Concerning the transition to ICD-10, healthcare providers face plenty of unknowns, says Jennifer Woodworth, director of the clinical documentation integrity program at
"I think the challenge we're all facing is we don't know what we don't know," she says.
Among Swedish's worries, she lists taking on the right amount of new staff members to handle clinical documentation improvement and keeping the nonprofit organization's accounts receivable and bill hold time from increasing.
Only time will tell the actual impact ICD-10 will have, she says. In the meantime, Swedish has sought to address areas of concern by preparing for ICD-10 implementation methodically and thoroughly.
"We're going to be prepared from A to Z, although we might find out we only needed to be prepared from A to N," Ms. Woodworth says.
Here are four key parts of the Swedish plan to get all the way to "Z" by October 2014.
1. Raise awareness. Swedish has split its ICD-10 preparation process into stages, and the first was increasing awareness, says Ms. Woodworth. October was the designated month of awareness, which involved clinical documentation integrity specialists talking to physicians and making sure they know the extent of the change.
"We had physicians saying that they knew ICD-10 was coming but they weren't going to be part of it," she says. "We know we have our work cut out for us."
2. Give physicians the education they want. The next stage — which took place in November — is action. This involved the CDI team splitting up to cover different specialties and becoming subject matter experts in those areas.
"We feel that having the expertise in each specialty gives the physicians a good point person to go to," Ms. Woodworth says. "It becomes a two-way conversation. It's getting to know, 'What do you need?'"
Part of the action stage is also tailoring ICD-10 education — an effort they have collaborated on with Nuance — to meet the needs of each specialty, she says. For instance, she says Swedish's orthopedic surgeons will likely want to approach training in a different way than the cardiologists.
The CDI team members will begin attending physician meetings to educate attendees and will work one-on-one with physicians in January, she says, well before dual coding begins April 1.
3. Explore new tools. Swedish is also exploring how it can adopt new tools to reduce some of the burden of documentation for clinicians, Ms. Woodworth says. The organization's coding process is now completely paperless, and several new programs have been put in place to help improve physician documentation. These new systems incorporate "smart tools" that can make documentation easier, she says.
"For example, a cardiologist could have a template in his notes that gives him all of the specific attributes he needs to document for a myocardial infarction," she says.
Additionally, hospital officials have looked into handheld apps for physicians.
"We just continue to look at every resource that's available and try to leverage that with physician education on the front end, and we'll give real results on how they're individually performing once they start dual-coding," she says.
4. Motivate physicians to join the transition effort. Ms. Woodworth anticipates the biggest obstacle Swedish' s ICD-10 preparation efforts will face is physicians who are reluctant to get on board.
"The physicians who are not really technically savvy right now or the ones who say, 'My documentation doesn't matter,' those are the same physicians I feel will have a hard time adjusting to the ICD-10 transition," she says.
In response, she says the organization plans to encourage them to participate by issuing physician report cards based on their response rates.
"That kind of ups the ante," she says. "It's not OK to not respond to documentation queries form the CDI team."
Overall, she says she would advise other CDI professionals to pay close attention to what clinicians want in the lead-up to ICD-10.
"Your providers are your number one client base," she says. "Find out what they're thinking. Don't go to 12 pages when they want three. We tend to overeducate, and the doctors say, 'Just give me the facts. Just tell me what I need to know.'"
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