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Electronic Health Record
Six Months In: Preparation Eased Community Hospital Transition to ICD-10

by Beth Kim, VP of Revenue Integrity, CHC


October 1, 2015, was a much-anticipated day for the U.S. healthcare system. It was the final compliance date for the shift from ICD-9 to ICD-10, a set of codes used to report diagnoses and inpatient procedures to identify health trends and track morbidity and mortality. The Centers for Medicare and Medicaid Services (CMS) characterized the change as “more than an update, a leap in how we define care.”


Physicians, hospitals and health insurance companies rely on these codes for diagnosing patients and billing for services. ICD-9 had been used since 1979 with periodic updates. ICD-10 would introduce 69,000 diagnosis codes from the previous 14,000. Originally set to take effect on October 1, 2014, the deadline for implementation was pushed to Oct. 1, 2015.


How It Fared


Despite some trepidation and anxiety, transition to ICD-10 went more smoothly than expected on both the provider and payor sides. Many billing elements remained fairly constant pre- and post-transition, including claims submissions, rejections and denial rates. Early reports suggest there have been no major disruptions in claim submissions and payment for providers, or a significant productivity drain. The delay in the implementation date allowed extra time for preparation, communication and training, decreasing the risk of major problems.


Readiness Makes All the Difference


To help hospitals get ready for the change, CHC’s support focused on communication, education and teamwork. Preparation and collaboration would be critical in making the move to the new system. Some of the steps to a less worrisome ICD-10 implementation included:

  • Formation of interdisciplinary hospital teams with representatives from various departments — not just medical records coders;
  • Monthly group calls for hospitals to share and discuss information and best practices;
  • Monthly meetings with individual hospitals to discuss project and action plans prior to the go-live date;
  • Collaborative testing with payors;
  • Development of contingency plans including safety net resources built into hospital budgets, such as contracting with coding companies to handle any potential work overload;
  • Online ICD-10 health education not only for coders but all affected parties;
  • Offering user-friendly apps for physicians;
  • Dual-coding exercises, focusing on hospitals’ highest-volume cases.

Looking ahead


Although data related to the actual impact of ICD-10 (positive or negative) is currently limited, one thing is clear: the critical role of documentation in the ICD-10 coding set. For instance, similar injuries on opposite limbs cannot be accounted for in ICD-9; with ICD-10, different injuries or varying severities of medical conditions can be coded. The bottom line is that enhancing documentation can lead to better, more efficient patient care. Documentation also gives valuable information to health care providers providing follow-up care to patients. Clinical document improvement (CDI) programs can be added to a hospital’s tool kit for staff education.


Finally, change is constant. A code freeze has been in effect to help manage the transition to ICD-10; however, regular updates to ICD-10 code sets will begin on Oct. 1, 2016, to account for new technologies and diseases. Implementation of an estimated 1,900 diagnosis and 3,600 new procedure codes are scheduled when the freeze lifts.


CHC takes a collaborative approach with clients to help them navigate change, such as ICD-10 implementation. Learn more about CHC Revenue Cycle Assessment offerings including coding and related support services.

Tags: Coding, Electronic Health Record, Healthcare Reform , ICD-10
Evaluate Your EHR for Improved Quality

by Amy Boykin, SVP Quality, Patient Safety and Care Management, CHC


Across the country, hospitals continue to make significant investments in the implementation, enhancement and use of electronic health records (EHRs). The use of EHRs to coordinate and share more complete patient information is widely recognized as a way to improve quality of care and patient safety. However, EHRs can also be a new source of medical errors with the potential for patient harm.


Inherent EHR challenges


A study in the Journal of the American Medical Informatics Association found that a majority of safety events identified in an earlier RAND Health study resulted from the EHR itself, rather than user error. Triggers include:


• Unmet display needs. Information presented on the screen did not address the clinical needs of the end user.


• Consequences of software modifications, including improperly configured software, upgrades and out-of-date software.


• Data exchange failures. Patient safety was compromised through poor patient-matching during data exchange or an inability to get necessary information from another hospital’s system during an emergency.


• Hidden dependencies within the EHR. For example, when an inpatient was transferred to an outpatient area temporarily, medication information was automatically deleted when the patient returned to the inpatient setting.


• Pre-populated default clinical information, such as “within normal limits,” can increase the risk of adverse events — and increase the risk of non-compliance with hospital and Medicare accreditation standards. Improper use of default function clinical information put patients and hospitals at risk. CMS surveyors finding inconsistencies may cite an immediate jeopardy finding and recommend termination from the Medicare program.


Mitigating risk: recommendations and resources


Recognizing these potential EHR risks, in March 2015 the Joint Commission released guidelines to prevent adverse events. Sentinel Event Alert #54 offered three key recommendations.

  • Safety culture. Create and maintain an organization-wide culture of safety, reliability and effective change management.
  • Process improvement. Develop a proactive approach to process improvement that includes assessing patient safety risks through tools such as Failure Mode and Effects Analysis (FMEA).
  • Leadership. Enlist multidisciplinary representation and support in providing oversight for health information technology planning, implementation and evaluation.

Additionally, the U.S. Office of the National Coordinator for Health Information Technology developed Safety Assurance Factors for EHR Resilience (SAFER) guides to help hospitals and healthcare organizations complete self-assessments to optimize quality of care and patient safety through the use of EHRs.


Put technology to good use


The EHR can improve quality of care and enhance the efficiency of documentation from physicians, nurses and members of the patient care team. Use the resources identified here to self-evaluate your EHR in order to identify and improve work processes and systems to prevent potential patient harm.


Learn more about CHC Information Technology services including technology assessment, the EHR and Meaningful Use incentives.

Tags: Electronic Health Record, Meaningful Use

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