I. Challenges
Given current case, one best planning strategy to adopt is a combination of Team Involvement and Reciprocity (Dunn, 2015). As not all coders agree on proposed change, persuading remaining coder could be "bought in" by seeking support of another manager, probably in Human Resources Department (HRM). This selection is based on a performance-compensation basis. More specifically, a change from ICD-9 to ICD-10 should be "sold" to non-boarding coder based on a better performance due to more enhanced capabilities of ICD-10 compared to ICD-9 and hence more workflow efficiencies and, ultimately, more customer satisfaction and better compensation prospects. Beyond non-abiding coder's resistance to change, major challenges include education efforts to learn ICD-10, integration of newly implemented ICD-10 into different platforms and applications in current family medicine practice and, of course, communicating change to staff. These challenges are addressed in next sections in more detail.
II. Six Month Tactical Plan
In order to properly plan for proposed change, planning process should cover equipment, materials and manpower areas (Dunn). Given current situation, a six-month tactical plan can be developed as per below areas:
II. I. Communication & Education
The whole practice needs to be fully aware of benefits of shifting to ICD-10 from ICD-9. This can be performed by proper communication and education as shown in more detail under "Change Communication" section.
II. II. Implementation:
→ Equipment & Materials:
The required change in current case does not involve concrete material and equipments. Instead, a coding skill is required in order to implement proposed shift from ICD-9 to ICD-10 coding system. Thus, conventional areas of procurement, installation and maintenance and user acceptance required to properly implement new equipment and purchase / replenish older ones do not apply. Instead, skill development as a service provided by an external health informatics service company is required. Over a six-month span, learning a new coding system requires more focus, let alone full acceptance of all staff (which, in current case, is not achieved, yet). The coding skill development is, indeed, an enormous undertaking and is well confirmed in actual practice ("The ICD-9 to ICD-10 Crosswalk Made Easy," n.d.). In more practical, actionable steps:
Procure ICD-10 coding skill development service from an established software developer and vendor, e.g. HealthFusion ("About HealthFusion," n.d.).
Partially introduce ICD-10 into current practice as a "beta" implementation in order to validate new coding system's efficiency not only for coders but also for staff and patients.
→ Manpower:
As noted above, learning to code using ICD-10 is not easy and often requires a prolonged change process. Indeed, research literature shows that, in order for ICD-10 to generate differentiated diagnosis outcomes, coders need to "gain experience" using new coding system (Quan et al., 2008) in order to better optimize what is, so far, similar results using both coding systems. In more practical, actionable steps:
Apply newly learned coding skills into existing coding implementations. This should be an initial step to gradually phase out ICD-9. The non-boarding coder can still use ICD-9, until he gradually comes to accept using ICD-10, based on above discussed criteria.
II. III. Review & Final Adoption (or Not)
Review progress, if any, upon adopting new coding system.
Phase out ICD-9 by end of planned six-month implementation period.
III. Impact on Staff
Given current case, one coder remains a stumbling block to fully implement ICD-10. His efforts are, for one, required given size of our medical practice. Two coders are, on another hand, already enthusiastic about ICD-10, which is a good boost to persuade "resisting" coder by means discussed above. The full adoption / acceptance of ICD-10 at our medical practice remains a bigger challenge, however. Thus, in order to properly communicate proposed change, our staff can be better informed by, for example, setting up virtual announcement boards, sending SMSs and/or organize group meetings.
Change Communication
As just noted, communication of proposed change to our medical staff can be performed using one or more methods mentioned above. The communication message should emphasize decided benefits of shifting practice from ICD-9 to ICD-10. Mainly, ICD-10 is widely seen by medical community as expanding coding directory and hence improving diagnosis and treatment courses ("ICD-10 Training," n.d.). Thus, by emphasizing added value of ICD-10, our medical practice staff can be better positioned to fully adopt new coding system.
References
About HealthFusion. (n.d.). HealthFusion. Retrieved from https://www.healthfusion.com/about-healthfusion-integrated-emr-software-companies/
Dunn, R. T. (2015). Dunn & Haimann's Healthcare Management (10th ed.). Chicago, IL: Health Administration Press.
ICD-10 Training. (n.d.). HealthFusion. Retrieved from http://www.icd10codesearch.com/training.php
Quan, H., Li, B., Saunders, D., Parsons, G. A., Nilsson, C. I., Alibhai, A., & Ghali, W. A. (2008). Assessing Validity of ICD-9-CM and ICD-10 Administrative Data in Recording Clinical Conditions in a Unique Dually Coded Database. Health Services Research, 43(4), 1424–1441. Wiley Online Library. 10.1111/j.1475-6773.2007.00822.x
The ICD-9 to ICD-10 Crosswalk Made Easy: ICD-10 Code Lookup. (n.d.). HealthFusion. Retrieved from http://www.icd10codesearch.com/
