If you haven’t heard of ICD-10 by now, you’ve probably been living under a rock. Though CMS has talked about the impending implementation of ICD-10 like a boy crying “Wolf!,” the days of false alarms are over—at least that’s what the experts are saying. That’s right: it’s finally happening, folks. And the mandatory transition to the new diagnosis code set will be here before we know it (even if it is 20 years late). Let’s take a short break from your preparations for the switch to ICD-10 to review how we got here and how we can learn from those who’ve “been there, done that.” While this history lesson won’t be nearly as entertaining as an episode of Drunk History, it will give you a better understanding of our long—but necessary—road to ICD-10 (feel free to have a drink anyway).
Boy Meets World Health Organization
It all started with WHO (sadly, not this one). I’m talking about the World Health Organization, the public health sector of the United Nations, which is responsible for the development of International Classification of Diseases code sets, including the outdated and limited ICD-9 and its updated, more comprehensive successor, ICD-10. The WHO began developing the new and improved code set all the way back in 1983, but it didn’t get the final seal of approval until many years later.
The 43rd WHO assembly finally endorsed ICD-10 in May 1990, and the WHO released the full ICD-10 code set in 1994, just one year after Boy Meets World hit the airwaves. Remember that show? It’s been more than 20 years since Cory and Topanga first met. Now those love birds have a daughter in seventh grade, and the WHO is preparing to release ICD-11 in 2017—and the US still hasn’t adopted ICD-10.
However, many other countries did adopt from the ICD-10 cabbage patch—and in a much more timely fashion. According to a CMS ICD-10 overview presentation, 99 countries currently use ICD-10 to report morbidity, including all of the United Kingdom (1995), France (1997), Australia (1998), Germany (2000), and our friendly neighbor to the north, Canada (2001). Currently, the US only uses ICD-10 to report mortality on death certificates. Needless to say, we’re behind the times.
But that’s not all bad news. Our habit of procrastination also has given us the opportunity to learn from what other countries have experienced during their own transitions to ICD-10.
Toto, We’re Not in Kansas, Anymore
For example, Australia—one of the earlier adopters—is an excellent role model for the US to follow as we prepare for the switch. According to an article from the American Health Information Management Association (AHIMA), the Australian National Centre for Classification in Health (NCCH), which “planned the transition [and] conducted code review,” valued training so greatly that it formed an Education Working Party to conduct coder education. It spent years preparing clinical coders for the new code set: “Between 1995 and 1999, the NCCH prepared education material and ran 81 courses during 130 days for 2,423 participants in all states of Australia and New Zealand.”
Not only did the NCCH offer workshops involving “‘train the trainer’ sessions, face-to-face workshops with clinical coders, and workshops for all users of the classification,” but it also conducted a survey to determine where coders needed more education and then offered “a series of 13 Post-Implementation Workshops” to help “clarify particular issues raised in the surveys and through the NCCH query process.”
After all those years of education and re-education, the NCCH found that its coders needed at least “12 weeks to learn the codes and six months for them to get comfortable with ICD-10.” With that level of training, coders were able to get back to normal productivity levels just “four to six months after implementation.” Moreover, the same AHIMA article indicates that the NCCH’s commitment to education was matched by its clinical coders’ eagerness to learn and willingness to adapt its systems and technology, which played a huge role in Australia’s success.
Other countries had less successful implementations—like Canada, whose lack of education, early involvement, and technical readiness (among other issues) resulted in an uncomfortable and costly implementation process that lowered productivity—permanently.
So, what’s a clinic to do?
Now that it’s our turn to take a swing at ICD-10, we’d be wise to follow Australia’s game plan. As a provider, that means you should model your own plan—assuming you have one, which you should—after that formula for success, making adjustments as necessary. Given Australia’s experience, you should allow your staff no fewer than six months to truly understand ICD-10—to the point that they could train new members of your staff, if need be.
We’re just over seven months away from October 1, 2015, so it’s in your best interest to start educating yourself and your staff as soon as possible—and not just on the new code set. To improve your chances for a smooth transition, be sure your staff is comfortable with technology, too—and that you’re using the right software for the job. To get ahead of the ICD-10 curveball, take a cue from the land down under. With proper planning, education, and software, you and your clinic will be ready to swing for the fences come October.