Physician’s offices, hospitals and healthcare facilities are working hard to meet the requirements of healthcare reforms and are finding that they need to deploy multiple technology projects to meet these requirements. To further complicate matters, October 2015 is the deadline for completing the migration from medical coding using the ICD-9 format to ICD-10. Failure to comply will result in serious financial consequences.
When Long Island’s largest healthcare system needed to ensure a smooth transition to ICD-10 coding at multiple ambulatory practice centers, they turned to Custom Computer Specialists (Custom). Custom is a technology solution provider that works closely with healthcare organizations throughout the Northeast helping them implement the technology needed to remain in compliance with healthcare regulations while meeting the needs of their staff and patients.
Managing a Complex Migration
The tenth revision of the International Statistical Classification of Diseases and Related Health Problems, ICD-10, contains a staggering number of medical diagnosis codes (68,000) and procedure codes (87,000) compared to its predecessor, which contained only 14,000 diagnosis codes and 4,000 procedure codes. The increase in the number of codes will allow healthcare organizations to capture far more granular data about symptoms, risk factors, and commodities; which should result in dramatic improvements to patient care, clinical and billing accuracy and disease tracking and trending.
A successful ICD-10 migration depends on careful planning and analysis. Differences in the two code sets require a complex conversion including upgrades to the technology systems that capture, report and manage diagnosis codes, particularly the electronic medical record (EMR). The Long Island-based healthcare system, which also serves the residents of Manhattan, Queens and Staten Island with a large network of community, specialty, tertiary and affiliate hospitals and ambulatory and physician practices, was committed to complete the ICD-10 migration in 2014. “This was a very highly visible project across the client organization,” says Tom Franson, Director at Custom. “The CIO told us that the three top priorities for 2014 were ICD-10, ICD-10 and ICD-10.”
The health system, which had an existing relationship with Custom’s managed services division, made the strategic decision to outsource the ICD-10 migration of 27 of its ambulatory medical practices. “From a regulatory perspective, the organization bears liability if a practice fails to comply,” explains Franson. “To ensure consistent compliance across practices and reduce its exposure, the health system decided to work with us.”
ICD-10 Migration, Step by Step
Custom’s five-step process simplified the complex transition to ICD-10.
Step 1: Assessment. The first step was to perform individual practice assessments. Custom IT experts determined which systems and workflows would be impacted by the ICD-10 upgrade. This included developing a list of involved vendors and systems and working with the practice to evaluate the impact of the deployment on different employees and functional areas.
Step 2: Gap Analysis. Since each practice used a specific EMR, customized to meet the needs of their practice and providers, the next step was an EMR gap analysis. The implementation involved approximately 20 different EMR applications from multiple EMR vendors. The gap analysis revealed the availability of ICD-10 upgrades for each EMR, determined the system requirements for the pending transition and identified equipment and technology that needed refreshing.
Step 3: Remediation Plan. Based on the results of the assessment and gap analysis, Custom’s technology experts developed remediation plans that included hardware upgrades for desktops and servers, and software changes to operating systems, desktops, servers and networks. The assessments, gap analyses and remediation plans were provided to the health system, which approved the remediation work and the purchase of new hardware and software.
Step 4: EMR Upgrade. The EMR upgrade is perhaps the most complex step, because it requires a high level of coordination among multiple vendors. Each vendor had different release dates, system requirements and technology and support resources. Custom worked directly with the vendors to determine product release dates, purchase and install new hardware and software and manage the deployment of the new ICD-10 code databases into the EMRs.
Step 5: Testing and Training. Finally, to ensure clinical accuracy and proper reimbursement, the practice staff had to be trained to navigate the ICD-10 database and to send and use the new codes. Before going live with the new ICD-10 codes, Custom had to test the new version of the EMR applications to make sure that transactions could be correctly sent to insurers, billing services, clearinghouses and the Centers for Medicaid and Medicare Services (CMS).