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Outfitting for the ICD-10 Voyage – Breakaway Thinking

Posted on November 19, 2013 I Written By

The following is a guest blog post by Laura Speek from The Breakaway Group (A Xerox Company) and Honora Roberts from Xerox. Check out all of the blog posts in the Breakaway Thinking series.
ICD-10 Boat
These are challenging times for healthcare providers in every imaginable vessel – and the whitewater ride is not over yet. Just around the bend looms the transition to ICD-10, scheduled for October 1, 2014. Most providers know the wisest course is to start preparing now, yet few have dared to navigate these uncharted waters.

For many, a major problem is not knowing where to start. Others may be suffering from protracted procrastination. And still others may be well on the road to ruin via the path of good intentions.

An effective way to put some wind in your ICD-10 sails is to get real about the serious costs of noncompliance. After October 1, 2014, claims must be submitted using ICD-10 coding to be eligible for reimbursement. In other words, if you don’t bill with ICD-10 codes, you simply won’t get paid. And that’s the cold, hard truth.

The transition to ICD-10 will affect every facet of healthcare, but it begins with understanding the basic differences between ICD-9 and ICD-10. First and foremost, ICD-10 is not just a simple expansion of ICD-9. There is no reliable one-to-one mapping system. Some ICD-9 codes equate to multiple ICD-10 codes, while some do not correspond to any.

ICD-10 codes include much greater specificity; care providers must document etiology, laterality, exact anatomical site, and other information. Patient encounter documentation must include proper detail to enable coders to locate the correct ICD-10 diagnosis and procedure codes. Physicians and mid-level providers should begin to assess their documentation today to identify where ICD-10 coding requirements are already being met and where improvement is needed.

Because clinical documentation is at the core of every patient encounter, it must be complete, precise, and accurately reflect the scope of care and services provided. Assuring depth and consistency of documentation represents a challenge for many organizations.

ICD-10 encompasses a huge increase in accessible codes. The ICD-10-CM diagnostic code set, used in all healthcare settings, increases from roughly 13,000 to 68,000 codes. The ICD-10-PCS procedural code set, used within inpatient settings only, expands from roughly 3,000 to 87,000 codes. It should be noted that ambulatory settings will continue to use CPT (Current Procedural Terminology) procedural codes.

Given this massive growth in coding scope, the importance of detailed clinical documentation becomes even more pronounced. Physicians and other healthcare providers typically are not trained to develop proper documentation skills in medical school or residency; nurse practitioners (NPs) and physician assistants (PAs) generally do not receive such training during graduate school or clinical rotations. Hospitals and healthcare systems need to compensate for this training deficiency by instituting educational programs and tools that align healthcare providers with proper documentation practices to clear the decks for successful transition to ICD-10.

ICD-10 requires physicians, NPs, and PAs to thoroughly document each and every patient encounter to a much greater level of specificity than is needed in ICD-9. Nonspecific or incomplete documentation within ICD-10 will cause delays, claim denials, cash-flow interruptions, and inaccurate quality reporting. Definition and terminology changes inherent in ICD-10, particularly for surgical procedures, will also require focused education and training.

At the end of the day, providers aren’t coders. They are far less concerned with ICD-10 codes than they are with improving quality of care. This is where ICD-10 can be viewed as a welcoming beacon on a rocky shore. It gives healthcare providers an incentive to establish a clinical documentation improvement (CDI) program. In fact, implementing and sustaining an effective CDI initiative should be a top priority for all healthcare organizations preparing for ICD-10. For those with no CDI program in place, the time to begin is now. Consider improved clinical documentation as essential equipment for maneuvering through the twists, turns, and churns that accompany the voyage to ICD-10.

Honora Roberts - Xerox
Honora Roberts is Vice President of Healthcare Provider Services at Xerox.

Laura Speek  - The Breakaway Group
Laura Speek is a Learning and Development Specialist at The Breakaway Group (a Xerox company).

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

Factors that Influence Healthcare Information Technology Adoption – Breakaway Thinking

Posted on October 16, 2013 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest blog post by Laura Speek, learning and development specialist at The Breakaway Group, a Xerox company. Check out all of the blog posts in the Breakaway Thinking series.
Laura Speek  - The Breakaway Group
Healthcare organizations of nearly every variety are heavily involved in analyzing a smorgasbord of choices in electronic health record (EHR) technology. While some care providers still face the challenge of transitioning from paper to digital records, others are already moving to next-generation electronic systems.

Clearly, the cornerstone benefit of EHRs is improved patient care. However, that objective is best achieved when healthcare organizations look beyond software implementation (the installation phase) and orchestrate true technology adoption (overall integration for clinical benefit).

Consider the analogy of a wedding and a marriage. Software implementation is a momentous, finite event, similar to a wedding ceremony, that marks the beginning of a long-term partnership. The ensuing marriage demands that couples work diligently to learn how to live together in a way that is harmonious and meaningful. True technology adoption requires an extended commitment, comparable to a marriage. Over time, the organization coordinates efforts to seamlessly integrate a software system into daily workflows, procedures, and processes. The result is an enduring, measurably beneficial marriage with technology.

The Breakaway Group (TBG) is a company that works in healthcare and has conducted extensive research to identify elements of successful EHR adoption. Studies have shown that certain strategies can significantly contribute to the integration process. Referred to as the “four corners of adoption,” here are our research-based recommendations for successful EHR conversion.

Four Corners of Technology Adoption
The Breakaway Group Four Corners of Technology

Engaged Leadership: Leaders must possess the insight, will, and ability to direct and inspire teams throughout the adoption process. Engaged leadership begins with communication of a common vision and purpose that permeates the organization from the top down. Informed and enthusiastic healthcare leaders set the tone for creating a culture of adoption, which research has proven is vital for successful EHR integration.

Speed to Proficiency: TBG’s research indicates that targeted, streamlined education can significantly reduce training time and associated costs, while rapidly building user proficiency and confidence. The goal of developing proficiency to perform common daily tasks – as opposed to requiring mastery of multitudinous software bells and whistles – can be achieved in very short order. Brief, role- and scenario-based online courses that are relevant, self-paced, and accessible on demand appeal strongly to adult learners. Motivated learners generally complete assigned courses, score well on review tests, and rapidly assimilate new technology into routine workflows.

E-learning is a financially attractive alternative to instructor-led education. However, some healthcare organizations supplement online courses with carefully developed in-person instruction about unique or complex workflows that are not well suited to electronic formats. Our research confirms the effectiveness and efficiency of a “blended” educational approach that combines digital and personal delivery systems.

Performance Metrics: Positive change nearly always emanates from constructive, quantitative examination. In other words, “what is measured will improve.” Studies prove that rigorously tracking and analyzing performance metrics can uncover opportunities for adjustments that substantially bolster technology integration. The key is to establish reliable systems for collecting performance metrics early enough to yield meaningful results and to prescriptively analyze that data on a regular basis.

Adoption Sustainment: True EHR adoption requires a plan for accommodating software updates, new medical discoveries, and changes in workflows – a process referred to as “optimization.” Optimization addresses post-implementation issues involving best practices, workflows, and related educational revisions. This key adoption element requires continuous effort, examination, and the willingness to make mid-course adjustments to fine-tune the relationship between an organization and its technology.

The Breakaway Method™

TBG’s intensive research led to the publication of Beyond Implementation: A Prescription for Lasting EMR Adoption, a book that has inspired many hospitals to re-examine their approach to technology integration. Careful analysis of our research data led to the development of The Breakaway Method™, a comprehensive EHR-adoption solution. To date, our methodology has helped nearly 1,000,000 healthcare staff members rapidly embrace new HIT software. Our method reliably accelerates bona fide adoption while minimizing organizational stress and disruption.

In the course of working with hundreds of medical organizations, using EHR systems from vendors of all varieties, we have acquired valuable insights. TBG has identified some common HIT adoption issues and helped clients envision and implement successful resolution strategies. Over the coming months, we have the opportunity to share our experience, observations, and recommendations concerning adoption challenges successfully met by different types of care providers. Stay tuned.

Laura Speek is a learning and development specialist at The Breakaway Group, a Xerox company. She can be reached at: To learn more about TBG, go to:

Xerox is a sponsor of the Breakaway Thinking series of blog posts.