ICD-10: The Time is Now

The recent announcement from the Department of Health and Human Services on the delay of mandated ICD-10 compliance to October 2014 has elicited feedback from both sides of the coin – some are thankful to have additional time to consider the transition, others are frustrated as they see this delay as indicative of slower adoption of broader health IT initiatives. With the compliance deadline now set in stone, providers have bonustime to consider how best to make this transition work for them.  While it may seem like you’ve been given a green light to focus on other priorities, the time to embrace this change is now and physicians can and will play an active role in this effort.

Finding the Right Solutions

As a doctor and CMIO, I know the frustrations faced day-in and day-out when it comes to finding the right combination of technologies to address compliance-related issues, like ICD-10.  Moreover, I realize the importance and time associated with weighing the pros and cons of each and every solution;the details that must be considered with the subsequent roll-out; andfinally, the actual adoption of these solutions by physician users.  To help provide some guidance as you get smart about the changes associated with ICD-10, I wanted to share some of my own go-to resources.

Instead of viewing ICD-10 compliance as a headache, let’s think of it as an opportunity.  With the right tools and staff in place, you’ll be able to take advantage of everything that ICD-10 offers – including improved quality of care, more timely reimbursements, and smarter disease and care management.  The key to getting your arms around ICD-10 is understanding that this change can be managed by adopting cutting-edge practices and technologies far in advance of the deadline.

As a starting place, you should consider leveraging tools like HIMSS’ ICD-10 Playbook and CMS.gov, and also sign-up for the ICD-10 Watch newsletter.  As far as social media is concerned, I’d recommend following@Brad_Justus and leveraging the #ICD10 hashtag on Twitter for some real-time commentary.  Additionally, look for opportunities to learn from your peers whether at trade shows, through personal connections or via web-based interviews with industry leaders.  One educational podcast worth viewingto get a more holistic view of the changes associated with ICD-10 involves the University of Utah Hospitals and Clinics (UUHC).  I’ll talk more about how they’re using clinical documentation and coding technologies to streamline the transition to ICD-10 later so as to provide a broader understanding of the moving pieces involved in this transition.

Clinical Documentation: Friend vs. Foe

For as long as I can remember, clinical documentation has been “the ugly step child;”a necessary evil as it relates to the patient care process.  Today, technology is making the actual capture of patient data less formidable and voice recognition is one key solution that physicians are using to streamline the input of this data, both structured and unstructured.  In just a short time, we’ve come a long way in clinical documentation –from paper to typing to leveraging mobile devices and speech recognition to populate the patient note.  Now, advancements in the iPad and the related digital health revolutionarespurring a major transformation in the way we, as physicians, document and approach the care process from patient visit to future large patient population analysis and trend reporting.

The frustrations surrounding the ICD-10 transition map back to the current pain associated with time and resource drain related to documentation and coding.  But with new challenges come new solutions aimed at addressing these frustrations.  As mentioned, speech is already streamlining the capture of patient data for physicians.  Now, automated clinical language understanding technologies aimed at ensuring real-time appropriate documentation related to adhering to ICD-10 coding changes are available.  These clinical language understanding (CLU) solutions help take clinical documentation hurdles from friend to foe by acting as a medical assistant of sorts and prompting physicians for additional information to ensure a more complete, timely coding process on the back end.

Real-world Application: University of Utah Hospitals and Clinics

There’s plenty of insight to be found on the Internet as it relates to how technology can aid in the transition to ICD-10.  Instead of doing a deep dive on the technology itself, I want to share some insight from one provider already in the throes of the ICD-10 transition– the University of Utah Hospital (UUHC).  Their story helps encapsulatethe complexity and potential associated with this change.

Connie Tohara, Director of Health Information at University of Utah Hospital, believes strongly that the patient narrative holds the key to accurate coding, reimbursement and better patient care associated with the ICD-10.  Without complete patient records, coders will have a more difficult time selecting the appropriate codes (jumping from 17,000 ICD-9 codes to approximately 141,000 codes in ICD-10) that reflect each patient’s care.To help encourage the capture of complete patient notes, Connie is promoting a focus on specificity in documentation and she’s implemented speech recognition to help manage the time and resources associated with the capture of specific patient details by physicians.

In addition, Connie and teamhave established an overarching Clinical Documentation Improvement (CDI) program aimed at enhancing provider understanding of documentation requirements per hospital policy and regulatory requirements. UUHC hasalso adopted CLU solutionsin an effort to first streamline clinical documentation by monitoringphysician documentation continuously and, when necessary, prompting for additional information to ensure all data is being coded by ICD-10 standards.

Understanding the detailsof how speech and CLU solutions fit together as part of the clinical documentation process is crucial for all of the medical community.  As a physician, you need to determinethe best documentationfit for you as it relates to the creation of a complete, unique patient record that’s in-tune with ICD-10 changes.  A deeper appreciation for the documentation and coding process changes associated with the ICD-10 transition will also help paint a picture as to why major time, attention and resources are being spent on enabling this concerted documentation effort.

Speech recognition and clinical language understanding technologies can be used to address knowledge, productivity and workflow issuesassociated with clinical documentation and the transition to ICD-10.  As a physician, you must take ownership of step one in this transitionseriously – the creation of a detailedpatient record. As a key part of the medical community, you play an important role in transitioning to ICD-10 so gettingsmart on the coding changes, technologies, expected protocol and related timeframe for implementation are vital to ensuringthat you’re part of a streamlined approach to this patient-care focused change.



  1. Julie says:

    I recently wrote a similar article about the ICD-10 delay. I hope that the transition can be looked at as an opportunity like you said. Nuesoft recently posted a funny music video parody (of Jay-Z’s 99 Problems) on ICD-10 that I thought you might enjoy– http://www.nuesoft.com/blog/99-problems/

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