Deadline ICD-10: Y2K all over again?

Dec. 24, 2010

There are five critical areas to address when planning the shift to ICD-10.

The deadline set by the Department of Health and Human Services for U.S. health records systems to implement the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is Sept. 30, 2013. But ICD-10 is considered by many experts to be the Y2K of the U.S. healthcare industry — and just as the computer industry had to mobilize a massive effort to avoid the consequences of inaction, healthcare providers have just three years to undertake the systems overhaul needed to make the change.

The usefulness of moving to ICD-10 (growing from the current 17,000 numeric codes to more than 141,000 alpha-numeric codes) lies in the granularity of information that can be provided on diseases and their treatment, potentially leading to more effective tracking of outbreaks, better and more timely treatments and even cost savings, as practitioners can zero in on what works best. This is why many countries' health systems have already moved to the new coding standard.

Despite the benefits of making the shift to ICD-10, many U.S. health-related organizations have yet to begin even planning for the change. Like the massive undertaking in the computer industry to address the threat of Y2K failings, the healthcare industry has a choice between time and money — if you don't have the time, you've got to spend the money.

It doesn't have to be this way
This is an issue that the CEOs need to own: They are the only ones who can survey the organizational landscape, identify which systems need modification, provide leadership where collaboration with outside entities is required, communicate with all the affected parties regarding the changes ahead and how different communities of interest will be affected, identify what resources can be applied, and commit the funds to make it happen. There are five critical areas to address:

The current landscape
Not surprisingly, the use of ICD codes extends far beyond medical records. The first step to successful implementation is understanding all the ways that the current system, ICD-9, touches records systems. The chief technology officer has to assess existing systems to identify which ones will be affected by the change. At the same time, the chief financial officer should look at how the change will affect billing, insurance carriers, physician practices and patients.

Modifying the systems
One painful aspect of the U.S. healthcare delivery system is a lack of standardized systems; every hospital, clinic, private practice, insurance company and pharmacy has something uniquely tailored to its situation. The designated project lead must reach out to all the organization's partners, clients and vendors to identify what changes are needed and who will be responsible for making them. It is not as easy as simply asking that the ICD coding field be made bigger to accommodate the longer ICD-10 numbers. Any programmer will tell you that introducing such a change will have unforeseen ripple effects throughout the software. There will need to be contract modifications with specific plans and manpower commitments from software providers. The sooner the CEO gets these in place — allowing more time for the work, including testing, evaluation, revisions, more testing and evaluation — the less it will cost in the long run.

Available resources
With the perception of a long lead time, many CEOs may consider it more cost effective to undertake the changes in-house. The IT division leadership should know whether its employees possess the skills and knowledge to take on the project, or whether the organization would be better served by hiring new employees or contracting out the work.

Given the importance of getting ICD-10 implementation done correctly by the deadline, this will take active involvement by the leadership team, with tangible milestones that can indicate if the project is on track.

This is an easy aspect to overlook, but just as critical to success as all the other components. Change is always hard, and if funds have to be diverted from one part of the organization to invest in the ICD-10 project, there will be resistance. Physicians may be eager for the information that ICD-10 will provide but not realize there will be changes in the systems they are now comfortable using. Only the CEO can speak to all the different — and, occasionally, competing — communities within the organization and lay out the reasons for the change and why it is worth the cost in money, time and routines.

It's a hard truth of the healthcare industry: Finding the funds for any project not directly related to patient care is a challenge. Again, however, having three years to make the change allows for greater flexibility. The CFO can help by providing an estimated return on investment. If the organization starts now, what is the burn rate? How prepared will it be for the change versus starting later, burning through more resources faster and running a higher risk of missing the deadline?

Training coders
You may have noticed there's been no mention of training the coders, the people who actually will be most affected on a day-to-day basis by the shift. This is actually one of the easier aspects of moving to ICD-10.
The training on the new coding needs to be done fairly close to the implementation deadline (four to six months in advance); any earlier and they may need refresher training.

The American Academy of Professional Coders ( devotes an entire section of its Web site to ICD-10. There's even a countdown clock to show how many days, hours, minutes and seconds are left before the shift must take place.

Commit now to ease implementation
ICD-10 is coming, whether your organization is prepared for it or not. With it comes the prospect of improved diagnosis and treatment that can save patients' lives. Getting there may be a challenge, but it doesn't have to be a hasty, costly process.
If the leadership of every organization is willing to step up and commit now all necessary resources to planning, then implementation will become an orderly transition.

Greg Moore is vice president of health IT solutions, TechTeam Government Solutions.
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