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With the upcoming ICD-9 to ICD-10 healthcare mandate approaching, the client engaged TEKsystems to support the transition, ensuring its Epic environment was customized to be able to handle the code changes.
The client is a large Catholic health system located in the Midwestern United States, boasting more than 150 locations including hospitals, long-term care and senior living facilities, and physician offices. A comprehensive range of services are available through the client’s healthcare system such as heart and vascular care, maternity, neurology and stroke, senior services, weight loss surgery, cancer care, and addiction and behavioral health. The client has been a partner of TEKsystems since 2011.
Established by the World Health Organization, the International Statistical Classification of Diseases and Related Health Problems, or better known as ICD, is a standardized coding system for classifying; medical occurrences such as signs and symptoms, diseases and injuries. Healthcare payers and providers use these codes for everyday processes from coordinating benefits and reimbursement amounts, to conducting research and performing billing activities.
ICD-10 is the 10th revision and enhancement of the classification. In the United States, all healthcare organizations are required by law to comply with the ICD-10 code sets by October 1, 2014 per the U.S. Department of Health and Human Services. It can take several years for organizations to prepare for and implement the new code set; it is a complex and significant undertaking that involves not only installing and testing software, but also from a human perspective, educating and training those who will be affected in their day-to-day work.
To comply with this government-issued mandate, many healthcare organizations are consulting with third-party providers to support them through the transformation from the ninth revision, ICD-9 to ICD-10, by the 2014 deadline. They often lack the experience, skills and bandwidth to navigate the transition in-house. And software vendors that have updated products for this massive industry effort are not necessarily assisting organizations with understanding the software and how to use it. The transformation can be overwhelming and many organizations do not know where to begin. They are concerned about the potential loss of user productivity during the transformation and learning curve period, and often their internal IT department cannot handle the additional workload.
The client, a large health system, utilized ICD-9 codes across its network of over 150 locations. With the ICD-10 deadline approaching, the client required support remediating all of its systems. This was a significant and highly involved transformation for the organization not only because of its size and geographic scope, but also because of the nature of the new code sets. ICD-9 and ICD-10 code sets are fundamentally different in a number of ways, and because of these differences the upgrade is even more complex. ICD-10 contains approximately 155,000 diagnosis and procedure codes, a massive jump from approximately 17,000 codes within ICD-9.1 Additionally, the structure of the code was not consistent between the two versions; ICD-9 code sets are three to five characters in length, while ICD-10 sets are three to seven characters in length, allowing for more specificity than before. The arrangement of alpha and numeric characters is inconsistent between the two code sets as well. ICD-10 is a step up from ICD-9 in terms of benefits to users and patients: the information conveyed through the codes can be more detailed to improve accuracy, but introducing the new code sets to an environment is further complicated by the various improvements.
Our client was using an Epic electronic health records (EHR) system. Notably, there are three versions of the Epic system that can support ICD‑10 codes (Epic 2010, 2012 and 2014). While these versions support ICD-10 codes, there are certain nuances that cannot happen through a straight‑forward upgrade. For example, consider the code structure where ICD-9 code versions are five digits while ICD-10 code versions are seven digits. Epic only supports the expansion of fields so end users can enter information; it does not automatically populate any back-end information required to make the codes usable. Nuances such as this would need to be addressed in order to achieve ICD-10 compliance.
As part of the client’s system, Epic has a utility or technological function that can be put against the Epic system installed at the client to look for every instance that an ICD code is used. The utility performed an inventory of ICD-9 codes and allowed the client to identify what codes should be accounted for when planning their ICD-10 work. The utility estimated the client would need approximately 7,500 hours to remediate its application to be ICD-10 compliant. Knowing that the utility does not account for everything, the client needed further validation. An internal analysis was conducted and the client arrived at approximately 21,000 hours required to remediate its application. Given that the two audits were significantly different, the client was concerned; the time and financial implications of inaccurate planning could be tremendous, and the client was convinced the remediation would fall somewhere in the middle of these two estimates.
Given our EHR implementation and ICD-10 transformation expertise, TEKsystems proactively approached the client to help. We proposed conducting a query to determine if we could provide a more accurate estimate of hours using our own proven methods. We would then perform remediation over a one-month period.
TEKsystems proposed performing a business readiness assessment to understand the current state of the client environment and identify key module changes needed, mapping the necessary updates. The team would evaluate the two previous estimates—the Epic utility and internal analyses—of time required to remediate all Epic modules related to ICD-10 compliance. TEKsystems would then provide our own third-party calculation of resource hours based on baseline average modules, unique tasks expected and complexity factors determined during our assessment. We would empower the client by educating and providing a more detailed understanding of the actual ICD-10 remediation tasks needed and prioritization of those tasks. Following this upfront planning, we would leverage our ICD expertise and industry best practices to provide recommendations for assessing and remediating all Epic applications requiring ICD-9 to ICD-10 code changes. Upon completing the remediation, we would facilitate end-to-end testing to ensure the successful transformation to ICD-10.
The TEKsystems team would remain a transparent and communicative partner throughout the engagement, offering visibility into team composition (i.e., resource plan), creating project timelines required for remediation of the Epic modules related to ICD-10 readiness and providing weekly status reports.
TEKsystems successfully supported the client’s efforts to facilitate ICD-10 code changes. We assembled a team of two practice directors, a delivery manager and a project manager to conduct the initial analysis of hours required. A team of as many as 12 health information technology professionals, with various industry certifications, led the remediation effort. Throughout the engagement, we provided the client a dedicated core team that remained involved from beginning to end; this core group included practice leadership from TEKsystems’ ICD-10 practice and our EHR Implementation practice, the delivery and project managers as well as an Epic technical lead.
As proposed, we kicked off with conducting a comprehensive assessment to validate or disprove the Epic utility and internal analyses of hours. Through our query, we determined that the client needed to account for approximately 16,600 hours to remediate the application to be ICD-10 compliant—falling in the middle of the two previous analyses performed, as the client’s instinct had suggested. From a financial perspective, this was a significant realization. In saving hours, TEKsystems helped save the client money. It was anticipated the remediation would cost between $3.5 and $3.75 million, but with our due diligence the client learned the remediation would cost under $3 million, a major savings that would not have been achieved without our support. Our assessment took into consideration process elements that the comparative Epic and internal audits did not plan for; for example, given the size of this effort, maintaining a layer of delivery management would be critical to staying on target. There was also time for practice leadership and EHR practice delivery’s involvement. Our ICD-10 experience enabled us to foresee needs such as these and factor them into our analysis, increasing the accuracy. The client was not only pleased with the results of our assessment, but extremely impressed with the quality of deliverables and information they received from the TEKsystems team.
Based on our assessment of the client’s system, operations and environment, we delivered a custom resource and project plan to implement the changes needed to enable the client to achieve ICD-10 readiness. We analyzed the client’s legacy system and took a carefully documented, comprehensive inventory of a range of customizations and complexities specific to their system that needed to be taken into account during remediation. We then performed the remediation over a one-month period, managing to the client’s timeline. Lastly, we conducted robust, end-to‑end internal and external testing to ensure code changes were functioning properly.
1American Medical Association, The Differences Between ICD-9 and ICD-10, 2012.