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How a Full-Scale ICD-10 Test Helped Flag Transition Issues

By Jennifer Bresnick

- The idea of performing a full-scale ICD-10 transition simulation may seem like a daunting prospect to many healthcare organizations that are still trying to get their impact assessments completed.  But for a handful of Cerner clients, the beginning of October wasn’t about panicking that there is less than a year until the big switch.  It was an opportunity to participate in a comprehensive, week-long mock ICD-10 transition that allowed the organizations to pinpoint potential trouble spots, refine workflows, improve documentation, and get answers to pressing transition questions.

Ken Kilmer, ICD-10 Project Manager at Nash Health Care System in North Carolina and Sam Grefrath, Senior Manager of Compliance Practice at Cerner, sat down with EHRintelligence to discuss the lessons learned from the mock transition and give other healthcare providers some meaningful advice ahead of October 1, 2015.

Why did Nash Health Care decide to participate in the ICD-10 transition event?

Ken: We’ve got a dedicated project team that has been working towards ICD-10 compliance since 2011, so we’ve been looking at this for quite some time, and have endured a couple different delays of the deadline.  The reason that we decided to participate in this cutover test event is because we are pretty proactive.  We remediated our systems early.  We upgraded all of our systems so that they function in an ICD-10 world, and we just really want to stay ahead of the curve.  We understand the importance of testing, and we were excited to participate in the Cerner event.  We felt like it was a great opportunity for us to make sure that we had a good plan for the actual transition.

The event itself is to not only just test our Cerner products specifically.  The event itself is actually to test the entire process of converting our hospital to the ICD-10 world, and it included testing workflow changes that we need to make and testing some processes that fall outside of a normal workflow within the hospital, but are required because of the ICD-10 compliance.

What are some of the steps you took during the cutover test to ensure a smooth transition?

Ken: We needed a detailed activation plan for this event.  Any time you go through a major change like this – and we’ve gone through a lot of projects here at Nash – the more detail you can check off, the less chaos you’re going to endure as you go through your conversion.  Cerner provided some great template information for us.  Before the event, we went through and reviewed all the steps, added some things that were specific to our needs, and made sure we had enough detail in that plan so that pretty much anyone could execute it.

We also developed some test scripts.  This was more than just a test of system configuration changes.  It was actually a test, like I said, of the entire process.  So we had some test scripts that walked through a patient’s encounter with us and was really end-to-end from the beginning of their encounter through to releasing a claim out to the payers.

The feedback we got from the people who have participated in the other aspects of testing was really positive.  They felt that this validated the other types of testing that we had done, and really made them feel like we were ready for the event.  We really focused on putting as much detail as possible into our transition plan documents.  Even if we were to experience staff turnover, whoever came in and replaced a person that has enrolled in the cutover plan would be able just to pick it up and work from the document. because we were able to get that level of detail into it.

So it was a good event because it not only tested the process of converting, but it allowed us to test just the end-to-end capabilities of our systems to produce a claim in an ICD-10 world and to process the patient producing the claim.

Was the event a success from Cerner’s point of view?  What lessons did you learn about the preparedness of your clients?

Sam: We really encouraged all of our clients to participate, knowing that preparation is everything when it comes to ICD-10.  We had a large number of clients, ranging from large health systems to small critical-access hospitals.  So there were a lot of different size providers that participated.

A lot of our participants did have questions as they proceeded through their testing and as they updated the pieces of collateral that they used.  But for the most part, they weren’t actually encountering system issues. Their questions focused more on education.   They had questions around how to configure something or how to change something.  We were actually very easily able to give them the answers they needed so that they could continue on with their testing process.  We had far fewer issues than what we had originally anticipated, given we had not done an event like this before.  So we felt like it was a big success for all of our clients.

One of the things we found was that success had little to do with the size of the organization.  It was really based on how much work had been done to prepare for the event.  So, for the organizations that really took a lot of time and put in the effort to customize their test scripts and to customize their cutover plans and their step-by-step items, those were the clients that had far fewer questions than others that were really just taking a first pass at this.

Coming out of the event, I think the participants feel more prepared – or at least know what to do the next time we do an event like this.  And Cerner is planning to host another testing event in March to align with the CMS acknowledgement testing so we can encourage clients to not only participate in our event but other industry events as well.

After participating in such a thorough simulation, what’s your advice to other providers who are looking to prepare themselves for the  ICD-10 switch?

Ken:  My main advice is to do this type of testing now, if you can.  We were relieved that we participated in this event because we identified some deficiencies in our documentation.  Now that we’ve addressed those, we’re going to have a much better product and a much better plan for the night of activation.  So I would say to other providers that they should do this testing now.  Don’t wait until you’re crowding up against the deadline.

We’re adding another round of testing.  We’re going to participate in the March testing event that Sam referenced, because as we went through this process, we discovered that we had enough questions to cause a few bumps in the process.  We want to try and have a smoother event the next time so we can make sure that we’re more ready, and there’s a little less chaos.

So if you’re a hospital out there and you’re not already thinking about doing this type of testing, then it’s something you should consider.  People just tend to do this right before the event, and I don’t think it’ll give them time to react and prepare the way they could be otherwise.

Sam: I completely agree with Ken.  We have another year, now that the date has been pushed back to 2015, and there is ample time to do some full-scale testing.  We feel that is a key strategy to helping clients ensure that this is one of the biggest, most substantial non-events that happens to our industry in years.  That’s really our goal: to prepare our clients for this challenge.



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