Electronic Health Records

Policy & Regulation News

Bi-directional Communication Affects ICD-10 Implementation

By Vera Gruessner

- The ICD-10 implementation deadline has been delayed twice in the last three years, but seems to be set to take place on October 1, 2015. Some providers are still skeptical and feel that a postponement may happen again. Another delay will further impact hospitals and physician practices.

EHRIntelligence.com recently spoke with Drex DeFord, former CIO of Seattle Children’s Hospital and Scripps Health, and Erik Giesa, Senior Vice President of Marketing and Business Development at ExtraHop, to discuss their viewpoints on preparing for the ICD-10 transition.

“Having been CIO at two different hospitals during the first pass at ICD-10, I think there was a lot of work that went into the initial preparation,” DeFord begins. “As we got closer to that first ICD-10 date and there was more talk about it being delayed, and now it’s going to be more of a ‘boy who cried wolf’ situation and sure enough that happened.”

“If nothing else, it gave those who were the true laggers time to catch up. I think most of [providers] really didn’t think that another delay was going to happen. When I talk to my peers across healthcare, they’re really in a good spot.”

It seems that the prior ICD-10 delays allowed for providers to get completely ready for the coming transition. Currently, clinical documentation standards are mostly set in place and the majority of medical facilities have begun testing their ICD-10 compliant systems.

“I think there’s still a lot of folks who are wondering if somebody will slip in one of the ICD-10 delays into some legislation that doesn’t necessarily have to do with ICD-10. I think there’s still some skepticism out there about whether ICD-10 will be delayed or not. For the most part, we hope not,” DeFord concluded.

Erik Giesa mentioned how the majority of providers have invested a fair amount of time and money into the ICD-10 implementation and now feel truly ready to transition to the new coding set. ExtraHop offers a new tool – the ICD-10 Audit Bundle – to further prepare providers for the final steps in the transition.

“It’s not just a conversion, it’s also making sure that the same workflows that were in place prior to conversion will maintain and continue post-conversion. I think most people are ready to go and they need to prove it as well,” Giesa said, adding that there are benefits to tools that determine whether systems are truly ICD-10 compliant.

When asked about some of the biggest challenges facing providers during the ICD-10 transition, Giesa stated that the conversion is based on the underlying applications, which are essentially a “black box” to providers and payers. The most difficult challenges seem to be the underlying applications themselves.

“From my vantage point, the conversion itself is based on the underlying applications that use those codes,” Giesa said. “Whether it’s the EHR, clinical applications, or ambulatory care, those applications are a ‘black box.’ All of the interfaces and modules are based on the knowledge and purview of the vendors themselves.”

“Healthcare organizations can be overly dependent on those vendors to make sure the interfaces are working properly and performing well. There’s this desire to get back control. And put control and accountability back to the CIO and their team.”

Drex DeFord agreed: “The vendors and their applications are often ‘black boxes’ to CIOs, so having the ability to see what the traffic is in and out of those ‘black boxes’ is critical to feel comfortable that the testing is going as well as hoped.”

“Having the ability to look at your entire network and see where those codes are transiting the wire, that’s actually a very important piece for making sure you’re not surprised on the ICD-10 Go Live day,” DeFord said.

When it comes to best practices for integrating the new coding set, Giesa said that “it starts with auto-discovering.” Be sure to answer the question, ‘who’s using ICD-9 codes?’

“Auto-discover everything that’s communicating ICD-9. Where is it? What application is generating? Which application is consuming it? How many are being generated from where? And at what volume?” Giesa said.

Afterward you will be able to see all of the message types and where they come from. This can help providers prioritize their efforts and ensure that they have the necessary resources deployed for critical messages.

Continuing on best practices, Giesa mentions the importance of team building. “Organizing the people and the processes around tackling the ICD-10 conversion and building the teams to do so” is vital for healthcare organizations around the country.

“On the people and process side, from a best practice perspective, one of the biggest things was clinical documentation improvement,” DeFord said. “Being able to completely document everything that you could document in the medical records so that it could be coded properly. That was one of the biggest people and process efforts we had under way.”

In order to avoid payment delays once the ICD-10 integration is underway starting on October 1, the two experts suggest constant monitoring of messages. Tracking bi-directional communication and receiving acknowledgement from the payer is key in ensuring that claims do not slip through the cracks.

“Having the right architecture and platform in place to make sense of the dependency, inter-relationships, the transactions themselves between applications, these all map back to patient quality in care, [healthcare] access, and safety,” Giesa concluded.



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