ICD-10 will cause a major transformation in the way health diagnoses and procedures data is recorded, stored, and processed, for almost all healthcare providers. The new coding system will affect most business and clinical operations within hospitals. The potential impact of ICD-10 will include multiple system upgrades and testing cycles, increased staffing needs, and significant training across the organization.

Most hospitals should already have completed their internal ICD-10 impact assessments and implementation plans. But, as reported in earlier posts, almost half have not done so. If you are currently preparing for your ICD-10 assessment, consider the following recommendations: 

1. Your ICD-10 assessment project leader should have experience working  in a leadership role with ICD-9 and other coding. If this is not practical, we recommend that you include a supporting “executive ICD-10 knowledge leader” on the assessment team, who will provide necessary technical and regulatory guidance. In some organizations, this may be the HIM leader, but many hospitals must seek outside help for this role.

2. Because your assessment will impact systems and processes across the hospital, set up a flexible, multi-skilled assessment team. Ideally, the team will be an interdisciplinary mix of individuals from senior management, HIM, billing or finance, revenue cycle management and IT.

3. Provide initial “awareness” training sessions to stakeholders either before or very early in the assessment process. ICD-10 is complex, and many healthcare staff do not understand how a “simple”coding conversion will affect them and their work. In our experience, many hospital staffers incorrectly believe ICD-10 will have little or no impact on them. Develop easy-to-understand programs that cover:

• ICD-10 Regulatory requirements
• The long term benefits of moving to ICD-10, including its relationship with Meaningful Use / MIPS
• The differences between ICD-9 and ICD-10, with examples
• Impact on departments and the overall organization
• Impact on documentation practices
• Risks created by not implementing ICD-10 or an inadequate implementation.

Awareness training will prepare your organization for the assessment and implementation activities to come, and make it clear that many staff members will be involved in a variety of ways. A solid awareness program should help your assessment team gain the cooperation needed to collect high quality information.

4. Develop a realistic but strict assessment project timeline and stick to it. Reinforce the importance of meeting the timeline to all stakeholders. Depending on the size and complexity of your hospital organization (excluding large multi-hospital systems), your assessment will take at least eight to 16 weeks. 2014 will be looming by then!

5. Use a “blank slate” approach in your assessment, to determine where ICD-9 data elements reside in your overall healthcare environment. Do not assume you already know where it is.

Some providers have made the mistake of assuming “switching over” to ICD-10 is essentially an IT vendor issue. In fact, since hospitals can have 50 to perhaps 150 software systems, there is plenty of IT attention needed — but in the court of the IT staff as well as the vendors. Moreover, ICD-10 data resides in many locations, including IT and other third-party hospital systems, along with data integrations and interfaces, end user department documentation, workflows and processes, and payer systems.

Your assessment should consider systems and processes throughout the organization, including (but not limited to) EHR, revenue cycle, discrete clinical systems (e.g. Laboratory, Radiology), administrative and reporting systems, owned physician practice systems, interfaces, and related forms and documentation.

This is just the first in a series of actions that need to be taken as part of your ICD-10 assessment, but you have to start somewhere. If you are stalling, don’t. Get the ball rolling and take these steps to prepare for your assessment, to ensure that delays are limited once you dive into the full assessment.

Where are you in your planning? What progress has your hospital made and at what stage are you experience challenges?