The Boy Scouts' motto, “Be prepared,” was the condensed message of three health information technology experts at a panel discussion more formally titled “Lessons from the Field: ICD-10 Strategies and Key Findings” at Wednesday's opening session of the College of Healthcare Information Management Executives fall CIO forum in San Antonio.
Preparation key to ICD-10 success
The panelists were Albert Oriol, the chief information officer at Rady Children's Hospital in San Diego; Cassi Birnbaum, director of health information management at Rady; and Carole McEwan, project manager for ICD-10 at the SSM Health Care system based in St. Louis.
Oriol said his organization's leadership was fortunate that it was flagged early by Birnbaum to start preparations for the conversion to ICD-10. Under a federal rule, hospitals, office-based physicians, health plans and claims clearinghouses all must start using the International Classification of Diseases, 10th Revision diagnostic and procedural codes by Oct. 1, 2013.
But to Birnbaum, “We didn't think it was too early. In HIM, we started about 2½ years ago with training and coder awareness.”
Birnbaum said Rady has an advantage in that the shift to ICD-10 will come after the “rapid implementation” of an electronic health-record system and work on a clinical documentation improvement program.
“There were a lot more carrots” dangled in front of staff than just ICD-10, she said.
It has been widely reported that coder productivity nose-dived at hospitals in Canada when it switched to ICD-10 nearly a decade ago.
At Rady, due to all of its advanced work, and some hope that computer-assisted coding will improve efficiency, Birnbaum said the children's hospital should see a short-lived productivity drop of 10% to 15%.
But McEwan is less optimistic.
“We expect an immediate 50% drop,” McEwan said. After the initial six months, “We're hoping that long term it will be under 30%. And I think that's conservative, and I've done a lot of research on that,” she said.
Even with a fully functional EHR and computer-assisted coding, McEwan said, “we don't know how much under” 30% that long-term productivity loss will be, so SSM is preparing now. “We've already begun staffing up.”
Oriel said one “critical decision” that has yet to be made and implemented in concert with the ICD-10 conversion is how to handle upgrades to a scattering of smaller databases within the hospital.
“Because we're an academic institution, we do a lot of research and we have lots of (Microsoft) Access databases all over the place,” Oriel said. “We're going to have to tackle that.” Should the hospital “forget the rinky-dink databases” and require all researchers to use one clinical data warehouse? “That's going to be a tough decision.”
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