April, 2014:

ICD-10 Delay: Now Get It Done Correctly


Since the delay of ICD-10 until October 1, 2015 at the earliest, many healthcare organizations have questioned what the delay means to their existing ICD-10 implementation programs.   At the time the delay was announced, most organizations fell into one of three categories in terms of ICD-10 readiness:

  • The Prepared
  • Those Getting Prepared
  • Those Who Remain Out to Lunch

Organizations residing in the first two categories expressed frustration at the delay.  They appropriately took control of their own fate, identified and managed risk, and prepared or were preparing their organization for this change.  The third group however either held false hope their EHR/PM vendor would take care of everything, or they were banking on a delay. 

Regardless of which category best describes your organization, the plan forward is simple:  take the newly allotted timeline to get it right. 

Many organizations have delayed other important transformative or IT efforts until after ICD-10 given their limited resources and the work effort necessary just to achieve ICD-10 compliance.  Some organizations took a much broader strategy for their conversion, leveraging this challenge as an opportunity to better enable their physicians and clinical staff to optimize clinical documentation workflows – thus improving quality reporting and patient outcomes.    

With the delay now in place, organizations should absolutely continue implementing their ICD-10 program.  However, the delay does provide opportunities for ensuring the broader success of the ICD-10 program in preparing your organization to more effectively compete in the era of expanding value-based reimbursement models. 

Organizations should take advantage of this opportunity by re-evaluating project scope.  Identify opportunities for including other initiatives into the ICD-10 conversion program in order to more fully streamline clinical documentation workflows.  Ensure your training program is inclusive of new workflows and EHR functionality, not just coding principles and requirements.  Engage payers and intermediaries to ensure your testing program is robust.  Expand your use of dual coding and evaluate reimbursement variance to prepare your organization for the downstream financial impacts.  Optimize the use of informative, specifically predictive analytics and clinical decision support within the EHR. 

ICD-10 poses several risks to a physician practice.  Take advantage of the delay to not only ensure compliance, but also to improve your ability to manage your patient’s health.   

MIR_3989-Brad Boyd

Population Health Management Webinar: Friday, May 16th 3:00 EST


Confused by all of the buzz around population health management (PHM)? Join Culbert Healthcare Solutions and wellcentive as we sort fact from fiction in this 45 minute conversation titled: Population Health – what it is and what it’s not. 

Following our discussion you’ll be able to answer: 

• What are the four components of a PHM solution? 
• How can a PHM solution help my healthcare organization? 
• What business strategies do I need to have in place before I pursue a PHM vendor? 
• Can I achieve a PHM-like solution through proper use of my EMR and HIE? 
• What are some examples of real-life results using a PHM solution? 

Date: Friday, May 16, 2014 
Time: 3:00 – 3:45 EST 

Space is limited, reserve your spot today!

Next on the Epic CMIO’s Agenda…

The role of the CMIO has transformed in the past decade – from one of a practicing clinician with part time communication duties, to a full time role of driving health record implementations, adoption, data governance, quality management and decision support.

The CMIO is certainly part of a large leadership team, though many organizations look to this leader as the facilitator, spokesperson, solution-finder and issue-resolver.  Slow turnaround by the Pharmacy and Therapeutics committee on clinical content review? Get the CMIO involved!  Medical Executive meeting about EHR training in the bylaws? CMIO is the scapegoat! Business Intelligence technology and tool review? The CMIO is likely the sponsor.More and more, persons in this role have some background in technology, software, statistics, informatics and even user experience design.  Successful CMIOs can no longer don the cheerleader vest and stay off the field.  Learning the specific behavior of the diagnoses calculator in Epic, learning to build an asynchronous best practice alert and even configuring reporting workbench views are all fair game.  

Some of the latest and greatest discussions surround the maturity of Epic’s Cogito reporting and data management toolsets, the pros and cons of implementing diagnoses preference lists with ICD-10 and how to tailor medication alerts to improve physician response and patient safety.  The CMIO is tasked with herding the knowledge across the organization, though also executing the plans to enact change on a grand scale.

Malcom Gladwell wrote in “The Tipping Point” about Mavens (people in the know, system folks, idea people), Connectors (networkers, knowing where the knowledge is and knowing the community), and Salespeople (persuasion experts, storytellers).  

Perhaps we’re asking the CMIO to embody all three archetypes in this age of healthcare.  Fair or not – it’s a role with increased visibility and responsibility.  We must continue to build governance models to support these key leaders and empower them to drive decision making faster and smarter than ever before.


 Director Epic Practice

Delay in ICD-10 Implementation: What you can still do now-

The delay in ICD-10 implementation is an opportunity to hone the skill set of your physicians, coders, and clinical documentation specialists.  It is also a time to review your operations and create the efficiencies needed to get the revenue cycle in tip top shape.

Take this time to drill down into your data, analyze your coding vulnerabilities and your potential reimbursement impacts.  Analyze what physicians or what physician services  are needed to develop more specified documentation to more fully describe the services they are rendering and the diagnostic reasoning behind the services or tests ordered.  Continue to have your coder’s dual code a certain percentage of charts per day to develop their skill set. 

Create teams comprised of physicians, coders, CDI specialists and key revenue cycle staff that review the data.  Have the team develop a strategic plan to move the organization closer to an ICD-10 compliant environment.  The plan should include an auditing and feedback loop that encourages the development of more precise documentation from the physicians, while it encourages the coders and CDI specialists to hone their skills and improve accuracy and proficiencies. 

In addition, the strategic plan should include Revenue Cycle Optimization. Revisit your work flows, ask yourself if they are as efficient and as effective as possible.  Examine your denials; how many by type per payer?  Ask yourself why you have the denial.   The root cause analysis will be a valuable exercise and assist you with updating processes, procedure work flows and systems to eliminating the denial, thus increasing cash flow and reducing your accounts receivables and work force hours spent in re-work.

The data analytics and developing a strategic plan on how to utilize the data, will launch you into the great experience of becoming a more finely tuned organization and assist with moving toward an ICD-10 ready organization.

Are You Personalizing Your EHR ?


Allscripts TouchWorks Optimization Webinar: Fri: April 25th 1:30-2:30 EST

Join our webinar on April 25th from 1:30-2:30 EST to learn tips and tricks for optimization as you start to look beyond the Allscripts v11.4 upgrade.  Please register here: 


Protect Custom Work Before PM/EHR Upgrades

It is important to apply upgrades to Practice Management (PM) and Electronic Health Record (EHR) systems as they are released by your vendor.  Taking upgrades as they are released ensures that you have the latest content available.  As we all know, upgrades take much preparation and planning and one item I always address is the backup and safekeeping of custom .rpt reports when preparing for an Allscripts PM or EHR upgrade.  Items such as PM encounter forms, EHR prescriptions and EHR order/lab order requisitions can be customized for your practice and I have customized many over the years.  I learned the hard way, long ago, the importance of keeping regular backups of my customized reports.  During upgrades to Allscripts PM and EHR the .rpt reports are overwritten by standard versions, thus, wiping out all custom changes.  To prevent the loss of custom reports I began creating backups every two weeks and started placing a copy in a safe location off of the Allscripts servers.  Then, post-upgrade, I simply replace the standard copies with my custom versions and I am back in business.  Of course, if the new version of the .rpt has additional functionality that I want to use, most of the time I can simply paste my .rpt format into the new shell and I have both my custom changes and any new functionality (simplified procedure description, but you get the point).  I have saved myself a lot of re-work in implementing this routine.  Again, vendor updates are important and should be applied regularly, absolutely.  However, I suggest that the best way to approach upgrades as they relate to custom reports is to be pro-active, back them up, and save yourself a lot of re-work!