling off a list of areas affected, including eligibility, registration, clinical documentation, charge master, coding, and claims. The health system hopes to streamline its remediation effort by standardizing its clinical and financial operations on a new enterprise system, from Epic Systems, Verona, Wis. Epic will supplant some legacy systems that currently feed claims, such as lab and ancillary systems. But the ongoing deployment means that the ICD-10 remediation work is a moving target. "We're still working on our ICD-10 inventory," says Beekman.
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