ICD-10: CMIOs Can Aid Process
Despite the recent one-year implementation delay to October 2014, ICD-10 should be a top priority for CMIOs over the next two years. G. Daniel Martich, MD, CMIO and VP of physician services at the University of Pittsburgh Medical Center (UPMC), discusses his role in the facility's progress on ICD-10.
We started the initiative in 2011 by forming an ICD-10 executive committee. As you might expect, the financial department is heavily engaged, so our CFO is leading the effort. I, along with our CIO and several business unit colleagues, serve on the executive committee. As CMIO, I'm in charge of the education and training components.
What we've done is learn that ICD-10 is a bigger deal than Y2K as it is real—by contrast—and we feel relieved to have a bit of a reprieve with the year-long extension. We decided that implementation is best broken up into smaller bites. There are education and training components, as well as several other smaller workgroups.
We're currently interviewing and sampling multiple products. We've engaged a consulting firm to help us assess our current state and where gaps are in our ICD-10 preparation.
Multiple individuals need to be educated, not just coders. The biggest educational component is for the physicians, as most don't think about this.
The specificity required by ICD-10 is such that physician documentation really is going to be impacted. There are laterality and acuity aspects that need to be documented. Previously, you could indicate that a patient had congestive heart failure (CHF). That's not enough anymore. The new system will need to know: Is the condition acute or chronic? Left ventricular? Systolic? Physicians haven't typically used documentation such as, "The patient has acute left ventricular systolic dysfunction causing CHF leading to an ejection fraction of 30 percent."
It depends where organizations are in terms of their evolution of EHRs. Assuming individuals have basic EHRs deployed, the big bite for the CMIO is how you can support physicians and other care providers with documentation tools to get to appropriate ICD-10 coding levels.
Also, physicians generally need to do a better job of putting a diagnosis on a patient early in the care process. Care providers need to employ tentative diagnoses earlier, because that drives care pathways that we're designing within the EHR. Those are areas that the CMIO can influence.
If you haven't started this project, start now. It's not too late. Get the education component out there to care providers to create awareness; maybe even frighten them a little. A little scare tactic may be appropriate because most physicians' eyes glaze over when you discuss ICD-10. Finally, be a problem solver. Help physicians come up with solutions for documentation and order sets that are easy for the end user to use.
Can you describe UPMC's ICD-10 implementation?
We started the initiative in 2011 by forming an ICD-10 executive committee. As you might expect, the financial department is heavily engaged, so our CFO is leading the effort. I, along with our CIO and several business unit colleagues, serve on the executive committee. As CMIO, I'm in charge of the education and training components.
What is your ICD-10 implementation status?
What we've done is learn that ICD-10 is a bigger deal than Y2K as it is real—by contrast—and we feel relieved to have a bit of a reprieve with the year-long extension. We decided that implementation is best broken up into smaller bites. There are education and training components, as well as several other smaller workgroups. We're currently interviewing and sampling multiple products. We've engaged a consulting firm to help us assess our current state and where gaps are in our ICD-10 preparation.
In the educational process, what have you discovered?
Multiple individuals need to be educated, not just coders. The biggest educational component is for the physicians, as most don't think about this. The specificity required by ICD-10 is such that physician documentation really is going to be impacted. There are laterality and acuity aspects that need to be documented. Previously, you could indicate that a patient had congestive heart failure (CHF). That's not enough anymore. The new system will need to know: Is the condition acute or chronic? Left ventricular? Systolic? Physicians haven't typically used documentation such as, "The patient has acute left ventricular systolic dysfunction causing CHF leading to an ejection fraction of 30 percent."
How are you executing on the education rollout?
We have an ongoing, widespread awareness campaign, so not only physicians but physician assistants, nurses, as well as the 55,000 UPMC employees, understand this is a broad-reaching project and could affect everyone. If, for some reason, we miss a coding opportunity and the coding doesn't justify the billing, it could significantly impact the bottom line.
What do you see as the CMIO's role in ICD-10 implementation?
It depends where organizations are in terms of their evolution of EHRs. Assuming individuals have basic EHRs deployed, the big bite for the CMIO is how you can support physicians and other care providers with documentation tools to get to appropriate ICD-10 coding levels. Also, physicians generally need to do a better job of putting a diagnosis on a patient early in the care process. Care providers need to employ tentative diagnoses earlier, because that drives care pathways that we're designing within the EHR. Those are areas that the CMIO can influence.