Communication needs to be robust and thorough for any kind of organizational change, and that’s particularly true with the transition to ICD-10. Many levels of staff, clinicians and administrators all have a stake in making the shift to ICD-10 smooth and successful.

Health Data Management recently conducted a web seminar on final preparations for ICD-10. Topics covered in the seminar provide important suggestions for providers getting ready for October 1. Moderated by HDM Editor Fred Bazzoli, those participating in the seminar included:

  • Aaron Miri, CIO at Walnut Hill Medical Center.
  • Jean McCammack, Chief Quality Officer at Walnut Hill Medical Center.
  • Debbie Schrubb, Corporate Director of Health Information Management and Kettering Physician Network Coding at Kettering Health Network.
  • Stephen Stewart, Interim CIO at Schuylkill Health Systems in Pottsville, Pennsylvania.

Fred Bazzoli: Communications seems to be a linchpin of your efforts. Who should be coordinating on ICD-10 within an organization, and what kinds of conversations should you be having about the overall effort—if things are going well, or they’re going poorly?

Stephen Stewart: We’ve tried to encourage the entire leadership team to be positive and involved, and it's a great time to be visible, because the organization as a whole is going to go through some interesting times. I hope ICD-10 turns out to be a non-event, but I don't think it will.

We're going to watch discharges, not files billed, really, really closely for any changes in the numbers, and try to have an early strike force that, if things are backing up, can identify the root problems and craft solutions.

You want to be sure that you don't, in an attempt to solve a symptom, misdiagnosis the disease. We are concerned that if we allow ourselves to become reactionary, we could do more harm than good. So we have to take some time to think it through, and really analyze what the issues are, and to do that effectively we need to have early identification of trouble spots and address them, across the revenue cycle.

I'm fairly confident about our information technology side, although it took a while to get the IT staff to really grasp the role they potentially could play here, and how they have to be part of the triage when things happen. We've installed a lot of new systems that have been tested, but aren’t production-hardened yet, so the IT staff must be prepared for whatever happens. Coders are going to work six days a week and longer days, if necessary, to attempt to stay current. I've got more than normal IT staff scheduled to be in the hospital, and additional people on call in the event that we have problems that we need to respond to quickly.

Debbie Schrubb: Our ICD-10 conversations have included our revenue cycle leaders, as well as the vice presidents of finance. We've also been talking with different physician groups over the last couple of weeks and provided education to the staff of those practices down to service-line specifics, and ensured that if they run into problems in those first few weeks they know who to reach out to.

We’ve been talking to physician leadership as well, so those leaders, including chiefs of staff, are telling their peers that this is for real. We’ve told them they need to pay attention to the coder queries. That they need to document as specifically as they can. And they shouldn’t ignore those queries, because they're going to come back at them if they do.

Finally, we’ve kept up the conversations with the coding team--the managers, our coding business analysts, and our front-line coders--making sure we’re encouraging them and just reinforcing that we're going to get through this together.

My coding business analyst team will tell you that we've got this. They feel very confident we'll get through it. Will we have bumps in the road? Absolutely. But the key is going to be communicating each and every day through the process.

Stewart: It's like a go-live on a new system.

Schrubb: That’s right.

Bazzoli: We've touched on the clinical staff in terms of communication. What kind of communication needs to be occurring with them on a regular basis? And is there anything in particular they’re being told these last few weeks?

Stewart: I think the big message is, this isn't going away. I think the two ICD-10 implementation delays created a false sense of security in some peoples’ minds that somehow this would just not happen. So just preach and preach again and teach and teach again that this is coming.

Aaron Miri: I agree with all of that, as well as try to do some private communication with your nursing and front-line staff through reminders on screen savers and other types of messaging. But e-mail is the worst way to communicate with clinical staff. They're all on the go. They don't have time.

So find a way, either through a poster board, or during their daily or hourly huddles, or even the handoff meetings, to talk about this. Make it part of the conversation. Make it a well-known thing. October 1 is coming, and this is what's going to happen.

Also make sure there are clinical advocates spreading the message, because if there's a grumpy physician in a unit, you don't want the nearest nurse to be unaware what’s happening on October 1st.  Anything you can do to communicate, even over-communicate, will be appreciated.

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