D'Arcy Gue

Just-In-Time ICD-10

August 12, 2013

ICD-10 3 Minute Read

As we approach the “one-year-to-go” milestone in the federal ICD-10 timeline, the healthcare industry should be worrying. A new report by AHIMA (American Health Information Management Association) and the eHealth Initiative has reaffirmed that many providers remain substantially behind the conversion curve.

The October 1, 2014 deadline is speeding toward us, and clearly, many hospitals will have to deploy a “just-in-time” implementation strategy.

But before we dive into strategy, let’s talk survey results.

As reported in mid-July by Healthcare IT News, AHIMA and the eHealth Initiative conducted a national survey of healthcare providers from late May through June on the expected impact of ICD-10 implementation. Similar to the earlier WEDI Survey, this report concluded, “significant barriers to ICD-10 implementation continue to plague healthcare providers, including: staffing and training; workflow and productivity; lack of knowledge; and cost of software upgrades.” Of  281 respondents, 45% were acute care hospitals, 12% integrated delivery systems, and 12% clinic or physician practices. Clinics, physician practices, and acute care hospitals will be the most negatively affected.

Bottom line: The July 2013 AHIMA-e-Health Initiative report confirms that healthcare providers “continue to lag….Despite the extra year of preparation provided by the delayed compliance date, they expect to encounter significant barriers, challenges, and revenue losses following ICD-10 implementation.”

Payers and vendors have had ICD-10 projects in process for two or three years in many large hospital systems. Most smaller hospitals have not. Today, they do not have the “luxury” of years to get the job done.

All of which brings me to the concept of “just-in-time” ICD-10.

Organizations who are just beginning their ICD-10 projects can’t take the 21 months CMS has scoped out as an appropriate implementation timeline (for small hospitals.) It will be a major challenge for them to successfully deploy ICD-10 by October 1, 2014.

Here’s the scope of the problem….the high-level elements of implementation, using CMS’ Timelineinclude:

icd-10 timeline

The concept of “just-in-time” ICD-10 is threefold:  the project must be streamlined by an authority on ICD-10 and its impact; ICD-10 must be a top priority for the executive team; and projects must have aggressive, full time leadership.

While providers just starting out will have to complete CMS’ key steps to conversion, they will have to compact the process.  Lower level tasks will have to “give,” as will a lot of internal resistance.  Merriam-Webster notes that compaction — reducing the size or volume of of a complex project —  means that “a lot of niceties are going to get crushed.”

Leaders must be resourceful. Strong leaders who are clearly supported by the C-suite, will streamline the process from start to finish. This may require abbreviating or simplifying some tasks, resourcefully finding effective shortcuts, re-grouping subteams, combining efforts of stakeholders, getting external expertise, preempting political roadblocks, setting drop-dead deadlines, and much more.

There are no instant solutions here, I’m afraid. But, look forward to more ideas on our blog on how to make “just-in-time” ICD-10 work, in the near future.

AND, join the new LinkedIn groupJust-In-Time ICD-10, for focused Q/A, discussion, resources, experiences and ideas. 



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