Planning Forward For the ICD-10 Transition in a Multi-Hospital System

April 9, 2013
Moving forward to make the transition from the ICD-9 coding system to the ICD-10 system, as mandated by federal authorities, is no easy feat. Indeed, even the largest and most sophisticated patient care organizations face multiple challenges as they navigate the numerous issues embedded in the change.

Moving forward to make the transition from the ICD-9 coding system to the ICD-10 system, as mandated by federal authorities, is no easy feat. Indeed, even the largest and most sophisticated patient care organizations face multiple challenges as they navigate the numerous issues embedded in the change. At the 20-hospital University of Pittsburgh Medical Center (UPMC) health system in Pennsylvania, CMIO G. Daniel Martich, M.D. is helping to lead his fellow clinicians, informaticists, and others at the UPMC organization to move into and through the transition.HCI Editor-in-Chief Mark Hagland spoke recently with Dr. Martich regarding the transition process taking place at UPMC. Below are excerpts from that interview.

Where are you right now in terms of your ICD-10 preparation?

In late spring, we kicked off our executive management steering committee on ICD-10, which is being chaired by the system CFO, but includes individuals from every one of our business groups. I’m on the steering committee. There are about 10 of us altogether, including, for instance, the COO of the health plan, the CFO for the system, the CFO for the hospital and community services division, a representative from our long-term care, etc. And our health system CIO Dan Drawbaugh is on the committee, too, of course.

G. Daniel Martich, M.D.

And how often are you meeting?

Right now, the executive committee is meeting monthly. And, working under its oversight are four main workgroups, whose work spans all the task areas, with subgroups of various types. For example, we’ve got an education/communication workgroup, with representatives from every group that does anything with education or communication, and I chair that group. We also have a process workgroup that is focused on understanding the workflow changes needed in each particular business unit and area, including assessing opportunities for process improvement as we transition, as well as any risks. And we have operational managers who are the enterprise project managers for the project in toto. On the process side, the COO of our health plan is the chair of that workgroup.

And then there are other levels of workgroups, correct?

That’s right. We’re a matrixed organization, so for example, within the physician services division, we have another set of workgroups, covering the academic sites, the non-academic sites, and Children’s Hospital of Pittsburgh. Altogether, there are four workgroups within physician services, and another four within the hospital division. Some of those are specific to location and some are specific to position. And each of the subgroups addresses the needs of particular groups of clinicians and others, for example, hospital-based coders; and we have a nurse education workgroup.

Where are you overall in terms of your progress?

We’ve probably taken a few steps forward so far on the ‘journey of a thousand miles’; we’ve kicked off each of the working groups, and the sub-working groups have kicked off. Have we rolled up our sleeves? No, not yet. We’re in the midst of vendor selection right now related to computer-assisted coding solutions, for example. One area where we’ve made progress is with something called Intelligent Medical Objects, which is a tool that can be embedded into Epic, Cerner, or any EMR. Ten days ago, we installed IMO into EpiCare. And what it does is it says, for example, this patient has diabetes with eye involvement; and IMO goes into the database and finds the appropriate ICD-9 code; and the promise is that eventually it will help clinicians search for the appropriate ICD-10 codes.

And everyone using it is loving it. We’ll probably be going live with it in Cerner, our inpatient EMR, starting next spring, while we’re live now already on the physician practice side. And [computer-assisted coding] helps in the visit coding, and has been quite beneficial so far. [The solution we’re using] doesn’t do the fancier parts of the computer-assisted coding; we’re working through those discussions now, and we’ve already demoed each of the products we’re interested in.

What do you see as the biggest challenges right now, both for UPMC and across the industry, as you talk to other CMIOs?

I actually think that the biggest challenge is educating the users about how this will improve productivity. Most physicians don’t have a full awareness of ICD-10, or even if they’re aware of ICD-10 coming in the next couple of years, they fail to connect the dots on how this will affect them. And we hope to do concurrent coding, so that on the back end, an inpatient coder can say, Dr. A or Surgeon B, you need to clarify this point for us, and not put a fist through the computer or go down and punch that person in the nose. We need to get to efficiency so that we’re prepared for Oct. 1, 2013.

It seems to me that there’s great potential for care delivery improvement with ICD-10, right? And perhaps this isn’t clear to a lot of people in healthcare yet?

I think you hit it on the mark; organizations that are used to doing data analytics are saying, perhaps this might be another tool in the tool belt around data analytics, yes. But what it really does is that it creates a bit of a game-changer in terms of what insurers can do around data; it will allow our largest insurer, the government, to understand what the highest-volume diagnoses are; it will allow a certain amount more of granularity with regard to procedures. So I think it will provide on a macro level a greater ability to do data analytics, and it will be a game-changer for CMS and other large insurers, to better understand where their dollars are going.

What would your advice be to other CIOs and CMIOs right now?

It goes back to the ‘get started’ talk. You’ve got to get started; because even the AMA were successful—and I can’t imagine they would be—in getting the date changed [referring here to the American Medical Association’s petitioning the federal government to delay the Oct. 1, 2013 required transition date], people have got to get going on this. So I don’t see the U.S. government changing their requirements at all. To a certain extent, this is an ‘aha’ moment, and some people get cold feet at that moment. But unless there’s the pressure of the deadline, things don’t happen. Of course, there are a lot of things being thrown at us at the same time, and it’s a lot of changes to deal with. And certainly, on a micro level, my colleagues and friends the doctors, feel as though this is yet another thing added to their to-do lists. But we want to give them the tools to make them more successful in their practice, and ease them into this. And you’ll see, as we draw closer to 2013, that computer-assisted coding technologies and products will become more and more prevalent.

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