Party Like it’s 2013: Three Sobering ICD-10 Workflow Realities – and Three Ways to Address Them Now

In October 2013, the ICD-10 diagnostic code set will officially replace ICD-9 for all billing claims submitted by providers. With nearly ten times the number of codes as its predecessor – and every code itself growing to a longer, alphanumeric format – ICD-10 will require exponentially greater detail to be entered into every patient record and every physician and hospital bill.

Coders aren’t the only ones who will be disrupted by ICD-10. The transition could be painful for HIM directors, CFOs, CIOs, physicians and anyone else with financial, clinical, administrative or technical responsibility – at hospitals as well as in professional practice settings.

From a document workflow perspective, what will our lives look like on 10/1/2013? My crystal ball isn’t the greatest – if it were I’d be buying tickets for tomorrow’s Powerball drawing right now – but here are three “new realities” I think are a lock:

The demands on physician documentation have skyrocketed.

ICD-10 is more than an expanded set of codes. It’s the framework for a much more detailed patient record than we’ve ever had before. The ICD-10 codeset requires physicians to document items such as laterality, stages of healing, previous episodes of care and many others.

To support this new level of detail, physician documentation must be sufficiently comprehensive, highly legible and extremely accurate.

Communication among the care team must be instantaneous and seamless.

A little math: ICD-9 contains approximately 17,000 codes. According to CMS, ICD-10 will have about 140,000 codes.

Now, picture coders sifting through paper-based documentation, poring through transcribed notes and scrambling to contact physicians to flesh out all the details they need to complete a charge. Think about how long that process can take today, using these legacy documentation methods.

In 2013, every bill must contain nearly ten times the amount of clarity and detail based on the numbers above. Without a platform that facilitates real-time, concurrent information access and communication between physicians, coders and the rest of the care team, documentation review and billing could take ten times as long as it does today.

Physicians are critical to a successful ICD-10 document workflow.

Over the next two-plus years, the average hospital will invest thousands of staff hours and millions of dollars overhauling their documentation and billing workflows in preparation for ICD-10. How these investments look in October 2013 depends a great deal on how they’ve improved the lives of physicians.

In absolute terms, ICD-10 is much more a game-changer for coders than it is for physicians. But as the source of the myriad new data being collected under ICD-10, physicians hold the keys to achieving a truly streamlined and accurate document workflow. Technology solutions that fail to address workflow improvement for physicians, or minimize the impact of the physician workflow on downstream processes, will be hard-pressed to deliver the value they promise once we’re awash in the data demands of ICD-10.

Predicting doom and gloom for ICD-10 is a popular sport right now in healthcare IT. But despite the relatively compressed timeframe, your transition to ICD-10 is not a one-way ticket to a frustrating and painful destination. Let’s set our future shock aside for a minute and look at three opportunities to achieve a successful transition for everyone in the documentation chain of command.

Document improvement must start at the point-of-care.

Staff training for ICD-10 is a hot topic right now, with most of the attention focused on getting coders and CDI specialists ramped up for the transition. But what about physicians?

Let’s be realistic: Physicians have too much on their plates every day to participate in a rigorous ICD-10 training. Everyone in the room, from the physicians and the CIO to the HIM director, understands this. That’s why many physicians assume that the CIO will cook up some new documentation system to handle everything on the back end, while they’ll continue authoring notes as they always have. For the CIO, the alternative is to force every physician to participate in formal training weeks, if not months, in advance of the ICD-10 changeover.

Either of those routes is a disaster waiting to happen.

With an explosion of new codes to use, legacy documentation methods such as paper and dictation simply cannot support the speed and accuracy ICD-10 demands. The only way physicians will stay above water is by using tools that help them improve their documentation as they author it. Computer-assisted coding solutions that enable physicians to identify ICD-10 codes at the point-of-care help them create accurate and comprehensive documentation without compromising speed or comfort.

Solutions should support practice billing and other external data requirements.

Clinical documentation doesn’t exist in a vacuum. Within most hospitals, documentation should be readily accessible to users in a variety of areas: hospital billing, administration, quality reporting, risk management and more. There are also external users, such as professional practices, that demand access to documentation for billing and other administrative purposes.

For practice administrators, revenue cycle disruption during and after the ICD-10 transition is a huge concern. Given the increased size and complexity of the ICD-10 codeset, technology solutions that integrate easily with both hospital and practice billing systems will help ease the transition and allay billing concerns for everyone involved.

Physician adoption must be a top priority.

For CIOs and HIM directors, perhaps the biggest challenge of the ICD-10 transition is minimizing disruption of the physician workflow while obtaining documentation with sufficient legibility, accuracy, detail and clarity. The severity of the challenge rises exponentially with each distinct documentation method you must support.

Once ICD-10 is here, physicians cannot limp along using paper and dictation-based documentation methods. Providers simply will no longer be able to afford the manpower required to code and review nearly ten times the level of detail using these manual systems. Documentation tools that deliver computer-assisted coding in some fashion are essential to an effective and efficient ICD-10 coding workflow.

By giving physicians tools that allow them to customize their own notes, providers give themselves their best opportunity to achieve high rates of physician adoption. Flexible, customizable electronic documentation solutions empower physicians to create document structures that streamline review and billing processes, saving everyone time and aggravation and helping both practice and provider capture increased revenue.

No matter your perspective – financial, clinical, administrative or technical – the transition to ICD-10 will create seismic change across the spectrum of healthcare delivery. But with the right tools implemented at the right time, providers and practices can facilitate an organized and efficient transition to ICD-10 for physicians, coders, practice administrators and the rest of the care team.