Detour On The Road To ICD-10

How one health system is adjusting to the delayed implementation of the new ICD-10 healthcare coding standard.

Deborah Graham, Programmer/Analyst

July 18, 2014

5 Min Read
(Source: <a href="" target="_blank">Kate Ter Haar</a>)

Easy-to-Mock ICD-10 Diagnosis Codes...

Easy-to-Mock ICD-10 Diagnosis Codes...

Easy-to-Mock ICD-10 Diagnosis Codes... (Click image for larger view and slideshow.)

I started on the journey to ICD-10 compliance eager to get this transition done, just like any other regulatory project. I didn't anticipate any insurmountable problems that would slow down implementation within our health system.

ICD-10 is a modernization of the international standard for diagnosis codes, and until recently the Centers for Medicare and Medicaid Services was pushing to make the US variation the standard for submitting insurance claims, with a firm deadline of October 1. Then Congress intervened and delayed the deadline by a year.

My organization had a plan, we had a project manager, and my part of the organization was in a good place. We had sent out test claims and received passed results from a number of payers. We were scheduled to do end-to-end testing, including sending to the payers and getting results back. Then, unexpectedly, the rug was pulled out from under us when the compliance date was changed.

[If I made the rules? Read ICD-10 Momentum: Let It Roll.]

My organization decided to halt all ICD-10 related activity until there was a firmer date and we were closer to the deadline. We canceled a number of consultants' contracts and almost everyone who was under the ICD-10 project budget is now gone. The detailed project plan that took up a whole wall outside the kitchen is gone. No one talks about ICD-10 anymore, except occasionally to ask where payer testing was when we stopped and which payers approved us before we stopped testing. There is a corner of a small whiteboard that still holds the payer testing results for my part of the organization, in the hopes that we would pick ICD-10 back up soon and continue where we left off. As more and more time goes by, my inclination is to clear off that whiteboard, knowing we will have to start testing from the beginning again, as if this is going to be a totally new project, with a new team, new project manager, and new rules.

So, as we detour off the path to ICD-10, what all-encompassing project has taken its place in our lives? For my organization, there is a major initiative called Patient Access. We are working to make it easier for patients to contact us and get an appointment in a more timely fashion. My team is focused on patient self-scheduling. We have talked with our scheduling and electronic medical record (EMR) vendors to see what will be required to allow patients to schedule (not just request) their own appointments.

We have looked at a few options, such as an online provider registry, our scheduling vendor's own online solution, and a custom solution. We are leaning towards the custom solution, as that gives us the most control to be able to do what we want, to implement the exact solution we need, and to own the solution going forward so we can add features and make changes, and it has the lowest upfront and maintenance costs.

We are planning on using our EMR's existing patient portal by sending available appointment slots to the EMR's app/website through the interface and letting enrolled patients book appointments with their providers. Another portion of this project will be to allow existing patients to book appointments with any provider in our system when they are referred to that provider by their PCP, such as to a cardiologist. This would not be restricted to primary care providers who work for my organization, allowing any PCP to not only refer a patient into our system, but to log into the website and book the appointment while the patient is standing in the PCP's office and submit the referral with a click of the button. We also plan on offering new patients the ability to schedule new appointments with PCPs, after some level of an identification and security process.

My organization has plans to resume ICD-10 testing around six months before the new date that is cast in stone. If there is a hint the new date might change again, the feeling will be one of "crying wolf" and the organization will not ramp up as much or as far ahead of the date as we did when we were aiming to make the October 2014 compliance date. In the meantime, we are using the resources available and working on this Patient Access initiative.

Gearing up again will be a waste of time and effort and we will have to retest as if we never got good results the first time. It's a shame that all the effort that went into the original ICD-10 compliance date is now going to be a waste of time. We will need new people, new teams, and new rules to go with the new compliance date. We had a team that worked well; it's going to be hard to recreate that dynamic and get up to speed in a timely manner. We have to get to know the new team members, how they work, and what they require for communication ("Whatcha doing?" may not work with the new team).

It will be a new learning curve that will need to be climbed again, when it all could have been almost over and done by now.

Has meeting regulatory requirements gone from high priority to the only priority for healthcare IT? Read Health IT Priorities: No Breathing Room, an InformationWeek Healthcare digital issue.

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About the Author(s)

Deborah Graham


Deborah Graham is a senior programmer/analyst at a large hospital system in Massachusetts working in the IT department on the provider practice side of the organization. She has more than 14 years of healthcare IT experience and over 25 years of programming experience in a variety of languages and market segments, including healthcare, high-tech, and desktop publishing. Deborah's current language of choice is Cache ObjectScript (formerly known as M or MUMPS). Her favorite language is LISP. Her future plans include getting an app on Apple's App Store. In her spare time, she serves as the webmaster for her local garden club's site.

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