ICD-10 and electronic health records are most frequently considered separate projects, undertaken by separate teams – but perhaps they ought not be.

Government Health IT spoke with Heather Haugen, vice president of research at the Breakaway Group, a Xerox subsidiary, about opportunities the ICD-10 delay opens up in terms of clinical documentation and alignment with EHRs, controlling coders' learning curve, the anticipated productivity loss following the compliance deadline and why healthcare entities are waiting on their tech vendors to get the conversion underway.

Q: How did the delay come about, anyway? I have to think there was a lot more involved than a pair of open letters the AMA sent to HHS Secretary Kathleen Sebelius and House Speaker John Boehner.
A: Like all things, I think it was political. I do think, though, that when HIPAA 5010, so few people were prepared and there were so many issues, that it brought it to people’s attention that, "Wow, this is a small piece of this. Imagine what will happen when we move to the next piece." And so I think that opened people’s eyes to the complexity of this and that they have to be serious about it.

[See also: A look inside AMA lobbyists' role in the ICD-10 delay.]

And I think the AMA had a pretty strong impact on what was going on, representing physician practices, although there are all kinds of rumors about why and how. Interestingly, I think many people found the delay to be most troubling because they didn’t know when the new date was. So I’m very happy that we have a date, a target, so for people who are good stewards of the process and were working on that it helps them. And in healthcare we have enough stresses that we don’t need to add anymore.

Q: Speaking of stresses, one aspect of the ICD-10 conversion that has drawn a lot of attention is the anticipated loss of coder productivity in the time after the compliance deadline. Given the extra year, what can providers do to avoid that?
A: Some of the things people are doing now. Coders need to learn more anatomy, more physiology, more of those kinds of things in order to prepare for this. But my strong opinion is that the coder is going to be on the receiving end of poor documentation. So we talk about how we are going to start with good documentation, which is going to help the coder. What if I gave the opportunity to practice using ICD-10 for a month? You’d get really good at it. So practice. And it’s easier to get coders to do that work than it is to get physicians. They know their world’s about to change and it makes them very nervous.

There’s another concept from the learning literature called "fail-fast." There’s no better way to learn than to fail, very quickly, and to get immediate feedback. Now, we don’t want them to do that during the first month in the ICD-10 system – that would be a nightmare. If we allow them an environment where they can fail fast, they actually learn very quickly. Having this additional year, we need to be spending our time giving those coders some time, which is hard to come by in healthcare, to learn the system. But it would pay off in that first months if we have a nice cadence of working rather than being behind the eight ball, making mistakes, missing bills.

Q: Following that, another issue we hear a lot about with ICD-10 is the need for better documentation. Particular to clinical documentation, what are the big opportunities that ICD-10 presents?
A: One of the things that was shocking to me, and maybe shouldn’t have been, was this real focus on, "This is a mandate and we’re just going to have to do it." I think when you say that to clinicians, their brain turns off – and kind of for good reason. It’s something that they have to do and they’re not really signed on for. So one of the things we’ve been working hard on is determining how to understand what clinicians are trying to accomplish, and help align some of their interests with what we need to do around ICD-10. To understand, from a research perspective, that the benefits we get from better understanding the specificity of disease, there’s some real value around public surveillance, and how we report in our individual healthcare organizations, about the types of diseases and conditions that we’re treating.