Literally and figuratively speaking, physician education and engagement is the most critical component of the ICD-10-CM/PCS implementation. We can discuss all the project management and impact assessments needs for ICD-10-CM/PCS implementation, but at the end of the day we cannot achieve any of it without physician engagement. I often listen to long discussions about ICD-10 and true there are some amazing areas of implementation that are being successfully addressed but I keep going back to “Well, that’s all fine and good but we still need the physicians to be on board and engaged in the process.” I have even overheard myself having these robust conversations about ICD-10 and thought to myself “who are we fooling.”
We really should be focusing efforts in this vital area. I have some suggestions about what those could be and my sense is it needs to be simple. There is not time to re-invent the wheel nor spend any more of our time between now and October 1, 2014 “information gathering.” It is time to take action because all the planning will not implement ICD-10, it is the action plan that determines our success. There are four key strategies where we can begin to streamline efforts to educate and engage physicians.
1) It has been said over and over that getting a physician champion or physician advocate who will be interested in wearing the ICD-10 hat and then sharing that with other physicians is crucial. I agree, I do hold with those that recognize the value of speaking the same language. What will begin to happen after some time is that gap between the physician and HIM will get smaller. Eventually, not tomorrow, we will have moved ourselves in the direction where physicians and HIM speak a more unified language in a more unified atmosphere. This is the long-term vision, it will take time to change. We must recruit some savvy physicians who love a challenge to help us.
2) Listen to the physicians input by asking good questions about how best to help them. It’s amazing to me we will sit and try to figure things out about physicians instead of just asking them. They hold a wealth of information that if we can get access to in building our EHR and EMR and CAC software could hold huge promise for success. Work directly with the physician champion and have him/her determine what their top 20 diagnosis codes are and start there.
3) Develop a database of documentation requirements for those top diagnosis and procedure codes. Lay out exactly what elements of information you will need to have for ICD-10. For example, with diabetes you will need type (I, II, drug-induced, other specified, secondary, gestational), complications, any manifestations, any long-term insulin use if they are a type II diabetic, etc. Make it clear exactly what needs to be documented. It’s not more information that we need in the medical record, it is certain specific pieces of information (precise information).
4) Work closely with your physician champion to begin educating the physicians at that point. One of the most effective ways we have is in approaching them with examples from their own documentation. This is where the importance of having the physician champion who knows the requirements of ICD-10 helps in distributing this information. They are in a position of respect, speaking the same language and then walking them into the ICD-10 world of documentation requirements.
In conclusion, recruit a physician champion, focus on the top 20 diagnosis and procedure codes, create a database of documentation requirements for those specific diagnoses and procedures, and assist the physician champion in preparing the training he/she will do with the providers or that you will do together with the providers as a collaborative team.